Any tips about preparing for Radiation Therapy?

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English Alf
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Date Joined Oct 2009
Total Posts : 2218
   Posted 3/25/2010 8:12 AM (GMT -6)   
As I am going to start have radiation therapy sometime in April by the looks of it I am wondering what tips anyone has.
This would not just be for my benefit, but might be something from which I could find things to add to the new useful list sticky thread which at present has almost nothing in it about radiation therapy.

To get the ball rolling I will quote the letter I had today from the radiotherapy department. (The original was of course in Dutch, but I have translated it as I think it contains stuff worth sharing)


Dear Sir,

You will shortly be receiving radiotherapy in your lower abdomen. In order for this treatment to as effective as possible it is important that your bladder is full and that your bowels (rectum) are as empty as possible.

During the preliminary consultation after you have emptied your bladder you will be given half a pint of water to drink to ensure that your bladder is full for the CT/MRI scan which will take place one hour later.

Five days before the CT/MRI scan it is important that you start a special diet to ensure that your bowels (rectum) are empty. (See below for the details of the diet. And if you have any questions please feel free to telephone the dietician on xxx xxx)

Please find enclosed a prescription for magnesium oxide tablets. You are to chew two tablets every evening starting five days before the CT/MRI scan. These tablets have a laxative effect. In the event that you have diarrhea during the radiotherapy you may, in consultation with the radiotherapist, stop taking the tablets.

While you are receiving radiotherapy you should keep taking the tablets; you should stick to the diet and, having first emptied you bladder, you should drink half a pint of water one hour before each treatment session.


Dietary Advice for Radiotherapy of the lower abdomen.
The aim of this diet is to ensure that the rectum is as empty as possible and moves as little as possible during the treatment session. It is important that your bowel movements are very regular, that the intestines are not irritated and that they contain as little gas as possible. You can achieve this by following the dietary and life-style advice below. This will increase the efficacy of the radiation treatment.

Tips for regular bowel movements.
Adjust your food intake to ensure you have three regular meals a day.
Drink two liters of water per day and vary what you drink e.g. Tea, coffee, water, still fruit juice, milk products, soup.
Chew your food properly or chop your food finely. And eat slowly.
Take regular exercise (if you can)

Tips for preventing flatulence and an irritated bowel.
Avoid the following.
Bread with nuts and seeds, black bread, muesli, cruesli.
Citrus fruits such as oranges mandarins, lemons and grapefruit.
Pineapple, dried fruits such as prunes, apricots and figs
Spicy foods such as sambal, red and green peppers, curry, garlic.
Nuts, peanuts and coconut products.
Beer (including alcohol-free beer) fizzy drinks and more than four cups of coffee per day.
Pulses such as brown beans
Raw vegetables such as lettuce, tomatoes, cucumber, plus asparagus, celery, mushrooms, cabbage, sweet corn, paprika, leeks, rhubarb, sprouts and onions.

The following ARE allowed:
Endives, eggplant, beetroot, cauliflower, broccoli, zucchini, peas, paksoi, mange-tout. Spinach, French beans, runner beans, fennel, chicory and carrots.

Tips to avoid swallowing air.
Some of the air that you swallow while eating may end up in your gut without you realizing it. It is important to prevent this and it can be avoided by eating slowly. A lot of air can also be swallowed while smoking, chewing gum or talking while eating.


This seems to show that I am in good hands

Alfred

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 3/25/2010 8:52 AM (GMT -6)   
Alf,

It may be good advice, but that's the oddest list I have ever seen on the subject. Perhaps something got lost in the translation to English?

The list of things allowed to be eaten is almost 100% of things I don't like to eat, so for me, it would be a great diet plan.

When I was going through SRT, my rad. oncologist told me to eat whatever I felt like eating, and that I would probably end up craving a lot of proteins, i.e. meats. She was correct. I craved meat most of the time.

As the number of treatments went on, I lost more and more appitite, so the dr. said to be sure to eat, even if it wasn't healthy eating choices, it was important to keep the body strong as possible.

I my case, as you remember, I had a lot of difficulties with radiation (most people don't, so don't let that worry you).

At the end of my 39 treatments, I had lost about 12-15 lbs, because I reached the point where I almost never felt hungry.

For all my other troubles with radiation, I really never had any trouble with loose bowels, which doesn't make sense, I know.

Best advice: Follow your doctor's orders as instructed. Every case is different.

David in SC
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, Caths #13 & #14 same time, 3/6 Cath #13 out - 4 days


Bootheel
Regular Member


Date Joined Oct 2007
Total Posts : 300
   Posted 3/25/2010 9:05 AM (GMT -6)   
I wasn't given any instructions about a full bladder or bowel movements. I was told to eat a high protein diet or "Bulk up" during the procedure, I lost about 10 lbs. but gained it back after the treatments. I was told to avoid fiber also, I experienced diarrea through the procedure but Immodium helped a great deal. I also had a temporary stricture in my uretha which Flomax cleared up. I would request a prescription just in case. Especially if you have to travel a good distance for the treatments. It came on suddenly so having the meds helps. Everyone experiences different changes during this time. Relax, follow the instructions and you will be just fine.
Age 65
Diagnosed 10/12/07
PSA 6.3
Biopsy 18 core samples, 2 positive <5%
Stage T1a Gleason 6 (3+3)
LRP  1/29/08
Post-op
Gleason 7 (3+4)
1 positive margin (.3cm)
T2C
4/16/08- Started Bi-mix injections 
5/15/08- 1st Post-Op PSA 0.07 Undetectable
8/11/08 -2nd Post-OP PSA 0.02 Undetectable
8/15/08- No more pads as of today  Whoopee!!!
11/13/08- 3rd post-op PSA 0.02 Undetectable
03/02/09- 1 yr. post-op PSA .09 Undetectable
05/13/09   PSA .18 (ouch)
Started IMRT June 13, 2009
Completed 37 treatments July 31, 2009 (66.6gy)
11/23/09 Post IMRT PSA .18
2/12/10   Post IMRT PSA 0.00


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 3/25/2010 11:47 AM (GMT -6)   
Alf,
The most importand thing is regular excercise or you will get fatigued. Also metamucil once a day will help any bowel issues. If you have any urinary problems then cut out all alcohol and caffine. I never had a problem eating anything, but I beleive that the more full your bladder is the better results you will have. I drank 32oz of water before every treatment
JohnT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT


JB71
Regular Member


Date Joined Nov 2009
Total Posts : 206
   Posted 3/25/2010 12:06 PM (GMT -6)   
I'm starting my radiation on April 26, but my on going incontinence is a very big worry for me since my oncologist has told me that at whatever level of incontinence you are on day one of your treatments, they will most likely remain at that for the rest of your life.

THAT SCARES THE H*** OUT OF ME.

I was alsotold about the full bladder/empty bowel stuff but nothing about magnesium oxide pills.

Posting YOUR recommended diet is most appreciated by Debbie as I'm sure she will see to it that I stick with it.
Age, only 71.
July 2009, PSA 9.1, free ratio 0.16
September GLEASON 4+4=8, T2A
Prostate 44cc.
Calcium: 2.46  (range: 2.20 - 2.65 mmol/L)
25 Hydroxy Vitamin D: 102 (range: sufficiency:
76 - 250 nmol/L)
Bone Scan: Negative
CT Scan scheduled for Dec. 1st. Negative.
Started Casodex 50mg. on Nov. 6, first pill of 30.
Got Lupron 22.5mg ( 90 day ) on  November 19.
No real side effects as of Dec. 15 except dry skin and hair but getting quite 'porky' in the belt area even though now I go to the gym, three times a week. Also I dont have a need to shave anymore so now I can save my 'shaving' allowance and direct it to my stash of Depends !
 
Christmas Day got my first hot flashes. Thanks Santa!
 
Open surgery done on Jan. 20th. by Dr. J. Chin at London's University Hospital.
 
Cath removel scheduled for Feb. 8th. Yes, I know,
that will be 19 days. Dr. is out of country until then.
====================================
Pathology Report:
 
Gleason Score: cannot be determined due to hormone therapy effects. ???????
Extraprostatic Extension:
present, left radial, multifocal
present, left basal, multifocal
Resection Margins:
Apical: involved by invasive carcinoma, multifocal
Bladder Neck: involved by invasive carcinoma, unifocal on left side.Other: non-tumoural prostatic present at resection margin.
Perineural Invasion: present.
Seminal Vesicle Invasion: absent
Lymphovascular Invasion: absent
Lymph Node Status: no malignancy in regional lymph nodes
Additional path. findings:
high grade prostatic intraepithelial neoplasia
 
Pathology Stage: yp T3a NO MX
==================================
Radialogist appointment was on Friday Feb. 26 with Dr. Glenn Bauman in London.
Got another Lupron 90 day shot today and he wants to start IMRT soon. CT Scan plus measure scheduled in about 3 weeks. ( march 15)
 
First PSA test since surgery on March 25th.
 
Next appointment with the surgery Doc is April 13.
 
Started a Facebook page for bikers with prostate issues at:
 
IMRT to start approx. April 26.
 
.


60Michael
Veteran Member


Date Joined Jan 2009
Total Posts : 2243
   Posted 3/25/2010 1:22 PM (GMT -6)   
Alfred,
That is a very thorough list so not anything that I can add to it. Some of that depends on the individual but I ate light meals several times a day. You are well prepared and I wish you the best.
Michael
Dx with PCA 12/08 2 out of 12 cores positive 4.5 psa
59 yo when diagnosed, 61 yo 2010
Robotic surgery 5/09 Atlanta, Ga
Catheter out after 10 days
Gleason upgraded to 3+5, volume less than 10%
2 pads per day, 1 depends but getting better,
 started ED tx 7/17, slow go
Post op dx of neuropathy
T2C left lateral and left posterior margins involved
3 months psa.01, 6 month psa.4, 6 1/2 month psa.5
Starting IMRT on 1/18/10, Completed 39 tx at 72 gys on 3/12/10
Great family and friends
Michael


Geebra
Regular Member


Date Joined May 2009
Total Posts : 476
   Posted 3/25/2010 6:53 PM (GMT -6)   
The only thing my RO insisted on is full bladder and the techs asked my every time if I had my 16 oz of water an hour before the treatment. I also was recommended to have an "unhealthy diet". Less veggies, more carbs and protein. Excercise helped with energy level and immodium was helpful towards the end of the treatment.
Father died from poorly differentiated PCa @ 78 - normal PSA and DRE
5 biopsies over 4 years negative while PSA going from 3.8 to 28
Dx Nov 2007, age 46, PSA 29, Gleason 4+4=8
Decided to participate in clinical trial at Duke - 6 rounds of chemo (Taxotere + Avastin)
PSA prior to treatment 1/8/2008 is 33.90, bounced on 1/31/2008 to 38.20, and down at the end of the treatment (4/24/2008) to 20.60
RRP at Duke (Dr. Moul) on 6/16/2008, Gleason downgraded 4+3=7, T3a N0MX, focal extraprostatic extension, two small positive margins
PSA undetectable for 8 months, then 2/6/2009 0.10, 4/26/2009 0.17, 5/22/2009 0.20, 6/11/2009 0.27
ADT (ongoing, duration TBD): Lupron started 6/22/2009
Salvage IMRT to prostate bed and pelvis - 72gy over 40 treatments finished 10/21/2009
PSA 6/25/2009 0.1, T=516, 7/23/2009 <0.05, T<10, 10/21/2009 <0.05, T<10


pasayten
Regular Member


Date Joined Mar 2007
Total Posts : 448
   Posted 3/25/2010 6:59 PM (GMT -6)   
Alf,
 
Looks like you are well pepared...   Only thing I would add is a few glow in the dark sickers on your belly...   That will definitely make you friends with the technicians...    Along with a bag of chocolate covered pomegranites once a week or so...   :-)
 
I also stayed at a friends house to be closer to the hospital for the 7 weeks and was doing my own laundary...  New blue jeans and white undies and socks do notmix well,  but the girls got a kick out of my lavendar underwear days...
 
I really ended up liking my technicians...   very profesional in moving me around,  but also with a great mood that always made the treatments very comfortable.
 
Praying for you for no significant side effects...
 
pasayten
 


After 3-4 years of annual PSA 4-6, biopsy recommended
3/13/2007 - 12 point biopsy - Left 0/6  Right 1/6 Gleason 3+3 T1c
4/24/2007 - DaVinci performed at Virginia Mason hospital in Seattle
5/2/2007 - Catheter Out! Final pathology of Gleason 6  T2c Nx Mx, approx 20% of prostate involved, positive margin, but only at 2 focal points.  
6/28/2007 9 weeks incontinance... Overnite, went from 4-6 soaked pads a day from prev 8 weeks to 2 barely wet pads a day.
7/12/2007 11 weeks post-op  Minimal leakage...  one small pad a day
7/18/2007 First Post-Op PSA...  0.01 !!! 
9/10/2007 Pad free and ED at 75% with 100mg Viagra generic
6/26/2008 2nd Post-OP PSA at 14 months...  0.02 
12/2/2008 3rd Post-OP PSA at 20 months...   0.03
10/30/2009 4th Post-OP PSA at 31 months...   0.13 (moved and diff lab)
11/3/2009 Retest at my original lab...  0.11  (followup with Doc sched 11/10)
11/10/2009 Discussion indicated biochemical reccurrence and need for salvage radiation treatment. 
1/21/2010 Another PSA test at 34 months...  0.14
1/26/2010 IMRT Salvage Radiation Treatment started
                  32 sessions for 64 gys total.
3/12/2010 Finished 32 sessions...  No side effects to date except a little
tiredness.  Slight changes in bowel movements the last week...   Would feel like I did not empty completely and get a little blood once in a while.  Also maybe aggrivated by a little constipation caused by cholesterol medicine simvastatin that I started in November and when I do not drink enough water. No change in frequency for bowel or unination though which was a blessing thru the whole process.
 

Post Edited (pasayten) : 3/25/2010 6:04:14 PM (GMT-6)


English Alf
Veteran Member


Date Joined Oct 2009
Total Posts : 2218
   Posted 3/28/2010 10:03 AM (GMT -6)   
I found out loads more useful stuff today.
I spent so much time checking out the AVL hospital website last year prior to my appointment with the da Vinci, that until today I had forgotten to go back and check it for info about RT.

They have a video presentation about RT and you can also download a pdf file of about 30 pages with information and photographs about the treatment and about side-effects etc (eg how to look after your skin if it gets sore) It is a pdf version of the booklet they will give me that includes pages for the hospital to write down stuff such as the number of the machine I am booked to be treated on as well as phone numbers etc. plus space for me to write down my questions.

It even says I may be able to claim from the health insurance company for my travel expenses for the six weeks of going back and forth to the hospital.

Where I am being treated is a combined hospital and research facility known for short as the AVL-NKI:
AVL= Antonie van Leeuwenhoek Hospital
NKI= Netherlands Kanker Instituut

Most of the AVL-NKI website is in Dutch, which is a pity, as I'm sure it would help HW folk to be able to understand it, there is however a short video presentation in English at:
wrm.streamingxs.com/?id=71064
this includes a brief shot of the Da Vinci that was used on me as well as one of the RT machines. (the patient in a bed being wheeling out of an elevator is not me!)

Prof. Marcel Verheij, the head of Radiotherapy is Dutch, but some of his details are in English (I was interested to note that he did part of his studying at Memorial Sloan-Kettering Cancer Center in New York):
www.nki.nl/Research/Faculty+and+Research/Divisions/Radiotherapy/Verheij.htm

Alfred

Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3742
   Posted 3/28/2010 11:14 AM (GMT -6)   
What about exercise, exercise, exercise? You've got a month to train for the big fight.
Use the time wisely. Nothing on TV is more important.

By the way I think that is good for any procedure - although I'm not sure it did me a lot of good. There is no way to tell.
Good luck to you.
Jeff
Married 34 years, DX Age 56. First routine PSA test on April 8, 09: 17.8. Start 2 weeks of Cipro to rule out protatitis. May '09 PSA: 22.6, 3 weeks later: PSA: 23.2.
Biopsy 6/10/09: 7/12 scores positive, 20%-70%, Gleason 6=3+3. Bone and C/T scans neg.
RP DaVinci -7/21/2009 @ Univ of Roch Medical Center
Left nerve gone, right partial spared.
Catheter removed - 7/31/2009 Pathology report received:
Gleason 3+4=7, Tumor size: 2.5 x 1.8 cm, location: both lobes and apex.
Extraprostatic extension present; Perineural invasion: present, extensive.
No Malignancy in Seminal Vesicle, vasa deferentia, lymph nodes 0/13
Prostate mass 56 grams. Pathologic Stage: pT3aN0MX
Post Surgery Status:
Potency - 12/11 5 months, Still no activity, zip. Using pump daily since 11/11. No effect with 20 mg of Cialis or 100 mg of Viagra. Shots next See Uro 1/22/10 Trimix #1. Try 0.08- 25%, 0.12-25%, 2/26/10 try 0.16 First Success! 90%.
Incontinence - 8/20 4 full pads per day
.. 9/7 3-4 full pads per day (Try cutting down on fluids. Bad idea. I know.)
12/11/09 5 months: 3 pads per day, 400-450ml/day
02/26/10 7 months: 3 pads but leak is now 320 ml (5 day avg.)
03/22/10 8 months: 3 pads per day, 280 ml/day (5 day avg.) PT says all muscles are tight and working properly. There must be another issue. Uro mtg 4/23. Did I waste 6 months?
Post Surgery PSA - 9/3 6 weeks - 0.05; 10/13 3 months - 0.04, 1/14 6 months - 0.05.


142
Forum Moderator


Date Joined Jan 2010
Total Posts : 7084
   Posted 4/13/2010 1:24 PM (GMT -6)   
Alfred,
We are getting close - had my planning CT scan today. They complained that my bladder is too small to "blow up" the way they want. Seems that it may be an issue when targeting the radiation.
Calypso aside, they still did three tattoos. Nothing pleasant about the one in the gut.

English Alf
Veteran Member


Date Joined Oct 2009
Total Posts : 2218
   Posted 4/13/2010 2:52 PM (GMT -6)   
142, I'm definitely on the same track as I too had my CT scan today. Not too bad.
I did think that the metal table I had to lie on was very hard and uncomfortable, even though I had a pillow and a padded thing under my knees.
It was also rather cold: I had not expected to have to be naked for it, but that makes another two young ladies who have seen me naked. (And one older guy.)
My wife came with me and was able to go with the technicians into their room to watch the pictures being made and look at my insides on the screen.
I had no problems with the tattoos, and they are so small I almost need my reading glasses to find them.
I don't know what they did to you, but before the CT scan they lined me up with the lasers then marked three crosses on me with red pen, then on the intersection of the crosses they fixed a small lead ball using tape. Then after I was slid out they removed the lead balls and did the tattoos.

I also had a half hour talk before the CT scan with someone who explained more about how the hospital organises the treatment sessions, docs appointments etc.

So I am due to start in 10 days and they will send me the details of the exact times etc in a couple of days. I won't get a fixed time for all 33 sessions, instead halfway through each week I will get given the times for the following week.
I don't get allocated a specific machine either, there are about ten available, so on arrival each day I swipe my pass at a scanner by the main door and a screen will tell me where to go on that day so you don't have to queue at reception each time to be told what to do.

I just hope I can cope with the travelling as I found today's trip a bit tiring, but maybe that was the stress more than anything else, even my wife came home saying she felt very tired.

My biggest problem at present is that I am not enjoying this diet they put me on very much. (I can't work out what to buy and what to cook either) It's all about having quiet insides and good BMs. They also said today that all prostate patients get treated after 10am to try and ensure that they have all had a chance to have a BM beforehand to make sure the colon and rectum are as empty as possible. And then they make you drink water to make the bladder full so that that pushes the other parts of your intestines out of the way. I was also told that I'm not to worry if having a full bladder makes me leak as they're used to that sort of thing.

It's late evening in Holland so I must go to bed to try and get a decent night's sleep.

Alfred

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 7084
   Posted 4/13/2010 3:50 PM (GMT -6)   
I'll be at a small clinic - basically built around the Calypso machine and the CT equipment just off site from a major hospital. Quiet - just the folks who are "next" in the waiting room. I've never seen more than three people there, but I am told they are always fully booked.
They actually start at 8 for people who have to arrange around their jobs. My job is 24x7 on call, so the time is not relevant. But I am on at 10:30 daily. They want you on an extremely regular schedule, without really explaining why.
I'm still wondering where all that water went. I should have been leaking by now.

The nurse did the laser / tattoos after the CT. Supposedly the computer lines up the laser based on the scan. I accused her of doing it with an old one-hole hand paper punch. They had me all covered up, but that was probably more for her benefit than mine. They took me to the Rad. specialist - so many cute girls, nothing to show for it. argh.
I go back next Wed. for a recheck xray, then rad. starts on Thursday.

Only 9 miles away, but a 45 minute drive each way. I'll be soon tired of that, I'm sure.
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