LDR Brachy, here I come...

And the journey continues…
AL righty then, some might have followed my adt/Casodex thread, followed by my IMRT post, so hopefully this will be my last thread. This one will be short and sweet, thinking positively here, in that I go in, 4 hours later I’m out, and on with my life I go, so to speak.
After being diagnosed in May and after my URO wanted to rip my prostate out, I contacted the leading RO in regards to brachytherapy in our area to see if LDR Brachy was a viable option.
And here we go…..
The first call with one of the nurses was very informative. She then pushed me to billing to see if Brachy would be covered before we went any further, and it was. One week later I was heading to the facility which is 45 mins away from my house.
My first thought, wow this place is really nice.
I had to fill out a whole bunch of forms before I arrived, then signed some more docs when I got there.
After 15 minutes of waiting I was then whisked away into an office by another nurse who took my picture, and asked me probably 100 questions.
Oh yeah, I sent every test to the facility the week before, so they pretty much had everything on me.
After all the questions, I waited about 5 minutes before the Dr. came in. He had already looked over all of my tests. Asked me all sorts of questions; explained Brachy, what he thought of all my tests, and what they all somewhat meant.
Off to another room I go where he performed a DRE..
Back into office two minutes later where he explained that it was unusual that he didn’t feel anything like he thought he would, based on the MRI findings and the biopsy.
He suggested that we send the biopsy reports to Epstein, which we did later on. In the meantime he then explained that he could do the Brachy as a single treatment, but based on my age, cores and what-not, he did not recommend it. Ugh I thought, because I had convinced myself that all I needed were seeds. Wrong!
But before he could perform the Brachy, he had to do a volume study.
Uh, what?
He explained it, but here’s a cut and paste job for anyone that wants to know what it is… A volume study is an ultrasound study of the prostate designed to help determine whether seed implantation is technically appropriate and is also used to plan the implant. It is a simple procedure which requires placing the ultrasound probe into the rectum and taking a series of pictures.
Simple, hmmmm maybe, fun, heck no! But of course I said, yes "let’s do it."
He had another nurse call to see if my insurance covered it. 15 minutes later she came back and said, yes.
We scheduled an appointment, but I asked if we could take care of it today since I’m here? Yep.
Had to wait 45 minutes and then the fun began.
The study was administered by two nurses, yep, two women, which is fine I guess, but a tad bit awkward, and here's why.
They make you change into a gown, that's the easy part. You then sit in a chair that has stirrups attached to the sides where they strap your legs in place. They put a towel over you ying-yang, thank god, and then the real fun starts.
Frist up, a catheter which I was not expecting. Never had one before, hopefully I never have to have one again. Okay when I have Brachy I’m pretty sure I will have one. UGH!
They then numb your back side with some lube, insert probe and start taking pictures. They press really hard in certain spots which isn’t comfortable at all.
Then the doc comes in, which was unexpected, and he apologized for the fun procedure, and made sure the right pictures were taken as he was pointing out things on the screen.
The whole process took about 20 minutes, and towards the end he said he could do Brachy, no problem.
I get cleaned up, back in the office we go.
The doc says it will take about 2 weeks for Epstein to get back and that maybe he will change the scores, but he pretty much doubted it. He then said what he thought I should do…….
If scores stay the same, take Casodex for one month making sure IMRT starts right after. Wait, what? He also said that I should do IMRT of the prostate bed. At that point I kind of went numb in the brain. I ask, *** is Casodex? He tells me and why he thinks I should take It., and immediately writes a prescription.
I of course ask all about why IMRT? He explains, but not to worry now, because maybe I will get lucky and not have to after Epstein takes a look.
We talked a lot more about Casodex, IMRT, Brachy, our cars, etc… And off I go home.
I’m really not one to worry, so the next 4 weeks were fine for me while I waited.
3 weeks later he called me and let me know that Epstein pretty much graded the biopsy the same, but also that he wanted to do genetic testing on me. He explained what it is and why, then said he would order it once his nurse finds out if it is covered, which it was.
A third part facility took care of that, two weeks later we get the scores.
After all of that, the Dr. Calls me and then tells me what he thought I should do. But also said it was up to me, and if I wanted to roll the dice, he would do just Brachy, but did not recommend it.
Since it was roughly 7 weeks since I was diagnosed, I spent a lot of that time researching IMRT, Brachy, Casodex, etc. So I took his advice,
I took Casodex for one month and ended it on the day I started IMRT. The RO that took care of the IMRT was one that he worked with years back.
A nurse from the facility that is doing the Brachy called me when I had two weeks left of IMRT asking me about my side effects, etc.. She scheduled an appointment for 3 weeks after my last IMRT treatment, but said that it was not written in stone. I just had to give her one week notice so they could cancel the seed order.
The dr. also called me that night, and asked me how everything was, and that it was my choice when I wanted to do the Brachy, but not to wait more than 6 weeks after IMRT.
Two weeks before the treatment a nurse calls me asking me if I wanted to move the appointed farther out, I say no let’s do it. She explains to stop taking any supplements, and gives me a run-down on the procedure. She says that I obviously need to take that day off, and it’s best to take a half day off the day before the procedure, more to come on that later.
She sends me an email explaining what I will need to do starting today, and all the way up to the procedure, stating that she will call again one week before seed implants.
She calls one week before, asking once again if I want to proceed, I say order seeds. She says to stop taking any form of aspirin if I take it, Tylenol is okay.
Once again she goes over how to prepare, and what the day will be like. She also stated that she will call the night before the procedure. Geeez, enough already.
Now the fun part she says, and this is all in the email I already received. I need to stop eating at 12 pm the day before the procedure, sticking to a liquid diet. I need to drink 10 oz. of Magnesium Citrate at 12pm and to stay close to a bathroom. Oh what fun this should be.
Last but not least, I need to do a fleet enema in the morning. Never had one, which should be grand at 5am.
Next up, Brachytherapy at 8am this coming Friday.
Hope I didn’t bore any of you.
Peace out.

good prep plan. You'll do fine.

Keep us updated.

Andrew

The volume study was the worst for me (biopsy, Lupron, IMRT, volume study, LDR). Your day before LDR is similar to what I had found when I searched before my procedure. However, at UCSD it was simply no food after midnight, water only, Fleet an hour before leaving house. Once they put you out, you will remember nothing. Catheter goes in after your out, at least for me, and was out before I came to in recovery.

Good luck -- you'll do fine.

Idog

Great detail in your last post. Similar to what I experienced except I didn't remember everything as well as you did!

Get well and hopefully your recovery will be as uneventful as your treatment.

Al

Figured I would give my one week update.
So reading back I think I missed a few things...
Drugs.. Besides the Flomax, they gave me antibiotics for 3 days and a form of prednisone (Medrol). I still have not taken the Flomax because I haven't needed it. I still drink anything I want with no issues, yet. Fingers crossed.
I questioned the use of Medrol because I haven't read about it being used after this procedure. Granted, I haven't really read much about the drugs prescribed after Brachy besides Flomax, etc. So I emailed them 4 days later and they came back saying that after doing these procedures for 20 plus years they have come to the conclusion that it helps the most after patients have had both IMRT and Brachy. This was interesting to know, and I have to admit, I'm pretty shocked right now that I'm really not having any urination problems. But only time will tell and I have Flomax waiting on the side lines.
The Medrol is used for 12 days and has really crappy side effects when you start it as its a steroid.
I stopped taking Tylenol on Monday.
For the first three nights I had night sweats from the anesthetics and all the drugs in my system, but those passed.
Today is the first day that at times when I move it hasn't felt like something was tugging in that area. It was a weird felling, that's for sure.
I'm still purple, which is a lovely sight, but the swelling is almost gone, and I think I will be able to start hitting the gym sometime at the end of next week. It's still sore some, but I no longer have a plan getting up and sitting down.
No problems with Bowels.
I stopped peeing a little blood yesterday, the nurse said that this can occur for a few weeks.
That's about it.
Peace out!

Dog: You bring back what are now, faint memories. I had so many of the same feelings and pains you are experiencing. You seem to have it well under control. My simple advice that worked for me is "walk"! Fake bowel movement feelings, groin pain, rectal discomfort, etc. were all manged and for the most part dissolved by walking them off in a relatively short period of time. Also, please read the SEs associated with Flomax! I really had more trouble with Flomax than I did with the LDR aftermath. Have faith in your therapy and exercise. I wish you well and please keep us posted.

Great summary Idog, enjoy Mexico

Time for a 30 day update.
Based on the half life of Brachy, my rudimentary guess is that the radiation from the seeds have decreased by 1/4. I know this isn't 100 percent correct, but close enough.
Sooooo... I still have not had the urge to take Flomax, and I'm guessing I will not have too.
I'm no longer purple or sore in the area at all.
In regards to peeing, it takes a tad more time to start, flow is not what it use to be, but once I get going it's fine. Nothing really to complain about.
My taste buds have recovered fully.
I no longer hate water.
I came back from Mexico 4 days ago and while I was there I went all out diet wise. What I mean is that I said, "screw it" I'm eating and drinking whatever I want. This still holds true through this weekend with Turkey day, etc. I will go back on diet later. Which really isn't a diet, just back to eating healthy again.
Some might have read my small freak-out in regards to weight loss. Well, when I came back from Mexico I frickn gained 7 lbs. Holy crap! So I'm pretty sure I don't have anything to worry about in regards to weight loss and it being something drastic.
But, if I want to eat like I have been doing this past 12 days, I now have to be very careful because my body does not like all that extra crap being consumed, and lets me know by making me head to the can, toot-sweet. I feel its a good thing, as it my body is basically telling me.. Stop putting that crap in me!
This also might have something to do with all the radiation, which we all know is the gift that keeps on giving.
I head back to my Brachy doc this coming Monday for a CT scan and a follow up.
P.S. One thing I have to write about is that Cancer sucks! My solder sister (retired nurse) called me up the day before turkey day and told me her BF, which is really her life partner, fainted two days earlier. After feeling like crap, they decided to take him to the ER the next day. Of course she made him as he said he was fine. Unfortunately the next day they diagnosed him with cancer of the esophagus and stomach. They will do a biopsy on Tuesday. Lets hope him fainting allowed the doctors to catch the cancer in time, because we all know how bad that cancer is. I have had two friends die of stomach cancer in their early 50's now.
Hope all had a good Turkey day
Peace out.