Quick Update

Today, I went to my doctor for my first Proton Radiation follow-up visit. I went a couple months early but wanted to get an idea of what my PSA score was. The last time it was check in July, it was 2.6. I got into my appointment pretty quick but waited for over an hour for the doctor to come in. We chatted for a few minutes before she snapped on her rubber glove. I looked like a deer caught in a car's head lights. I told her we really did not have to do this. She said if we didn't then, she would only be doing half her job. Anyway, she did end up doing a digital exam. Then, another lady came in and took some blood and gave me a flue shot. I asked when I should get the results. She said they should call me on Monday with the results.

Joke For Today

Rush Limbaugh's Chauffeur

Rush Limbaugh and his chauffeur were out driving in the country and accidentally hit and killed a pig that had wandered out on a country road.
Limbaugh told the chauffeur to drive up to the farm and apologize to the farmer.

They drove up to the farm, the chauffeur got out and knocked on the front door and was let in. He was in there for what seemed hours. When he came out, Limbaugh was confused about why his employee had been there so long.

"Well, first the farmer shook my hand, then he offered me a beer, then his wife brought me some cookies, and his daughter showered me with kisses," explained the driver.

"What did you tell the farmer?" Limbaugh asked.

The chauffeur replied, "I told him that I was Rush Limbaugh's driver and I'd just killed the pig."

Brief Update

Well, I have finished up three weeks back at work. Whew! The good news is that I only have a little over three weeks left to work this year. My last day of work is November 18. Then, I will be on vacation the rest of the year! Yeah!

Things have changed at Jill's House. Ed finished up his treatments a couple weeks ago and seems to be experiencing EXTREME Bloomington withdrawals. (Ed - I know what you are going through!) Loyd finished up his treatments last week and flew back home this last Friday. I am sure he is glad to be back home with Winney!

I ordered over 100 photos of Jill's House which I had sent to Bloomington. Sam's Club was a little slow and so I ended up with two orders of prints so there should be plenty of pictures to go around.

I am hoping to get a doctor's appointment this Friday even though my first official appointment is not supposed to be until January. They have some same day afternoon appointments on Friday and so I plan on calling in Friday morning to try to get an afternoon appointment. I thought it would be nice to get some early good news!

I guess that is about it other than some personal issues I am dealing with. I am not sure what I am going to do with all my free time starting in November. Maybe I will take up knitting. :-)

PROSTATE CANCER FAQs

Well, here is my attempt at documenting some for life’s many questions at least in the area of Prostate Cancer Proton Radiation Treatments here at MPRI.
Prostate Cancer FAQs (For Mature Audiences Only!)
(Disclaimer – None of this information is based on sound, basic medical information. So, read this at your own risk! I hope you enjoy the information below!)

FAQ 1 - What is the prostate organ; who has one; what does it do; can I live with it?

The prostate is a male organ whose main function is to store and secrete a clear, slightly alkaline seminal fluid that, along with spermatozoa, constitutes semen. The rest of the seminal fluid is produced by the two seminal vesicles. If the prostate is removed or “killed”, then the associated seminal fluid is not produced. So, the prostate is not a critical life sustaining organ which in only found in males. See http://en.wikipedia.org/wiki/Prostate for more details.

The other important thing about the prostate is that the urethra vessel travels though the middle of the prostate gland which carried urine to be eliminated from the body. When the prostate is enlarged, irritated, or cancerous, the flow of urine can be constrained. Also, during proton radiation treatment, the flow of urine through the prostate can be effected. This may be reflected in several ways: 1. More frequent urination; 2. a restricted flow; 3. Inability to fully empty the bladder. The urine flow and the seminal flow cannot occur at the same time. You can think of this like two trains approaching a draw bridges merging onto a single road. If the urine drawbridge is down, the seminal drawbridge has to be up and vice versa.

A Personal Story – When I had my prostate biopsy, an older man who lead my men’s small group Bible study asked me if there was any history of prostate cancer in my family. I told him that my Mom and grandmother never had it, so I should be in good shape! Unfortunately, it did not run out that way. BUT God is still good.


FAQ 2 - What makes Proton Radiation different from other prostate cancer treatments?

I have been told that there is no statistically proven difference between the different treatments for prostate cancer. However, I think most Proton Radiation patients would disagree. So, the main thing you need to consider is the side effects. There are three main goals when treating prostate cancer. The first concerning is saving your life, i.e., killing all the cancer cells. The other two main concerns (the priority will differ from person to person depending on their age and other individual preference) are: retaining sexual functionality and retaining bladder control. I think some other approaches may statistically have better results in these areas but I am very confident in putting my money on the Proton Radiation treatments.

This reminds me of a joke. George and Loyd (two old guys) were sitting around eating breakfast at Jill’s House one morning. Loyd was telling George that every day he takes 1/8th of a tablet of Viagra. George (thinking Loyd was just being cheap) asked Loyd, “What good does it do to take that small a dose of Viagra? Loyd says, “It keeps me from pissing on my shoes!”

FAQ 3 - What is involved in the basic proton radiation pre-treatment process?

The proton radiation process is individualized for each person (man). A special 3-D mold of the individual’s prostate is made from detailed x-rays which are taken after the initial consultation. A plastic body cast is also created from a body mold that is also taken during the initial preparation time (normally the two weeks occurring right after your decision to have proton radiation treatments). In most cases, you will also get your gold seed implanted at or around the same time your body cast mold is measured. The gold seed is used to provide the ability to location a constant, unchanging spot within your body so that the proton radiation treatments can be applied effectively and accurately.

FAQ 4 - What is involved in the daily pre-treatment proton radiation process?

The specifics of the daily pre-treatment proton radiation process activities can vary from person to person. For me, I am supposed to drink 16 ounces of fluids one hour before I have my treatment. Again, the amount of fluid and the time may vary for person to person but the basic process is the same. The reason for drinking the water is so that the bladder / kidneys are filled with water and drop down some away from the prostate and the associated treatment area.

Another pre-treatment daily activity (immediately before the treatment) is what we affectionately refer to as our daily “balloon ride”. This process involves the insertion of a balloon into the rectum and then filled up with three gallons of water (actually I think it is filled with 70 cc of “contrast”). This process (sometimes painful) servers several purposes: (1) – It pushes the prostate up and away from the rectum (more on this in a minute). (2) – It provides contrast to help get better x-rays which are taken daily in positing the patient for receiving of the proton radiation.

Note on rectal burning - One MAJOR goal of the use of the balloon is to prevent rectal burning or irritation of the rectal area. This is commonly associated with extreme rectal pain and occasional bleeding. (See FAQ on this topic below.)

NOTE: Most of us have probably experienced some minor rectal irritation AFTER a late night run to Taco Bell!


FAQ 5 - What is involved in the basic proton radiation process?

The proton radiation treatment process is very different from the normal radiation. Proton radiation, unlike normal radiation, can be directly to affect a very limited area instead of all of the cells in the path of the radiation beam. That is the reason why so much care and detail is put into the design and creation of your prostate 3-D metal molds. The molds are each individually designed to the contour of your prostate. There are two molds - one created to the contour of each half of your prostate. When the beam is applied, it comes through the mold and is transmitted in the 3-D shape of your prostate. This is an effort to insure that only the necessary prostate cells are treated.

At first, the entire prostate, plus approximately ½ of the exterior of the prostate is treated. This is to insure that all of the cancer cells are killed including those that may be external to the prostate.

FAQ 6 – How is my process being monitored?

Your progress will be monitored by your doctor. After your first full week of treatments, you will have a regularly scheduled weekly meeting with your doctor. Each of the three treatment rooms are assigned one day of the week to be doctor day. The focus of this meeting will be to monitor / discuss any side effects you might be experiencing. You should let the doctor know immediately if you are having any trouble especially with rectal pain or bleeding. At the end of your treatment, your doctor will also have a “final” consultation. This “final” consultation may occur during your normal last weekly doctor’s consultation. Your doctor may suggest you come back to Bloomington for a 6 -12 month checkup. In general, this is not required. MPRI does want you to report your 3, 6, 9, and 12-month PSA scores to them.

FAQ 7 – How many treatments do I get and what exactly is involved?

In general, all prostate cancer patients get 44 treatments. The treatments are administered daily, Monday through Friday, 5 treatments per week. The treatments are administered through the hip area. One treatment is administered through one hip and then the second treatment is administered through the other hip. The patients are positioned via CT scans which use the golden seed for positioning. Each proton radiation treatment lasts from 30-60 seconds each. Since the proton radiation treatments are applied exactly from the same position every day, this causes a reddening of the skin in the hip area of the treatment site.

FAQ 8 – How many treatment rooms are there at MPRI and are they all the same? How does MPRI compare with other Proton Radiation Treatment facilities?

There are three treatment rooms at MPRI (Room 3, Room 2, and Room 1). The first room you come to is Room 3 which was the last room “built” at MPRI. Due to that fact, there are some minor subtle differences between Room 3 and Room 2. Both Room 3 and Room 2 have the rotating beams. This means the table and patience do not move but the proton beam rotates 180 degrees. In Room 1 (the original treatment room), the proton radiation beam is fixed, i.e., does not move. In this room, the table and patient rotate 180 degrees instead of the radiation beam.

The Bloomington MPRI facility is one of the more recently developed proton radiation locations and so most of the equipment is more advanced than other areas. Loma Linda, one of the most popular sites, has technology and processes which area very different than those at Bloomington. For example, instead of using the plastic casing used at MPRI, Loma Linda uses a full body plastic pod which the patient lies in when taking their treatment.

FAQ 9 - Are there any specific foods I should not be eating?

In general, nuts should be avoided as they can cause rectal / stomach irritation which can be severe. There may also be an issue with popcorn hulls. The sensitivity of this area may increase after each proton radiation treatment. There also has been some discussion about not drinking beer during this treatment time. I think I have heard that you should not be taking any anti-oxidants during this time. Consult your doctor for specifics for each of these areas.

FAQ 10 - Are there specific activities I should avoid? (Oh, guys, this is not what you think!)

One common activity that is mentioned as something to avoid is bike riding. I think the idea here is that with the new, daily traffic in the rectal area, they want to avoid any possible irritation of this site. So, bike at your own risk.

FAQ 11 - What are the most common side effects that I might have?

Some possible side effects he mentioned were:

1. Skin redness
2. Bladder Irritation
3. Sterilization (he mentioned this was a certainty)
4. Rectal Irritation / Bleeding
5. Urinary pain
6. Impotence
7. Incontinence
8. Bladder contraction
9. Colon irritation
10. Constipation

FAQ 12 – What do I do if I experience any side effects?

If you experience any side effects which are causing you any discomfort, please consult your doctor ASAP. The goal of your weekly doctor’s meeting is to monitor any side effects you have and to address ANY discomfort you have immedicately. The most common side effect is rectal discomfort. The general prescription for this is some soothing ointment or procto-form. In most cases, the ointment ($10) will take care of your minor discomfort.

FAQ 13 - How do I tell if my proton radiation treatments are really working?

In general, during the proton radiation treatments, there is no way to check on the effectiveness of your treatments. The most that is done is that the doctor monitors your treatments for side effects only. The proton radiation treatments disrupt the make-up of the cancer cells. Once the cancer cell tries to grow and divide, it is not “healthy” enough to divide into two cells and therefore dies. The normal cells are healthy enough to divide normally. The dying off of the cancer cells may take up to a year or so. This is the reason for the 3, 6, 9, and 12 month digital prostate exams and blood tests to determine your PSA level. Gradually, you should see your PSA ratings go down below one and eventually down to close to zero in some cases.

FAQ 14 - Is the whole prostate treated with each of the two different proton radiation treatment applications?

Each proton radiation treatment consists of two individual treatments; one applied via each hip. Even though each application is applied using a different treatment mold, the whole prostate is being treated by each individual treatment.

FAQ 15 - Is the rectum being treated?

As noted above, during the first 28 treatments, your prostate and the surrounding ½” is being treated via the proton treatment. If you look at the diagram of the prostate area, you will notice that the back of the prostate is adjacent to the rectum. Depending on the position of our prostate to your rectum, a different percentage of your rectal area may be treated by the proton therapy. Your doctor can provide you exact details on what areas of your rectum is being treated (in color photos).

FAQ 16 - What is “cone-down” day?

“Cone-down” day is the day of your 29th treatment. Be prepared to be on the table for at least an extra 30 minutes. A special technician will be in the room to help calibrate the proton beam for the “Cone-down” setup. “Cone-down” day is the first day when your proton radiation treatment is reduced to only treat the prostate itself and not the surrounding ½” area. After “cone-down” day, you may see the red path on your hips shrink down into a smaller “circular” area.

FAQ 17 – What special opportunities are offered to MPRI patients?

There as several different opportunities provided to MPRI patients. One popular benefit is the freezer at MPRI. The freezer is located in the children’s play area and is often stocked with free food for MPRI folks especially those staying at Jill’s House. The freezer gets restocked at least once monthly so check it out. MPRI also offers a free YMCA membership. The best workout does not need to start at 5 a.m. Smoking Jacks Rib Shack used to offer free meals on Monday evenings but that has been eliminated. However, they still offer half price meals for seniors (those 55 and older) and that price is very hard to beat so try it out.

FAQ 18 – What are some places I need to see while in Bloomington?

1. Upland Brewing Company at 350 West Eleventh Street
2. Lennie’s Restaurant
3. Smokin’ Jack’s Rib Shack
4. Bowling Alley – just ½ block north (of Jill’s House) on Walnut Street on the right hand side of the street. They have $1 drafts on Tuesday and Thursday and $1.50 bowling on Mondays through Thursday.


FAQ 19 - Where should I stay if I am getting proton radiation treatments at MPRI in Bloomington, Indiana?

As far as I am concerned, there is only one place to stay in Bloomington where receiving proton radiation treatments and that is at Jill’s House. The staff and volunteers are great and the resident community is wonderful. Of course, all of that will be changing over the next week, as the last of the old residents migrate out of Jill’s House and back into the daily grind of our normal lives.

As we readjust to our old “normal” lives, I think there is one thing that we can all be sure of:

OUR LIVES WILL NEVER BE THE SAME!

On a personal note: As my last treatment day approaches, I just want to take this opportunity to says thanks to all the staff and residents of Jill’s House (past and present), the MPRI personnel, and those folks living in the Bloomington area. You have touched my life in a very special way and I will NEVER be the same. May God Bless You All! - KDS


Joke of the Day

String Theory

A string walks into a bar with a few friends and orders a beer. The bartender says, "I'm sorry, but we don't serve strings here."

The string walks away a little upset and sits down with his friends. A few minutes later he goes back to the bar and orders a beer. The bartender, looking a little exasperated, says, "I'm sorry, we don't serve strings here."

So the string goes back to his table. Then he gets an idea. He ties himself in a loop and messes up the top of his hair. Then he walks back up to the bar and orders a beer.

The bartender squints at him and says, "Hey, aren't you a string?"

And the string says, "Nope, I'm a frayed knot."

Joke Of For Today

THE IRISH DIET

An Irishman was terribly overweight, so his doctor put him on a diet.

'I want you to eat regularly for 2 days, then skip a day, and repeat this procedure for 2 weeks. The next time I see you, you should have lost at least 5 pounds.

When the Irishman returned, he shocked the doctor by having lost nearly 60lbs!

'Why, that's amazing!' the doctor said, 'Did you follow my instructions?

The Irishman nodded. 'I'll tell you though, by goodness, I t'aut I were going to drop dead on dat 3rd day.

'From the hunger, you mean?' asked the doctor?

'No, from the flippin' skippin' .

Life – Not On The Road

Friday, October 10, 2008

Well, it is Friday afternoon in St. Louis and life for me is back to normal – almost! I have finished my first full week up back at work. However, I am still having Bloomington withdrawals and I think about Bloomington and Jill’s House all the time. Pretty soon most of the folks I know at Jill’s House will be back to their own lives again and that will be kind of sad. That will really put an end to this chapter of my life. But I will still have some special friends there at Jill’s House with the staff and volunteers.

Scripture: (Psalms 37:3-7)

Psa 37:3-7 Trust in the LORD, and do good; dwell in the land and befriend faithfulness. Delight yourself in the LORD, and he will give you the desires of your heart. Commit your way to the LORD; trust in him, and he will act. He will bring forth your righteousness as the light, and your justice as the noonday. Be still before the LORD and wait patiently for him; fret not yourself over the one who prospers in his way, over the man who carries out evil devices!

Joke For Today

Monkey Balls

A guy walks into a bar with his pet monkey. He orders a drink and while he's enjoying it, the monkey jumps all around the place. The monkey grabs some olives off the bar and eats them. Then he grabs some sliced limes and eats them. Then he jumps onto the pool table, grabs one of the billiard balls, sticks it in his mouth, and to everyone's amazement, he somehow swallows it whole.

The bartender screams at the guy, "Did you see what your monkey did?"

The guy says, "No, what?"

"He just ate the cue ball off my pool table - whole!"

"Yeah, that doesn't surprise me," replies the guy. "He eats everything in sight, the little bastard. Sorry. I'll pay for everything."

The man finishes his drink, pays his bill, pays for the stuff the monkey ate and leaves.

Two weeks later, he's in the bar again, and his pet monkey is with him. He orders a drink and the monkey starts running around the bar again. While the man is finishing his drink, the monkey finds a maraschino cherry on the bar. He grabs it, sticks it up his butt, pulls it out and eats it. The bartender is disgusted.

"Did you see what your monkey did now?" he asks.

"No, what?" replies the guy.

"Well, he stuck a maraschino cherry up his butt, pulled it out, and ate it!" says the bartender.

"Yeah, that doesn't surprise me," replies the guy. "He still eats everything in sight but ever since he swallowed that cue ball, he measures everything first."