Finally time to recap the full experience of the side-effects from my brachytherapy.
[contrast with: "Tudpock's Brachytherapy" who escaped the side-effects]
Background: diagnosed with prostate cancer Nov 14
10/14: PSA 4.1
11/14: biopsy; 5 of 12 positive; GS: 3+3, 3+4, Dx: T1c
12/4: Cesium-137 brachytherapy (82cc prostate, 20 needles, 88 seeds)
The urologist/surgeon suggested radical surgery (w/lousy personal-skills/rapport/"bedside manner")
but I went for a second opinion and found a very competent/confident brachytherapist.
(sadly, when it came to the surgery, my doc was brought on as my urologist)
Scheduling found an
opening for Dec 4
Note: this was not really enough time to meet/discuss/plan/understand with all the docs.
Especially since the docs and their admins were out for thanksgiving holiday.
[the prostate cancer page at urology.ucla.edu/body.cfm?id=447 has good info]
This schedule put my post-operative recovery in December, rather than impact work in the new year.
[well, that was the plan/expectation]
Note: I recommend *not* doing surgery the 2 or 3 weeks before christmas/new-years,
Once again, the docs and staff will not be readily available for consultation.
The surgery went smoothly, as such things go, but 20 needles in the perineum leaves its mark.
First: the immediate impact of the surgery:
* Bruising and swelling of the perineum (everything you sit on)
-- This was effectively treated with prescript
ion pain-killer (darvocet, iirc)
-- Foam cushion, with perineal/coccyxical cutout when sitting
* The perineal nerves are stimulated/traumatized by the procedure (see below for effects)
* And lasted 5-7 days; at that point I felt pretty confident that all would be well.
this time, the radiation kicks in (88 seeds of cesium-137) weeks 1-4.
* Fatigue; basically, your metabolic reserves are consumed repairing the damage
-- Sit, lie down, take a break; you are tired: so rest and recuperate.
* Nausea; was not so bad for me, getting horizontal for fatigue also relieves the nausea
* "signal confusion" in the perineal nerves; lots of nerves run through the perineal/groin area,
the radiation causes to inflammation and irritation, so the nerves are very sensitive.
As a result, there is essentially "crosstalk": stimulation of one nerve is perceived as another nerve.
So: it feels like you need to pee, but the nerve signal crosses to the rectal nerves and causes a strong reflex to eliminate through the bowel (see also: tenesmus); In the first week, I "blew out" an external hemorrhoid;
Alternatively, pressure in the rectum can be perceived as "need to pee", the sensation of urine flowing through the ureter crosses to "erectile stimulation" (which triggers a reflex that blocks urination). Really, at this point one never knows if you are going or coming... try to pee and out comes poop. [occasionally, I would awake with a pain/cramp in my big toe: crosstalk]
What to do:
-- Relax. fight/break the reflex. hold TP (toilet paper) firmly against the anus to avoid over extending it. stand to pee (into a cup helps) hold that TP in case something drops that way.
-- suck it up: do the kegel-like exercise of closing the anus, and press finger up on perineum to get things in the right place for urination.
-- mixed success trying to urinate more often, good to not wait until there is too much pressure
-- pee into a measuring cup, so you know when you have done 3-4oz/hour (or whatever your rate is)
-- max doses of ibuprofen to reduce swelling and inflammation
Third: radiation proctitis: the radiation inflames the rectum (which further stimulates the nerve, above)
One noticeable effect is the creation/elimination of rectal mucus; which triggers the elimination response (or due to nerves above, an urge to pee, and then an elimination reflex...)
The sensitivity was extreme, the 'poop' signal could be from: gas, mucus, or any bit of fecal material in the rectum. (and the signal continues until whatever there is removed) and per above: urination is typically blocked until that rectal signal is removed. The feedback/reflex loop is treacherous...
During this phase, I was spending 20~30 minutes in the bathroom every 1-3 hours; this improved after ~8 weeks.
Note, the physical stress and pain of dealing with this further contributed to the Fatigue,
and since this was every 2 or 3 hours (even through the night) sleep deprivation was also a factor.
What to do:
-- I eventually got some Hydrocortisone suppository and that may help the inflammation (or maybe it was just time and self healing, can't be sure)
-- watch what you eat: you don't want to get constipated, but neither do you want a high-fiber diet. That was where I went wrong (because the fiber contributes to the irritation, and loose/pasty feces are more trouble to push and completely void than more formed stools. Avoid high-acid foods (an undigested tomato skin stuck to the hemorrhoid and caused extreme pain; if you get close to diarrhea, then the high-acid also leaves it mark)
-- watch *when* you eat: my cycle time is 18-20 hours, so do not eat in the morning (as that would come out in the middle of the night)
-- various postures and exercises help move things through/out the colon; standing a half-meter from the wall and leaning my coccyx/buttocks against that while stretching helped; hopping also was helpful (alternating free-fall with down-shock); vigorous bouncing/palpitating of the anal area (with that TP covered hand) helps move things down (or confirm that there's nothing there)
-- remember: it only hurts for a short time; once resolved/eliminated, the pain is gone and forgotten
After 10 weeks, life is back to almost normal, still careful of eating; still some sensitivity in the rectal nerves, but can work through the day, and sleep through the night (with a 4am trip to urinate)
Overall, I think brachytherapy was a better choice than radical surgery; but be aware that for some percentage of patients, the radiation can trigger a painful, exhausting challenge; hopefully you will have doctors that can identify and treat the problem, and by watching your diet avoid the worst of this.
Post Edited (jack54) : 2/22/2015 12:45:47 AM (GMT-7)