What Radiation Hath Wrought

* I read "After 50 Years, Radiation Leads to Thyroid Surgery" [Lifeline, Oct. 5] with interest, for I, too, am living with the aftereffects of childhood radiation, in a different way.

In 1954, at the age of 18 months, I was found to have a Wilms' tumor, a cancer that only occurs in the kidneys of young children. In an emergency operation, my right kidney was removed, and I subsequently received 45 doses of radiation. (It is now known, I believe, that radiation and chemotherapy are not necessary with this cancer if it is encapsulated in the kidney.)

Other than a huge scar around half my waist and a large area of radiation rash, I didn't seem to have many aftereffects to deal with until after the birth of my fifth child in 1989. After that, my back began to ache and I began to have spasms in the small of my back that would often leave me almost unable to move. X-rays indicated spinal deterioration due to radiation.

I have found a number of ways to deal with the spasms, pain and discomfort, and have been living a fairly normal life. But as the years go by, there have been more challenges to face. I have been told I have osteoarthritis in my back, which bothers me increasingly. The muscles on the lower right side of my back are atrophied, forcing the other muscles to work overtime, making me tire quickly when doing many tasks. I have to have a support pillow for the small of my back whenever I am sitting, so I carry a pillow everywhere I go. The radiation rash at my waist has an increasing tendency to become itchy and scabby, making it difficult to find clothes that feel comfortable. Any task requiring bending or stooping has become too painful to do, and I have had to discontinue many former activities.

I consider myself blessed to have lived such an active life so far, and to have been alive at all to marry a wonderful man and have five healthy children and now two beautiful grandchildren.

I think it is important that those with post-radiation problems speak out, for the benefit of others. I also believe that the medical profession should look more closely and honestly at the long-term effects of medical treatments, and inform patients of them when a treatment is recommended. Powerful and toxic treatments such as radiation and chemotherapy have their place, and can save lives, but are often overused or their effects underreported.

Karen McIver

Laurel

TB vs. Health Care Workers

* The tuberculosis articles "The Frontiers of Medicine" [Page A1, Aug. 10] and "TB Fights Back" [Cover Story, Aug. 17] shared valuable information with readers about this growing public health threat. However, the articles neglected to mention that registered nurses--the people who care for the highly contagious TB patients and are the backbone of the World Health Organization's plan for eradicating TB around the world--are risking their own health by caring for TB patients.

Health care workers have a 25 percent chance of becoming infected, but not necessarily ill, with TB in a 40-year career, according to a recent California Department of Health study. Until the Occupational Safety and Health Administration (OSHA) publishes a TB standard with enforceable protections, nurses' risk will remain greater than necessary. If OSHA's proposed TB standard is enacted, OSHA predicts that more than 100 health care worker deaths could be prevented each year in the United States.

The American Nurses Association believes it is essential to protect health care workers and that prevention is cost-effective compared with the cost of work-related TB infection. Unless health care workers are protected, TB will continue to grow as a major international health problem.

Beverly L. Malone, PhD, RN, FAAN

President

American Nurses Association

Washington

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