regarding salivary gland issues

From time to time (like today!) I get an email or a comment asking for good information about salivary gland damage from RAI, RadioActive Iodine treatment for thyroid cancer.

Unfortunately, post-RAI salivary issues are a lot more common than your doctor may let on. For the most part, the first flare up is (more) severe. Some people have one incidence, post-treatment, but many continue to experience periodic flare-ups, some triggered by eating certain foods (sour, spicy), or sometimes nothing at all.

If you're looking for some good introductory material about this condition, here is an article on ThyCa.org.

Here is the link to the article on MedScape about radiation damage to salivary glands. This is a much more technical article targeted at a medical professionals, but it also includes an illustration of a very beneficial massage technique (figure 7). (MedScape may require free registration.)

Last but not least, I recommend NSAIDs such as ibuprofen (Motrin, Advil) or naproxen sodium (Aleve) as both a preventative immediately after dosing with RAI and for the next 2 days, and as a treatment whenever the salivaries swell up and become painful.

An aside: I had trouble recently distinguishing jaw pain (TMJ/TMD) from salivary gland issues. Some ways to distinguish between the two: salivary gland issues will not cause clicking or popping when you open and close your mouth, as far as I know, and repositioning your jaw or opening or closing your mouth will not change the type of pain/pressure you experience from salivary glands. If you're hearing pops or your jaw joints hurt when you open or close your mouth, you're most likely suffering from TMD. Unfortunately, it's entirely possible to have both issues at the same time!

mouthful of salt

My parotid salivary glands are acting up something fierce lately. My face is mildly mumped, not so that anyone else can tell that they're swollen, but I can see it. They don't feel very good, either, so massage, while beneficial, isn't at the top of my list at the moment.

The worst thing is that I keep getting streams of salt water instead of normal saliva. I'm chewing a lot of gum but you know, salty wintergreen or salty peppermint just aren't doing it for me. I use my Biotene stuff religiously, too.

I wish I knew what triggered this behavior, so I could avoid it or at least expect it. I also wish I knew how long it's going to last. It has been going on for about a week now, and it's affecting my eating and desire to cook, too. When everything tastes salty, your whole relationship with food gets distorted. And this is probably the single worst time of the year to not be able to taste properly!

my face hurts, round 47

All of my salivary glands are tender and a bit puffy. Nothing as bad as the worst attacks I had in February, when the swelling in my parotids was remarkable (as in, DH asking me, "Is your face bothering you now? Your cheek looks weird"), but still, this is the most discomfort I've felt in several weeks. All the glands under my jaw are very puffy... I look like I'm developing a wattle. I hate that look!

When I had my brief sojourn with the low iodine diet (LID) at the beginning of May, I had a few problems. Now it seems the longer I stay on LID, the worse these problems are getting, and it's hard for me to think that it's just a coincidence.

I've also got some hypo symptoms, like itching. I'm curious to see what my TSH is when this process starts on Tuesday. I wonder what it would mean if I went hypo just because I went on the LID?

whine whine whine

I decided this morning to call my endo and see what she had to say. Yes, it is obnoxious to call your doctor with a non-emergency situation during the weekend, however I have had so many problems getting messages to her during the week that I did it anyway.

She agrees that it is an inflammation of my parotid gland.

She doesn't think this is related to my RAI. She expects it to resolve on its own with a little heat, but commented that if it doesn't, or if I start running a fever, I might need a course of antibiotics. She did mention that if it isn't better by Tuesday that I should go in and see her (that's the day she's in the office closest to me).

Honestly, I think she's delusional to not attribute this to the RAI. I made myself a little heat pack out of an old sock and some rice,and it's the perfect size to hold up against my face. The warmth feels good and it did seem to help, but this afternoon it went all spazzy again. Sometimes I get a big rush of salty saliva and it's quite disconcerting.

At Mass in the late afternoon, all the rest of my salivaries started that tingly feeling that usually means you're going to throw up. My stomach is as calm as could be, though, so I know it's just salivary weirdness. The left parotid is starting to ache a little, too, but nothing like the right one -- so far, and I'm hoping it doesn't get any worse.

I've had episodes today of feeling quite unwell -- nothing specific, just general overall ick. I have no idea what's going on, whether it's related to what's going on in my face or my gut or what. Grrrrr.

I slept until 10 this morning and took a nap this afternoon. The major accomplishment of the day was helping DS1 organize his facts and draft his Gila monster project. It is very interesting to see how an 8-year-old's brain works.

dx

I'm fairly sure of my face pain diagnosis: post-radiation effects on my parotid salivary gland. Here's a picture I'm nicking from the MedLine Encyclopedia:

It's definitely the parotid, the biggest of the salivaries, just under the cheekbone, in front of the ear.

After the movie, I experienced my latest weird symptom: very salty-tasting saliva, but only on the right side of my mouth, on the top. Extensive Googling turned up this article, RadioIodine and Your Salivary Glands. This article is a layman's version of a medical journal article I had found earlier. I would've had to shell out $44 to read the real deal, and probably would've only understood half of it, so I was very glad to find the summary.

Key grafs which I'm trying not to freak out over (emphasis added):

In most cases, immediately after high doses of radioiodine, the salivary glands, especially the parotid glands, become swollen and painful. Alternately, these symptoms can develop months later. In either case, the effects intensify over time.

(I did have "mumps" during the RAI isolation period.)

and:

Other organs known to concentrate and transport iodine include the gastric mucosa, pancreas, lactating mammary glands, chorid plexus and the ciliary body of the eye.

Have I mentioned that I've been getting a pain under my right rib cage, off and on, recently? I was thinking it was just adhesions or scarring from my gallbladder surgery last year, but now I'm trying not to think about what else it could be.

Anyway, I think I will let my endo know that this is happening and see if there is anything she needs/wants (me) to do. If inflammation of the salivaries gets severe, apparently, nerves can be affected and facial paralysis can result (whee!). Wouldn't want that to happen, but I've no idea what, if anything, they can do to treat this or fix any ongoing damage.