An Unexpected Procedural Change and Corresponding Concern

For the sake of emphasis and because of its relevance, I am including the following passage from my previous journal entry:

"When undergoing radiation for cancer, minor deviances produce major concerns. For a non-participant, it may be difficult to fully appreciate, but each unanticipated blip becomes a quality of life issue."

As the technologist escorted me to the dressing room one day last week, she advised me: "Today's treatment will take a little longer than usual, because of an adjustment to the beam aperture." "Less of the tissue surrounding the prostate will be radiated." What triggered this modification, I wondered? Had something shown up in the monitoring mechanisms that necessitated a change? Did the intestinal flareups indicate a need for a more focused approach? Had there been an error in the initial treatment plan that needed correcting? The technologist assured me (1)this was a preplanned change which occurs in about fifty percent of the patients she radiates and (2)the less collateral damage the better. Good reassuring information to be sure, but in my estimation ill-timed. I made a mental note to discuss this conundrum with Dr. Gud E. Nuff.

In my weekly discussion with the gud doctor I expressed my concern. To my surprise (dismay?) the doctor seemed unmoved. "It is a matter," he responded, "which the technologists are perfectly capable of handling." Perhaps so, I thought, but from my (patient's) perspective, there is room for improvement. In my humble opinion, the planned procedural change provides a golden opportunity for a meaningful doctor-patient dialog, preferably, early in the treatment process. I intend to address this issue in my exit interview.

More Blip, More Anxiety

When undergoing radiation for cancer, minor deviances produce major concerns. For a non-participant, it may be difficult to fully appreciate , but each unanticipated blip becomes a quality of life issue. My intestinal flare-up reemerged this past weekend. On Monday when removing the balloon the attending technologist advised me to consult my doctor because of the apparent rectal bleeding that had occurred. Rectal bleeding is never a good thing. As a proton therapy patient it is a potential calamity. Accordingly my case manager arranged for a consultation with the on-duty physician within minutes following my treatment. TALK ABOUT RESPONSIVENESS; ABSOLUTELY AMAZING.

In any event the attending physician, an extremely conscientious caretaker, after reviewing my record and asking a host of relevant questions concluded: (1) This particular intestinal disturbance was most likely caused by dietary indiscretion. * I had consumed two beers and several handfuls of peanuts on Friday evening and (2) the bleeding resulted from a combination of the intestinal disturbance and the normal irritation which accompanies the usage of the balloon. In his professional opinion radiation was not a significant factor, and in due time I would be just fine. From my perspective, I had dodged another bullet.

*A note on diet. During the active treatment period, i.e., a five day work week, proton patients are expected to avoid gas producing foods and beverages including carbonated beverages, leafy green vegetables, fiber etc. Fridays are supposedly "free days" when it is acceptable to return to your normal diet. Apparently I found an exception to the exception.

Progress Report

The gastrol-intestinal blip is substantially resolved. Dr. Gud E. Nuff appears to have been correct. The other really good news is I am half way through the treatment process. So far, so gud.

An Unanticipated Blip

Sixteen down, twenty-three to go. So far so very, very good. I have experienced a couple of minor side effects. The most disturbing symptom to date has been "intestinal turmoil" which under normal circumstances would generate little or no concern. Because I am in treatment, I suspected I may be reacting to radiation. Consequently, I felt a moderate degree of alarm. In addition I was concerned the intestinal disturbance which included the production of gas may adversely impact the treatment process. We prostate patients learn early on intestinal distress must be avoided.

In my last journal entry I discussed the various measures taken to immobilize the prostate. Intestinal gas has the opposite effect. It creates a moving target and undermines the treatment process. Because of my two-pronged concern, I consulted Dr. Gud E. Nuff. In his professional opinion these symptoms were neither caused by radiation nor were they affecting treatment. "Let's monitor the situation and go from there," he advised, which sounded both reasonable and reassuring. Its comforting to feel as if you are receiving gud care.