3-25-2016/Day 2 IMRT

So I went behind the door again today.  Treatment #2 of 28.

CCC Door

As I walked into the changing room, another unlucky guy was going into the treatment room.  I changed and waited in the waiting area for my turn. The guy came out and they called me in.  I went in, got on the treatment bed and slid my legs into my pre-formed pants. They nudge me a little bit until these green laser lights line up on my tattoos on my sides and lower abdomen. The techs walk out and the big machine starts its process.  The first part is an x-ray/CT scan that double checks where your prostate is located, with the gold seeds inside, and where your bladder and rectum are since radiation to those areas are a bad thing.  So after those are done and these large wall things slide back out of the way, a couple of other large arms with the accelerator start moving around me.  360 degrees.  Kind of cool, although a reminder of why I am there and that I am being radiated.  It spins around me, slowly, about 3 times.  Then the tech walks in, slides the bed back and says “you are all done” and “your bladder was nice and full -keep prepping that way”.  So two days and good on full bladder and empty rectum.

As I walked out, the guy before me was still there.  I went into the changing room and I can hear the tech telling him “Do you need more water?” “You need to feel like you have to pee when you get here so that your bladder is full”.   So this guy did not drink enough before his treatment.  That means he didn’t pass the X-ray/CT portion of the treatment.  Another reminder that I could be there longer if I don’t prep the right way.

I am scheduled for 26 more treatments.  Most of them will be at 8:20AM each day.  Altough on Monday, it is at 7:40AM.  That is a tough time to get my bowls empty and bladder full.  I think I might have to get up really early to trick my system.  Oh well… onward!

Till next time. cropped-favicon.jpg

3-24-2016/IMRT Day 1

Today was my 1st of 28 radiation treatments.  I will be given 1.8 Grays of radiation per day for a total of 50.4 Grays.  Add that to the 21 Grays I got already, I will have a total of 71.4 Grays.  The radiation will be to my prostate, prostate bed and lymph nodes.  That is to help kill any of those aggressive cancer cells that may have tried to move to other parts of my body.

I got there at 11:00 AM, after drinking a very large thurmos of water to fill my bladder. They showed me the Men’s waiting room and my cubby storage for my “shorts”. Actually they are the over sized blue paper hospital shorts. She put my last name on my cubby.  That will be mine for the next 27 more days (Monday through Friday).  They change the shorts each Friday.

RO Locker Room3

RO Locker Room1 RO Locker Room2

I walked past the large 6 inch thick radiation doors into the room that I will see for the next 28 days.  I got on the treatment bed and my previously fitted pants were already on the bed.  They adjusted me some more and started the process.  Today was a little longer because they double check the tattoo markers and measurements with the green laser lights that have a cross right above my prostate. The machine hums and starts to move around me.

RAJust before they were done, the tech came in and put two more tiny tattoos just above my pelvis.  I guess they needed some more for accuracy. Okay by me, I want them as accurate as possible.  I wouldn’t care if the tattooed a line all the way around me.  I was all done and could go #1 – what a relief.

So onward with the journey….  cropped-favicon.jpg

3-9-2016/IMRT Planning

I woke up really sore today.  I guess it is from the Zometa I.V. I got yesterday at my Medical Oncologist office.  The nurse said I would feel it in my bones for several days. Well she was right. My tail bone hurts the worst and I am walking like an old man because I feel it in my pelvis and knees.

So for today’s adventure, I went to Coastal Communities Cancer Center in Ventura.  In that building is the Cabrillo Radiation Oncology Medical Center where I will be having my Image Guided Radiation Therapy (aka IMRT or IGRT) by Dr. Fogel.  This is low dose radiation done daily over a 4 or 5 week period.

Today they are going to do the planning for that radiation process. So I was to drink a lot of water so that my bladder is full, but also make sure my rectum is empty.  Not a easy thing.  Go #2, but save #1.  I drank a very large thermos of water 15 minutes before I got there.  They put me on a scanning bed in front of a large CT scanner. Here they lined up some laser beams to my waist.  They also fitted me with my own air bean bag pants thing.  After I am laying on the bean bag, they fit it on me and then suck the air out.  Now it is formed to my legs so that I am in the same position every time on the radiation table.

IMRT Air Bean Bag Pants
IMRT Air Bean Bag Pants

Then they did a CT scan to check where the gold fiducials ( 3 gold markers placed in my prostate last week) are located in my prostate and then lined up to the laser beams.  After it seemed that everything was set, the tech marked my body with 3 little tattoos. Yup, permanent marks so the laser beams can find the spots again. It was a little needle that she puts tattoo ink on and sticks me.

In IMRT "Pants" with Tattoo
In IMRT “Bean Bag Pants” with Tattoo
IMRT Tattoo Dot
One of the IMRT Tattoo Dots (not the lines)

After all that was done, I was able to go to the bathroom!

So now I wait for Dr. Fogel to call me with the actual dosage and number of days I will need the radiation.  This radiation will be for my prostate, prostate bed and lymph nodes in the area.  That way we zap any cancer cells that may have tried to leave my prostate and take residency somewhere else in my body.  Another treatment that is essential when you have an aggressive cancer diagnosis.

Until next time.  cropped-favicon.jpg

3-8-2016/HDR Update – Zometa

Well it has been one week since my high dose radiation.  I am still sore in the undercarriage area, if you know what I mean.  I have had multiple side effects from the procedure. I have seen many commercials on TV that says “if you have painful urination” and I would think, how do you have painful urination, it just comes out. Well I know what they mean now!  They looked into my bladder with a camera (guess where they went in to see my bladder).  They also gave me a foley catheter. The urethra damage from those processes really hurts.  They gave me a prescription to help with the pain.  Now my urine is a nice supper dark orange.  I have to spray the toilet each time because it will stain it.  I will spare you the picture.

I also had my monthly visit with my Medical Oncologist today.  So for today, they gave me an I.V. of Zometa.  This is the medicine that helps prevent my bone density loss.  It took about 30 minutes for the stuff to slowly drip into my arm.

Zometa IV 3-8-2016

Next it was the 4 vials of blood to check my PSA level and all the other levels that matter each month.  Getting used to all the blood draws. cropped-favicon.jpg

3-2-2016/HDR Brachytherapy

This is my post High Dose Radiation Brachytherapy update.  Marcy and I traveled down to UCLA area the night before on Sunday.  We stayed at the W which was about 2 blocks away.  I was to show up at the 6th floor surgery center at 6AM, Monday, February 29th.  After a quick check in, I got ready for the anesthesiologist and the first part of the procedure.  Dr Kamrava, came in to greet me and talk me through the steps for the day.

Getting Ready
Getting Ready
Warming Up
Warming Up
Me and Dr Kamrava Pre Radiation

The smile on my face wouldn’t last all day….  They took me into the prep room where I got an I.V., and an epidural.  I didn’t really feel that shot because I was starting to get groggy with whatever else the anesthesiologist gave me.  The idea is that Dr. Kamrava would be inserting 18 catheters into my prostate from my perinium (undercarriage area). These are the catheters that are hooked up to the machine that puts the radioactive seeds inside to do their magic, or damage, depending on how you see it.

HDR Catheter Impant Process
HDR Catheter Impant Process

Next thing I knew, I woke up in another small room and the prepping was over. It took them about 3 hours for all the procedures. And that didn’t include any of the radiation yet.  They let Marcy came in to visit me.  This was the time that the Physicist and Dr Kamrava work out how much and where the radiated seeds would be placed inside my prostate. Another two and half hour wait.  (As a side note, Marcy and I always try to take a picture of the other one still under anesthesia – who knows why, but she got me)

Not Yet Out of Anesthesia – Thanks Marcy
Awake and Waiting for Radiation
BRUTAL: Those are the catheters sticking 6 inches into my backside!
BRUTAL: Those are the 18 catheters sticking 6 inches into my backside!
Big Heavy Doors of the Radiation Treatment Room

Yes those are the 18 catheters that they just put inside me.  First they used a scope to check out my bladder.  Then they used a trans-rectal ultrasound to place in the catheters. Lastly they put in a Foley Catheter because I am unable to walk or go to the bathroom.  About 2.5 hours later, they rolled me into the CT scan room to check out the placements again.  Some adjustments were made.  Damn that hurt. All of the epidural wore off and I had a self medicating machine for Dilaudid. But that wasn’t helping.  I think he turned them in farther.  So after that, into the radiation chamber.  The technician put on some classic rock for me to pass the time.  It took about 30 minutes and the fraction was done.  I just got 10.5 Grays of Radiation to my prostate. (Grays are the measurement of radiation absorbed into the body (side note: if you walked into a nuclear power plant and your body was hit with 10.5 grays, you would be dead in 2 to 14 days).

After the radiation I was wheeled up to my room.  Unfortunately this was going to be a long damn night.  Since I had all those catheters in me, I could not be transferred to a soft bed, I had to stay on the gurney!  2nd, I could only lay on one side or the other all night long! The dilauded that I was to push the button for only made me sick. They gave me something else but I could only take it every 6 hours.  I felt like I was in a torture chamber.  I watched the clock every hour.  I tried to pass the time with tv or my ipad but couldn’t concentrate on anything.  Brutal night.  The nurse had to help turn me over every 2 hours.   She came in and gave me a sponge bath about 6am.  At 7:30, Dr Kamrava came in to prep me mentally for the next fractions. Marcy came in to wish me luck.  I went down to the CT scanner again to make sure everything was in place.  If they moved, he would have to adjust (I’m thinking NOOO!).  Luckily for me, no adjustments needed. Sweet. They hooked up the catheters to the radiation machine, shut the massive lead doors behind me and it started again. Classic rock played again. I still heard the machine when the radiation seeds were put inside me.   I felt some of them go inside. That was a weird feeling.  Then the big doors opened and all was done.  10.5 more Grays.  21 Grays total for the 2 days.

Next was the part I was dreading… remember they put me out to insert the 18 catheters, well they don’t give you anything when they remove them.  Another doctor came in the room and I asked him if he was Dr Extractor?!  He said he liked that title.  He began by cutting the template away from my skin where it was stitched in place. Still weirded out by the stitching part.  Finally, he put both my knees up high and they rubbed my legs while he slowly pulled the thing out.  It seemed like I was giving birth.  Those things are in there about 6 inches.  Yes it is as brutal as I am explaining.

So all in all it was 2 days, 1 very long torturous night and 21 Grays zapped inside me.   Glad that is over. Honestly the staff at UCLA was great.  Everyone was nice and helpful.

I am home now resting and getting use to the side effects.  I have urinary urgency like you wouldn’t believe.  Seems I have to go constantly. But unable to actually get it all out since I can’t push very well. My prostate is swelling from the radiation and it is making it harder to go.  They gave me a handful of pills to take and of course, I can’t sit down on anything that is not very soft.

Next will be external beam radiation in Ventura. cropped-favicon.jpg

2-25-2016/My Therapy Dog

A few days ago I finally got my new puppy.  They say a dog has many therapeutic values.  I know in just a few days that “Gandalf” has given me some great times already.  He also got me outside in the backyard playing with him.  More than I was doing.  The little guy has a great sleep pattern and also has a burst of energy when he wants.

My daughter Sydney is coming over to watch him while I am down at UCLA having the high dose radiation treatments.

Not really looking forward to these radiation treatments and the subsequent side effects but I got to get it done.  Hormone therapy has been tough. Hot flashes are kicking my butt.  I will update again next week after the treatments. cropped-favicon.jpg

2-16-2016/HDR Brachy Pre Op

Today was my pre-op appointment at UCLA.   To make sure I am ready for the High Dose Radiation, they need to check me out.

The Physician’s Assistant went through my health history and then we went through the pre-op prep I needed to do the day before and all of the post op process and home care. I’m not really looking forward to this procedure but I know it is the best procedure to get close as I can to a cure.

Next was the pre-op tests. First on the list was a Trans-rectal Ultrasound.  Any procedure with “trans-rectal” in the name is going to be uncomfortable.  This was no exception.  The hormones have shrunk my prostate and the PA performing the procedure had to press fairly hard to get the right pictures. Probably the longest ultrasound I have had in the last year and half.   The PA doing it was nice about it and I was able to view the monitor with her so I had something to look at instead of facing the wall like some doctors make you do.   She gave me a copy for my records that I added below.  (It reminds me of a baby ultrasound where everyone is saying “OMG – so cool”, and you can see nothing in the picture)


Next on the list was the Chest X-ray.  Just had to wait a little and it only took about 5 minutes.  Simple.

Next was for them to draw blood.  A complete blood panel so about 5 viles.  The lady was nice but it took awhile to find my vein.  I don’t know why, but ever since I started having my blood drawn every month, my veins have disappeared.  They are hiding in each arm I think do to the constant sticking of needles.  I have had my blood drawn 4 times already this year.  On the arm that she went for today, there is already a bruise from last weeks blood draw.  So unfortunately, she put in the needle and had to “dig” around a little bit until about the 4th lateral movement. Then pop, the blood started to flow.  I have gotten use to the digging now.  On the way home my arm was hurting.  I assume another bruise is on the way. Oh well.

Finally a quick EKG.  I shaved the hair on my chest over the weekend to prep for this.  Sometimes the sticky pads pull on the hair.

That was my day.  I am tired.  Took 2 hours to drive the 58 miles in traffic on the 405 to UCLA today.  Then all the waiting around between tests.  I think I deserve a nap.  Good night!  cropped-favicon.jpg

2-10-2016/PSA Down

I got a call from my Medical Oncologist office today.  My latest PSA test came in at 0.58!   So nice that this hormone therapy is working to slow down the cancer.  This is really needed to make the cancer susceptible to the upcoming High Dose Radiation Brachytherapy at UCLA.

They also told me that Blue Shield did not approve the Prolia shot to help prevent osteoporosis. Instead they approved me to have an intravenous dose of Zometa. This will help with my bone density since the hormone therapy can reduce my bone density by 10% – which I can’t afford to lose! The I.V. lasts 30 minutes which I will do at my next appointment on March 8th, the same day I get my 4th Lupron shot.

Every single thing to treat cancer has so many side effects.  They say the side effects are supposed to be better than dying!   As I have been told, it is a marathon I’m running, not a sprint.   cropped-favicon.jpg

1-15-2016/Hormone Therapy Update

I got a call from the doctors office.  My testosterone level came back under 20!  I am officially chemically castrated. As a man, that is a word you never want to hear but it is the way to beat this and live a long life.

Getting really tired everyday.  I have to start lifting weights to counteract the tiredness and bone density loss.  That is hard to do when the bed calls me louder than the weights.  I also am just getting over a cold.  That made working out impossible.

On the good side, my PSA came back as 0.89! (The growing cancer is what produces the higher psa levels) That is great news as it means the hormone therapy is working to keep the cancer growing slowly so it doesn’t spread.  Getting ready to zap it with high dose radiation in a few weeks at UCLA.

I thank my wife, business partners, family and friends for their support during this treatment phase.  cropped-favicon.jpg