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.
Thursday, February 26, 2009
Thursday, February 19, 2009
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.
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.
Thursday, February 12, 2009
Friday, February 6, 2009
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.
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.
Friday, January 30, 2009
A Day at the Gantry
In proton vernacular the radiation treatment area is known as a gantry; it resembles the inside of a gigantic washing machine drum. It is roughly 12 feet in diameter and 10 feet deep; it is painted in hospital white. There are currently three such gantries at UFPTI. The gantry in which I am treated is staffed with seven technologists (three or four per shift) most of whom are attractive, super-friendly attentive young women. The one male staffer I have encountered is clean-cut and no less friendly or attentive. On our first meeting this young gentleman alluded to the church group of whom he is a member and with whom he interacted the prior weekend.
Extensive efforts are devoted to ensuring that a given patient is properly identified thereby guaranteeing he will receive the appropriate degree of radiation using the lens designed especially for his treatment. Likewise extensive efforts are made to properly align the patient and his prostate.
A typical day in the barrel -like drum occurs as follows:
---The patient arrives thirty minutes early and dutifully empties his bladder. On cue from a technologist he consumes 15 ounces of water.
---A technologist escorts the patient to a small dressing room. The patient exchanges his street clothes for a hospital gown which is as you might expect open in the back and in this case for good reason.
---When summoned the patient takes a fifty-yard stroll down a hall to the treatment area. A gantry crew member scans the patient's identification tag and has him confirm his identity by reviewing three computer screens each with his printed name and one of which displays his recent photograph.
---The patient mounts the gurney and positions himself in the body cast designed during his three day workup for the purpose of properly aligning and immobilizing the lower portion of his body. Gantry staff make minor adjustments to the patient's positioning as needed based on laser technology.
---The prostrate per se is properly positioned and immobilized by the introduction of a measured amount of liquid infused by one of the technologists directly into the patients rectum or within the confines of an elongated, well-lubricated elastic balloon. This procedure is the most emotionally and physically discomforting aspect of treatment. I am not sure how the crew decides who will carry out this task. I do know the administering technologist changes from day to day. Perhaps its a democratic rotation. Conceivably its the short straw method. Then again it may be the way in which my sister and I decided who's turn it was to do the dishes when we were children. This process consisted of a potentially endless debate of "it's yourturn," "no it's your turn" until we reached some sort of trade off compromise or the ultimate arbiter in the matter, our mother, decided whose turn it was indeed.
---With the push of a button a technologist rotates the automated gurney into the washer drum portion of the gantry.
---Xray machines roll out, one on the side, one from the top, for a final check on the alignment of the patient's prostrate. The beam zeros in on four gold marker's inserted in the patient's prostrate during his three day workup.
---When all systems are go the proton beam is unleashed on its cancerous target. There is no sound or sensation to signal its operation. The patient knows he is being radiated when the gantry crew quietly leaves the area. In a matter of minutes the crew returns. The treatment officially ends when the balloon is removed and/or a technologist assists the patient with his dismount from the gurney.
---A return stroll down the hall, a visit to the bathroom and redressing completes the process.
Although the treatment plan varies from person to person, typically prostate cancer patients undergo 39 such treatments on consecutive workdays.
In proton vernacular the radiation treatment area is known as a gantry; it resembles the inside of a gigantic washing machine drum. It is roughly 12 feet in diameter and 10 feet deep; it is painted in hospital white. There are currently three such gantries at UFPTI. The gantry in which I am treated is staffed with seven technologists (three or four per shift) most of whom are attractive, super-friendly attentive young women. The one male staffer I have encountered is clean-cut and no less friendly or attentive. On our first meeting this young gentleman alluded to the church group of whom he is a member and with whom he interacted the prior weekend.
Extensive efforts are devoted to ensuring that a given patient is properly identified thereby guaranteeing he will receive the appropriate degree of radiation using the lens designed especially for his treatment. Likewise extensive efforts are made to properly align the patient and his prostate.
A typical day in the barrel -like drum occurs as follows:
---The patient arrives thirty minutes early and dutifully empties his bladder. On cue from a technologist he consumes 15 ounces of water.
---A technologist escorts the patient to a small dressing room. The patient exchanges his street clothes for a hospital gown which is as you might expect open in the back and in this case for good reason.
---When summoned the patient takes a fifty-yard stroll down a hall to the treatment area. A gantry crew member scans the patient's identification tag and has him confirm his identity by reviewing three computer screens each with his printed name and one of which displays his recent photograph.
---The patient mounts the gurney and positions himself in the body cast designed during his three day workup for the purpose of properly aligning and immobilizing the lower portion of his body. Gantry staff make minor adjustments to the patient's positioning as needed based on laser technology.
---The prostrate per se is properly positioned and immobilized by the introduction of a measured amount of liquid infused by one of the technologists directly into the patients rectum or within the confines of an elongated, well-lubricated elastic balloon. This procedure is the most emotionally and physically discomforting aspect of treatment. I am not sure how the crew decides who will carry out this task. I do know the administering technologist changes from day to day. Perhaps its a democratic rotation. Conceivably its the short straw method. Then again it may be the way in which my sister and I decided who's turn it was to do the dishes when we were children. This process consisted of a potentially endless debate of "it's yourturn," "no it's your turn" until we reached some sort of trade off compromise or the ultimate arbiter in the matter, our mother, decided whose turn it was indeed.
---With the push of a button a technologist rotates the automated gurney into the washer drum portion of the gantry.
---Xray machines roll out, one on the side, one from the top, for a final check on the alignment of the patient's prostrate. The beam zeros in on four gold marker's inserted in the patient's prostrate during his three day workup.
---When all systems are go the proton beam is unleashed on its cancerous target. There is no sound or sensation to signal its operation. The patient knows he is being radiated when the gantry crew quietly leaves the area. In a matter of minutes the crew returns. The treatment officially ends when the balloon is removed and/or a technologist assists the patient with his dismount from the gurney.
---A return stroll down the hall, a visit to the bathroom and redressing completes the process.
Although the treatment plan varies from person to person, typically prostate cancer patients undergo 39 such treatments on consecutive workdays.
Friday, January 23, 2009
Prognosis
A physician by the name of Dr. Gud E.Nuff oversees my treatment at UFPTI. He is a radiation oncologist with over 15 years of experience. Dr. Gud E. Nuff's calm, cool, confident and somewhat laid-back demeanor belies the enormous responsibility he shoulders for ensuring the medical well-being of the patients under his care.
Based on the results of the battery of diagnostic tests administered in conjunction with my three day workup, Dr. Gud E. Nuff developed my treatment plan. Currently we meet weekly to discuss my progress. On the three occasions we have met I have managed to focus our discussions on what to expect in the way of outcome over the long term. Here is what I learned; in each of the areas which all prostate cancer patients share a particular concern:
CURE RATE
Cure is indicated by low-normal PSA readings and the absence of any biological indications of cancer. Dr. Gud E. Nuff estimated my chances of this type of outcome were in the 85 to 90% range.
IMPOTENCE
Dr.Gud E. Nuff is a glass full kind of guy. He talks in terms of potency not impotence. He advised me not to expect an improvement on this parameter. On the other hand, he reassured me I could expect to leave the treatment center with about the same degree of potency that, "I brought to the table."
BLADDER CONTROL/INCONTINENCE
"The likelihood of a problem in this respect," Dr. Gud E. Nuff opined, "are negligible, almost zero."
BOWEL/INTESTINE COMPLICATION
"The chance of a problem in this respect," Dr. Gud E.Nuff estimated, "are less than 8%."
In my estimation I am in gud hands with good prospects.
A physician by the name of Dr. Gud E.Nuff oversees my treatment at UFPTI. He is a radiation oncologist with over 15 years of experience. Dr. Gud E. Nuff's calm, cool, confident and somewhat laid-back demeanor belies the enormous responsibility he shoulders for ensuring the medical well-being of the patients under his care.
Based on the results of the battery of diagnostic tests administered in conjunction with my three day workup, Dr. Gud E. Nuff developed my treatment plan. Currently we meet weekly to discuss my progress. On the three occasions we have met I have managed to focus our discussions on what to expect in the way of outcome over the long term. Here is what I learned; in each of the areas which all prostate cancer patients share a particular concern:
CURE RATE
Cure is indicated by low-normal PSA readings and the absence of any biological indications of cancer. Dr. Gud E. Nuff estimated my chances of this type of outcome were in the 85 to 90% range.
IMPOTENCE
Dr.Gud E. Nuff is a glass full kind of guy. He talks in terms of potency not impotence. He advised me not to expect an improvement on this parameter. On the other hand, he reassured me I could expect to leave the treatment center with about the same degree of potency that, "I brought to the table."
BLADDER CONTROL/INCONTINENCE
"The likelihood of a problem in this respect," Dr. Gud E. Nuff opined, "are negligible, almost zero."
BOWEL/INTESTINE COMPLICATION
"The chance of a problem in this respect," Dr. Gud E.Nuff estimated, "are less than 8%."
In my estimation I am in gud hands with good prospects.
Friday, January 16, 2009
Treatment Begins
Good news: (1) the diagnostic tests alluded to earlier have been confirmed negative which means the cancer is limited to my prostate, and (2) my treatment has begun. The UFPTI program included a tour of the facility, consequently, I knew what to expect. The initial treatment proceeded flawlessly. My emotional reaction to the procedure, however, caught me by surprise. I experienced a mixture of gratitude, fear, concern and amazement. Underlying these emotions was the knowledge that cutting edge science, modern medical technology and a sophisticated team of highly trained physicians, nurses and support staff had been assembled, in part, to treat a 72 year old man's cancerous prostate in an effort to salvage what remains of his quality of life. A somewhat melancholy and extremely humbling experience for which I am deeply grateful.
The remainder of this journal will be devoted to the treatment process. I will address outcome expectations (prognosis) and side effects as they materialize.
Good news: (1) the diagnostic tests alluded to earlier have been confirmed negative which means the cancer is limited to my prostate, and (2) my treatment has begun. The UFPTI program included a tour of the facility, consequently, I knew what to expect. The initial treatment proceeded flawlessly. My emotional reaction to the procedure, however, caught me by surprise. I experienced a mixture of gratitude, fear, concern and amazement. Underlying these emotions was the knowledge that cutting edge science, modern medical technology and a sophisticated team of highly trained physicians, nurses and support staff had been assembled, in part, to treat a 72 year old man's cancerous prostate in an effort to salvage what remains of his quality of life. A somewhat melancholy and extremely humbling experience for which I am deeply grateful.
The remainder of this journal will be devoted to the treatment process. I will address outcome expectations (prognosis) and side effects as they materialize.
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