Life lessons from a word game

My current level. You can buy hints as the little cart shows but I have never stooped so low.

Sometimes I’m so desperate for the last couple of words in a Wordscapes game that I try to fit German or French words in. There’s an L, there’s a U and an F and a T. Maybe in some parallel universe the German word for air, LUFT, will be the one and I can move on with my game.

But this blog isn’t about how addictive Wordscapes is or how hopelessly inadequate I feel when I have to cheat and watch ads for clues. (This is made worse by the fact that my son who doesn’t have my English teaching background whirred through in a few weeks and got bored because it was too easy.)

This blog is about the life lessons I have learnt from this beautifully crafted game which I now play multiple times daily on my phone thanks to Bobbi from our HNC support group.

The lessons

Aesthetics. The game is aptly named Wordscapes because behind each successive crossword is a landscape. Each time you go up a level you get a different background. I’m on “Arid” now and have what looks like Arizona with dry scrubby plains and magnificent vertical cacti. I’ve been through forests, plains and mountains, in the sea and the sky. Landscape photography is an art and good for the soul.

Cognition. Surely I know as many words as my son if not more. I’m older. Why can’t I look at the circle of letters and find the right words? It’s because my cognitive pathways are rusted in and stuck in familiar grooves. If a word doesn’t fit into the pattern for that game I can’t think outside the square. I try to go for consonant, vowel, consonant and my closed mind doesn’t allow for the fact that lots of words start with vowels. The good news is that I am aware I’m doing that and I’ve improved heaps. I think I’ve stretched some of the scar tissue in my brain.

Determination. I’m an impatient person so I was often giving in to the temptation to watch 30 second ads to earn one-letter hints when I was stuck. Gradually I’ve learnt that is not good for me. If I keep trying or go away and come back, 9/10 the word will come to me.

Economy. The way Wordscapes works is that you are given points or potential hints each day and store them at the bottom of your screen. You need 100 of these to get ONE letter on the crossword. So the idea is to store these for a rainy day but guess who was always in debt and frantically watching ads to pay for a letter? Ads that are not always available? Breaking the bank because I was too impatient to think? Now I use the bank of hints only if I’m desperate, when the ads are available and I have time. I will let a couple play through and boost the bank account. I like to run on over 300 in credit.

Motivation. We need praise and rewards to keep us going through a tough process! I always feel more motivated about doing my jaw exercises if someone says, “You’ve done really well.” It’s the same with Wordscapes which dishes out the regular “Brilliant!” and “Spectacular!” and gives you extra points for some games. (They need to do something about their so-called “Brilliance” points though because they go nowhere.)

Vobabulary. No, it doesn’t really stretch my vocab. Most words I know already although some of them are getting quite sophisticated now I near the end. There was one word, “axial”, that I was not sure of until I clicked on it to get the dictionary meaning (there’s a built in dictionary) and last night I came across the name of a weird cactus “saguaro” which of course, being in NZ, I had never come across.

Yeah, I could go on about the dangers of addiction and how I’m practising avoidance sometimes when I play this game too much. Should go out and mix more etc. Clean my windows. But this blog is just about what an insight the game gives me into the wily ways of our minds and the strange letter combinations that make up our beloved language.

Think positive?

When someone told me I had survived cancer because I had a positive attitude, I thought indignantly, no I did not. I was terrified. At the first hint of the C-word I started planning my list of funeral songs. I’ve always tended to expect the worst.

I think the person meant that I just kept going through treatments without much complaining. I seemed to be coping and in the end I survived. Little did she imagine the thoughts that ran through my head.

I don’t believe that a positive mindset can change the behaviour of cells in your body. All that mindset can do is make you stick to treatment and stay moving and keeping fit. I have noticed that people who get caught up in a cycle of fear and inactivity seem to do worse. Their cancer might not be worse but their lives are because they hide away and avoid fun, adventure and exercise, the latter of which might have some positive effect on physical recovery from cancer.

And stoicism. I’ve indulged in an excess of that only to crash and burn later spending most of a day in my hospital bed crying. As a psychologist said at a meeting, we have a right to “feel the feels”.

So positive thinking has to be taken with a big dose of salt. We have high rates of depression in this country and denying our own fears and anxieties by slapping a layer of positive thinking on top of them won’t do any good unless we deal with the negative thoughts first.

There is definitely a grain of truth in positive thinking though. A hopeful outlook can create a virtuous circle where you carry people along with you on a tide of good cheer. People respond better to funny, cheerful people and that can be another payback for positive thinking! I think a sense of humour is related to positive thinking too. If you see life as a tragicomedy and can laugh at your poor self, you’re halfway there.

I’ve been positive and I’ve been negative and positive is definitely better but it’s not an easy solution. Some of us will need help to find that positive outlook so we enjoy our time on this beautiful, chaotic planet no matter our state of health.

Livin’ alone

I wake up with a small pit in my stomach every morning. It’s not because I’m depressed but because I’m alone. Yes, after decades of having a rowdy household of three boys and a husband, I am now a woman living alone. One of the lonely people.

There’s a stigma associated with loneliness but I want to look at loneliness objectively, loneliness in general and the isolation of head and neck cancer patients in particular.

Did you know that there is a loneliness organisation on NZ? hThere’s an epidemic of loneliness in the western world. We might be more connected online but not so connected in our communities.

Why do governments care? It’s because loneliness is bad for the population’s health. And people are less connected these days leading to an epidemic of loneliness. It can be worse than smoking and drinking for the health.

There’s been a lot of study world wide on how councils can create a greater sense of community in their towns. One weird and wonderful idea is to create “pocket parks” (See pic in latest NZ Listener) a program to transform unused outdoor areas into green spaces where lonely adults can volunteer or simply congregate. Masterton residents were not best pleased when they were introduced. Especially as they blocked roads and took up parking places. Good on the council for trying.

It’s not people’s fault that they’re lonely. Some people find it hard to let others get close. Then as they become more isolated their suspicion that they don’t fit in can increase and they push people away more and more. A vicious cycle. And those of us who have had to give up social eating or who can’t talk well anymore will be lonely due to circumstances beyond our control. Our family, friends and acquaintances try to keep us close but might eventually put us in the too hard basket.

When I moved to Auckland in 2012, I didn’t know anyone apart from family in distant suburbs and it wasn’t long before my husband was in care with only a short time to live. Just as I reached out to the community by joining groups, I had another bad case of head and neck cancer which put me out of action for months. The vibes I got from people I had just met were that they found it distressing and would rather not know.

Eventually I came back. Rejoined groups, volunteered for Hospice shop work, took on roles in U3A and Senior Net. Helped at the Auckland Support Group. This gave me more confidence and mixing with people older than myself in the community was also a bonus. I had the virtue of being physically damaged but more energetic and active. God, it was hard though. Unless I saw family regularly I felt a painful sense of isolation. Added to that was my uncomfortable dental plate which I took out when at home (and still do). I had to scurry inside to put it on if anyone came. I was weak but that was how I felt with top teeth missing to the incisors.

The best things I did were the volunteering roles. They really lifted my confidence. I felt part of teams. I made friends or at least close acquaintances.

Another thing that helped was a change of attitude. With echoes of the Kennedy quote, it wasn’t what other people could do for me but what I could do for others.

I recently saw another upside down gem. It’s for women in the workplace but it can apply to anyone who feels needy and inadequate. We all have something to offer: “Never think that you are not good enough for anyone, always ask yourself if they are good enough for you.”

I like the freedom living alone gives me. All those years as a young mum when I dreamed of having time to myself. Now I have it in spades. Free as a bird. Just have to make sure I spread my wings socially on a regular basis.

As a social species, we are better together. 

In a flap

When I realised I’d have to have a hemi-glossectomy (half my tongue removed) I was relieved to hear that the missing bit of tongue could be replaced by a flap of tissue from my arm. Phew! There wouldn’t be a gaping hole and the remaining part of my tongue could push the flap around to enable me to talk.

This flap surgery is well known to vast numbers of head and neck cancer patients but the rest of the world knows little about it and even GPs seem confused. Twice I’ve been to different GPs on duty after a big surgery and they have  said, “I don’t know what I’m looking at.”

This article, a patient’s record,  is about the “free flap”, tissue taken from elsewhere in the body to fill a defect in the head and neck. What I didn’t know in those early days is that the flap of tissue (because it is big) has to have a blood supply. A “pedicle” (a long attachment) of vein and artery is removed from the graft site with the other tissue.

Many head and neckers have had tongue cancer and will be familiar with the tongue surgery to remove the tumour, the removal of a square hunk of tissue from the inside wrist plus a long string of blood vessels. They will have the raw wound from this graft site covered with a thin peeling of skin from the front of the thigh – the donor site.

This is big complex surgery and takes a team, including a head and neck surgeon and a plastic or reconstructive surgeon. It can take 8 hours or so on the operating table and the patient will probably need a temporary tracheostomy so they can breathe while the tongue settles down again.

There will probably be a neck dissection to remove lymph nodes along the side of the neck from below the ear to below the chin. The blood vessels from the forearm flap are joined to blood vessels via this cut in the neck. (I’m getting to the limit of my understanding here.)

However, if it goes well, it can give the patient an acceptable quality of life. There’ll be some change in speech sound but the speech should still be clear. The scars will never go away but after a year they are acceptable. You have a wide pink patch on your inner wrist with a long thin scar where the blood vessels were harvested. There’ll be a large square white wrinkly patch on your thigh where the skin to cover the wrist was taken.

Patients sometimes get a sort of  “turkey neck” from the neck dissection where the scarred side of the neck of an older person is firm and the looser skin on the good side spills out annoyingly on the other side of the scar.

These side effects were bearable for me and I have never felt any discomfort from my flap. My speech has a slightly unpleasant nasal quality. I suppose it sounds as if I have something in my mouth – which I have! A doctor called it “hot potato” speech. But is has never impeded me too much. After my first flap surgery I went back to part-time teaching but have to admit it was hard.

Some people don’t get used to their flap so easily. The flap is too bulky and has to be surgically “debulked”. One man said his flap felt like a wet flannel in his mouth. Some people go from a kiwi accent to a formal British one, I have heard. Personally, I’d rather have a posh accent than hot potato speech.

It’s hard to clean your mouth after a flap. Hard to get to back teeth because there can be scarring and tenderness where the flap is joined to the native tongue. A Waterpik or syringe might be needed to squirt water into the mouth and flush out the larger particles of food.

In my case, an unfortunate development was that my flap forced the native tongue into a gap in my teeth on the good side of my mouth. This part of the tongue turned into a small round red lump with the papillae worn off. Not a good look but out of sight out of mind.  At least I don’t have hair on my flap which is not unheard of, especially for men.

The first six months to a year is difficult. It can take a long time for the most superficial wound, on the thigh, to heal. The wrist wound looks red and raw for months until it fades into the innocuous pink. I wore a tennis wrist band for a long time. The tongue flap itself can heal well and even develop some of the  the appearance and texture of the rest of the oral mucosa or lining of the mouth – that pink, slimy, mucousy look. But generally it remains whiter than a tongue and can be very white and wrinkled like a hand held in water for a long time. After all, it is skin.

During the time in hospital, the healing can be hard. The wrist looks like raw meat and can get infected and full of fluid. I remember a nurse pressing on my wrist and the fluid squirting up to the ceiling like a putrid fountain. Laughter from the crowd!

The flap in the mouth has to have a good blood supply so right from the start it is checked with a Doppler device that checks its “pulse”. I vaguely remember waking up in IC and someone saying, “That is a viable flap”. Good, I thought. I remember later that it was not healing well in parts, had some “necrotic” (dead) tissue and had to be debrided with what looked like a drill. I have since found that debriding means cutting the wound in a criss cross pattern so that the body wants to heal it fast. It worked. Some people have to have their flaps redone. Rarely.

I had a second flap taken from my right wrist after a recurrence in 2014. It went over my inner cheek (buccal mucosa) and gum/jaw. Although I was four years older and in my late 60s, the whole process went a lot better. Maybe because the transfer of tissue was more superficial than for the reconstruction of a tongue. But now I have two pink wrist scars and on each thigh a square of wrinkly white skin.

Trouble with the tongue flap is that problems can only be dealt with by ENT doctors or staff in the surgical ward. GPs and dentists usually have no experience of these flaps so you need to have a clear line of communication with your team. You need to know who to ring if you have problems with the flap, such as it rubbing against a tooth.

Fortunately, there are taste buds throughout the mouth so a person with a tongue flap can still taste.

Terms

Microvascular surgery: Surgery on very small blood vessels such as those only 3 to 5 millimeters in diameter. Microvascular surgery is done through an operating-room microscope using specialized instruments and tiny needles with ultra fine sutures.

Pedicle: a small stalk-like structure connecting an organ or other part to the human or animal body, part of a graft, especially a skin graft, left temporarily attached to its original site.

Papillae: the tiny lumps on the surface of a normal tongue

Here are some notes from medical sites on the net

Microvascular techniques have allowed surgeons to readily transfer tissue from one region of the body to another. In the ideal situation, one must replace tissue lost with tissue that has similar characteristics. In the head and neck, tumor extirpation may result in loss of the thin mucosal covering of the oral cavity, pharynx, or larynx.

The radial forearm free flap is ideal for reconstruction of defects of the oral tongue.

The radial forearm free flap is a versatile flap that includes the volar forearm skin and the underlying soft tissues and fascia containing the radial artery as the perforator. It was first introduced by Yang Guofan in China in 1978. Since then, it has been commonly used as a donor flap for reconstructing the intraoral lining and resurfacing facial and neck defects.  It has been used in various sites, particularly for tissue defects remaining after a wide excision of head and neck malignancies. The radial forearm free flap has many advantages, including thin and pliable characteristics, a relatively hairless nature, and a long pedicle with a large external diameter, making it very useful .

https://synapse.koreamed.org/DOIx.php?id=10.5999/aps.2015.42.6.769&vmode=PUBREADER

Here are some articles about survivors who have successfully lived through this hand to mouth procedure.

http://www.dailymail.co.uk/health/article-40937/Surgeons-rebuilt-tongue–arm.html

http://newswise.com/articles/unique-surgery-creates-fully-usable-tongue

How photography helped me

After my big tongue op in 2009, I needed months to heal and get my speech back to some sort of normal so I stayed off work and took a photography course online. It was far too hard for me. I don’t have the technical understanding to get to grips with the manual functions of a DSLR (digital single lens reflex) camera and I just wanted to take pretty landscape pictures. I completed the course with a pass grade  and ever since then have enjoyed the five or six basic skills I took away from it. I’m going to share them with you because going out with camera or phone, taking pics of our world and sharing them is therapeutic.

Here are five skills in brief – for landscapes:

1.Edit. Every phone or computer will have basic editing software. Straighten the horizon! Crop. More later.

2. Hold the camera down low.

3. Obey the rule of thirds which means dividing the screen in 3 vertically and horizontally and placing the object of interest in the intersection of these lines.

4. Frame the object for a special effect with a tree for example.

5. Use the vanishing point sometimes – a road disappearing into the distance. Very emotive. 

Rule of thirds

Why edit? Digital photos often need sharpening. Do “Auto Enhance” or use the sharpen/clarify function. Be subtle. Crop and straighten if need be. A little crop will often bring the subject into better focus. Takes seconds/minutes.

Why a low angle? Makes the pic look more dramatic and adds some foreground like the grass on the foreshore of a beach – leads eye in and frames the pic.

Why the rule of thirds? It’s a art concept where an object not placed in the middle of a pic but to one side is more pleasing to the eye. The horizon in top third or bottom third looks better for example.

Framing? Things look more striking through a natural frame – but only sometimes.

Vanishing point. Eye is drawn into the picture and the point itself is filled with mystery, the unknown. Always makes an impact. Avenues of trees are good. 

Vanishing point

More stuff. The best pictures tell a story. I can’t do that yet. I’m a bit too impatient to wait for objects to be in place to make the pic more than a calendar shot but that would be another point for improvement. There’s also the idea of lines or objects leading the eye into the picture – a log of driftwood on the beach for example. Some of the ideas I’ve stated are cliches but good ones like the lonely tree representing the loneliness of the universe – or again shooting past the driftwood to add some feeling to a beach pic. 

Yep, taking some pics, editing them and then sharing them is a thing I enjoy and feel I can still do even if my health doesn’t persist. Sharing is so easy in today’s world and part of me wants to advocate for the conservation of New Zealand’s natural environment.

Good for the soul. 

And here is a website taking it up a level. Very easy to read. 
https://www.makeuseof.com/tag/5-photography-tips-for-beginners/

Not so magnificent obsessions

I vaguely remember the film Magnificent Obsession, 1954. I would have been 8 so why do I remember it? The title is floating in my memories but I’m writing about little obsessions now – little interests that keep you going. I’m thinking about people who have been limited by their head and neck like me or far worse. I can barely eat in a socially acceptable way, can’t bite or chew, I have an uncomfortable dental plate and mouth-guard and I’m pretty badly scarred.  But you know what keeps me going apart from friends and family? It’s my obsessive personalty.

That sounds like a bad thing and sometimes it has been for me (my obsession with the current world political situation for example) but the little positive obsessions have been really helpful and have brought me joy. There was the decade long obsession with Shakespeare that got me through my latter teaching years. When I had two classes doing Shakespeare in the same term, my imagination and intellect (such as it is) would be aglow. I read a book called “Shakespeare’s Imagery” and wanted to go to Stratford on Avon where a lot of the similes and metaphors he used got their origin. 

Another obsession was with alpacas after seeing a couple of beauties at  a Rotorua agricultural day about 10 years ago. That obsession has faded too but has given me an online identity on some sites. 

I’m obsessed with pohutukawa trees at the moment. Actually, I have been for a long time. I used to have a massive one outside my window during my childhood and those big old trees are wonderlands, covered in crimson flowers at Christmas. 

Secret weapon for moments of fear

When I started this latest head and neck cancer chapter, I was really scared. The cancer had come back which meant more difficult surgery followed by radiotherapy. It meant loss of teeth and later dental decay. It meant endoscopes and drills, needles,  extractions and biopsies and torches shone in my mouth. What horrible news were they going to give me next? How would I keep calm in the face of pain?

At the time, 2014, I was just beginning to live by myself as my husband had gone into care, so I had to find a way to cope with those little moments of fear and panic, let alone the wider fear of death and dying. Somehow I hit upon the idea of memorising an alphabetical list of things and chanting it to myself.

It sounds very strange but I learnt a list of Kiwi icons off by heart. We New Zealanders have gone to town with “kiwiana” in the last couple of decades. Long having struggled to define our identity as an independent,  bicultural country, we have iconised things like our native birds and trees, aspects of Maori culture and brands from the early days.

I had bought a poster from an Orewa tourist shop with a list of such items and put it on the toilet wall. After learning them by heart I had a calming device for every contingency.

Here are the first six items on the list:

  • Aroha = Maori word for love
  • Beehive = our house of parliament
  • Crown Lynn = an iconic crockery firm from the 50s
  • Downunder = slang term for Australasia
  • Eel = we have lots of them
  • Fantail = one of our cutest native birds

The first few were easy to remember but I used to forget some and had to think hard to retrieve the memory. What was U again? (It was “ute”.) This distracted me from the pain and panic. The list was particularly useful when the mask came down during radiotherapy and and the tongue depressor made my jaw ache unbearably.

One thing that made the list more memorable was that it was a pictorial list so each item had a stylised picture associated with it.

I still use it today if I’m having an examination and have to stop my heart beating like crazy. It works and I found out only recently that distraction techniques like this are commonly recommended by health psychologists.

Wish I’d looked after my teeth

So grateful for upper plate.

One of my first memories is of having five teeth out when I was five years old. Might have been because Mum used to put honey on our dummies. I remember coming out into the waiting room and being given a colouring book and pencils. When I opened my mouth to speak, blood poured out.

Here I am 67 years later still irked by my bad teeth. It’s not Mum’s fault but a combination of factors. Both parents had had all their teeth removed in their teens and were probably not great role models for tooth cleaning and avoiding sweet foods. We didn’t have fluoride in the water and there was no such thing as floss, interdental brushes and tooth mousses … Dental nurses had clinics in each school and cheerfully drilled and filled kids’ teeth with a sense of fatalism you wouldn’t see today.

I had multiple fillings each time I went to the dentist in Milford until I was 16 and free dental care ended. No one told me this was a sign that I needed to look after my teeth better. It was free! Having fillings was normal.

I remember the pain. The injections never worked properly in those days. When involuntary tears poured down my cheeks once, I was reprimanded by both the dentist and the assistant. “Oh Maureen! You have to be brave.” My greatest joy was when the dentist hung his drill up for the last time at the end of the session. There was a sort of motion that signaled to me that the agony was at last over.

University and no money to pay for a dentist. Started work and needed a tooth out. Stabilized teeth during 30s and 40s but then more decay again as I grew older. By the time I hit my 60s, I had lost a fair few teeth and had a number of root fillings. 67 and I had a marginal mandibulectomy of my left lower jaw and radiotherapy. Front teeth were broken in surgery. Trismus or limited mouth opening. Very hard to clean my teeth – gums and teeth in poor condition. However, I concentrated on getting through the treatment and getting over it. Getting dentures to fill the front gap. I did try to clean my teeth well, but let’s face it, I should have tried harder.

What am I left with now? A pretty appalling situation. A nice upper denture,  partial metal, gives me an okay smile and you can’t really see my lower teeth which are gradually breaking up. The lower two front teeth are stuck together like two tall trees swaying in the wind roped to each other or two close-knit tombstones. The others are stumps or half teeth. There’s nothing on the left side to hold a denture properly because of the flap over the gum. Strangely I’ve got some strong molars at the back but they are causing me to bite my tongue and cheek because of changes to the architecture of my mouth after a couple of big reconstructive surgeries.

I’m trucking on okay though. As long as I can keep the bottom teeth for a little bit longer my lower lip, palsied on the left by a cut nerve, won’t get sucked in too much more. I mean, I’ll cross that bridge when I come to it. Can’t have the lower teeth removed unnecessarily anyway because of the threat of osteoradionecrosis.

A lot of this sad story is because of the oral cancer and treatment but I do believe I could have lessened the damage if I had looked after my teeth more religiously. That’s what I’d advise other head and neck cancer patients to do. Don’t do a half pie job. You need to go above and beyond to look after your teeth after radiotherapy.

I’m very comfortable sitting here at my computer and I don’t want to get up but heck, I think I’d better go and … clean my teeth.

It’s the little things?

 

The minutiae of life or little things you notice. Life’s trivia or just things like a gerbera in flower or a rose bud. A gadget in the cellphone shop. God, if I hadn’t had an eye for these things in the last ten years or so of head and neck cancer issues, I would have been lost.

It ties in with the fashionable concept of mindfulness too. I was between appointments and feeling restless. Went for a walk ten minutes up the road to patchy patch of pine forest and native bush. I heard a shining cuckoo, a tui and saw a fantail and wax eye.  The aural and visual senses. Little things that calmed me down.

Past the patch of untidy bush was a view of the horizon with one of my favourite sights – all the distant craggy islands and peninsulas written clearly against the sky. You can count clear days like that on the fingers of one hand every couple of months. There was Little Barrier, Great Barrier and Coromandel all blue and mysterious behind the nearer, lower, greener islands.

Then a walk down what was an ugly new subdivision sloping down to Whangaparaoa Road. Now softened with banks of flax and flowering manuka. One particular bank had such a swathe of soft white manuka flowers that it hit my eye with joy. I wondered if anyone else ever noticed things like this. It’s much more of a little thing than the spectacular ocean view.

The Sunday Star Times had a great feature in its recent Sunday mag. “Don’t worry, be happy.” What were the little things people recommended to put you in a good mood? Say thank you, said one journalist. When you’ve been through a tough time write down the things that you are grateful for. Sounds cheesy she said, but it worked for her. Say no to things you don’t want to do said someone else. Rescue a dog, go outside and my particular favourite: clean something meticulously. The other night I cleaned in and around the kitchen sink and polished the stainless steel. Sometimes just one shelf in the fridge or one drawer will do it.

Do a little thing and do it perfectly.

 

Scars

Once upon a time I thought the small but thick white horizontal scar of the tracheotomy was a blemish. Now I see it as totally insignificant. People who have had head and neck surgery have multiple scars and that little number is nothing to write home about.

I’ve been thinking about scars and thought I would find out more about scar tissue.

From Wikipedia.

scar is an area of fibrous tissue that replaces normal skin after an injury. Scars result from the biological process of wound repair in the skin, as well as in other organs and tissues of the body. (You can have scars inside your body.)

Scar tissue is composed of the same protein (collagen) as the tissue that it replaces, but the fiber composition of the protein is different; instead of a random basket weave formation of the collagen fibers found in normal tissue, in fibrosis the collagen cross-links and forms a pronounced alignment in a single direction.

This collagen scar tissue alignment is usually of inferior functional quality to the normal collagen randomised alignment. For example, scars in the skin are less resistant to ultraviolet radiation, and sweat glands and hair follicles do not grow back within scar tissues.

So scars are a little bit good – they show healed tissue – and a little bit bad – they are of “inferior functional quality”. Scars can also devastate our appearance. While they fade over time, those on the face and neck do detract from our beauty. Neck dissection scars can tuck neatly into the folds of chin and neck but other scars like my chin scar are not a pretty sight. Below is a very flattering photograph of it.

My chin scar and a bit of the neck dissection scar beneath it.

I’m all good with it though because I don’t think scars in themselves are truly disfiguring. No worse than wrinkles for those of us in our twilight years. It’s the drooping of the left side of my lower lip that I find disfiguring and dislike. That’s why I smile a lot. When I smile it is not apparent.

Scars are tight and the surrounding skin is looser so there can be a sagging of one side of the chin and neck which we certainly don’t like.

I think it is the interior scarring that is more frightening.Radiation therapy can also cause prolonged tissue scarring. The muscles attached to your jaw may tighten and make it difficult to open your mouth and chew your food. This is called trismus and can be devastating. People who had radiotherapy before the more targeted IMRT might experience scarring in their throats long after treatment causing swallowing difficulties.

I remember a speaker once saying that the body’s response to poor bloody supply is to scar. We know that radiation can damage fine blood vessels. Once again, I’m at the limit of my knowledge but if scarring is a build up of fibrous tissue to heal a wound, then obviously too much fibrous tissue can causes problems, a state called “fibrosis”, a build up of excess fibrous tissue. (“osis” means an abnormal process or state) Note: only a small number of patients suffer from serious radiation fibrosis.

Back to scars on the skin. Yes, they can be unsightly if they are deep and jagged and push surrounding tissue into unlovely shapes. The fine scars can be tolerable, even a badge of honour though. You can wear them with pride as a sign of ordeals endured, a life lived on the edge. There’s the concept of broken things being beautiful when fixed.

Kintsugi, for example,  is the Japanese art of putting broken pottery pieces back together with gold — a metaphor for embracing your flaws and imperfections. Kintsugi can be a way to reframe hardships to remind yourself that you’re not a victim of your circumstances — and to help you come out the other side stronger. It’s a beautiful concept, could be helpful but like “positive thinking”, it needs to be applied with caution, especially for other people. Some breaks are hard to heal, some scars too deep for a glib answer.

A broken bowl stuck together with gold

So when collagen rushes to heal a wound with its mismatched fibres, yes, we can embrace the scars as proof of hardship and survival but only to an extent. There are scars and there are scars.