External Beam Radiation Therapy

More than 15 years ago I consulted a wise old man, a homeopath,  He used iridology and said that my only problem was in my lower organs (i.e. my prostate). How right he was! He gave me homeopathic and herbal treatments but I didn't persevere with it. If I had taken more notice of him I would not have needed the hormone or radiation treatment I describe below.
I had a lot of complaints about the hormone treatment (Zoladek), but after the radiation treatments it was not so easy to say what treatment caused what side effects. I'd lost my comparison points.
In 2007 I consulted a naturopath operating out of the local chemist shop. He again used iridology, but he didn't seem as accurate as that original homeopath.

Thursday, 22 February 2007: They seemed very nice: Con had done the imaging back in December; Shona had helped him (she disappeared again until near the end of treatment); Daniel was supportive, but didn't follow through; Belinda, I could have fallen in love with her once, very sweet; and Karen, a Chinese Australian, whom I would come to know as bubbly and fun. The problem was that they kept changing.
I was given an appointments card on that first day with my first week of daily appointments filled in. The plan was that I should go to the Appointments Clerk each day and hand in my card. She would note my appointment a week ahead, plus make any other changes. This clerk introduced me to a nurse who ran through the process of what was to happen. She gave me a tube of Sorbolene cream saying that the radiation would eventually burn my skin, like sunburn. She also warned me that eventually I wouldn't be able to use the bus, but didn't say why. Incontinence? What?
I was then taken to the Waiting Room in suite 2, which is on the third floor, which is really the ground floor. The nurse told the radiology staff that I had arrived, and I waited. More measurements were made and I was told to come back for treatment the next day.
I had a lot of waiting over the six weeks of treatment. I read a lot of books in that waiting room: part-read Vogler's The Writer's Journey; read David Lodge's Nice Work, read William Chapman's second book What lies did I say?, and started reading Chapman's Small World.
3pm appointment Friday, 23 February 2007: Radiology staff relaxed before the weekend, ready to go home, hoping to get an "early minute", excited questions "What've you got on?"
Abba played loudly in the treatment room. I joked that this was not the best music to stay still by. I was scared to move for fear they would radiate the wrong spot. They did ask my preferred music.
When I arrived I was instructed to undo my trousers and push my underpants down, then climb on to this bed (or platform) in the centre of the room. But I could leave my boots on. On the table I had to push my trousers and underpants further down and pull my shirt up (best to have it already partly unbuttoned). Rest hands on my chest. They then do their measurements, marked me all over, and turned on the machine which lit up the areas to be targeted.
A light and burring noise told me when the radiation was working. The machine slowly moved round me to do the fours spots, beaming down each time. The side opposite the radiating beam had a big flat x-ray. This was later removed.
Mobiles don't work in the room (lead sealed?). Staff leave the room before the radiation begins. Often different people come back to clean up and bring in the next person.
The buses were great for going into the hospital - enough time for me to go for fruit and vegetables to juice - part of my fight back. Despite my original good intentions I only walked home a couple of times. Mostly caught the bus as fatigue set in - more waiting time, more reading.
Tuesday, 27 February 2007: Feeling a bit uncomfortable after the 9am radiation.
Wednesday, 28 February 2007: 4.10pm radiation and then back to the waiting room to wait for Prof Y or his proxy. This time it was Dr Jo, another Asian registrar, who was sure he'd met me before. I assured him I hadn't and I missed Wan.
I complained about the urgency and frequency of my need to go to the toilet and my tiredness. I also asked if I needed to delay my next hormone injection given the resulting small size of my prostate and the problem this might cause for my brachytherapy. He didn't think I needed to delay the injection but said that he'd find out.
Friday, 2 March 2007: 10.20 radiation. More questioning about my weekend. I decided to talk about my anxiety-ridden adventures with Saturday dog training classes for my wife's out of control German Shepherd. That provided an endless supply of stories.
Wednesday, 7 March 2007: 3.20pm radiation and then back to the waiting room for appointment with Prof Y. I actually saw Prof Y who said that there was no point in delaying the hormone injections because the shrinking of the prostate occurs in the first few months of medication. He did a rectal check and said the prostate was flatter on one side. He joked that I would not tolerate him doing that in a couple more weeks of radiation.
That night I felt like I'd been through a wringer.
Friday, 9 March 2007: 2.40pm radiation. Plenty of time time to meet with Karen and Travel Agent in the morning to finalise arrangements for our Pacific cruise.
Monday, 12 March 2007: A public holiday. Good to have a nice long break of three days from the radiation.
Tuesday, 13 march 2007: 8.20am radiation appointment. Missed the 7.43am local bus. Walked down to the main road but none of the buses there stopped. They were all full. I walked into the city at a frantic pace but I did not arrive until 9am. Traffic was heavy because of crowds and blocked streets for the Clipsal car race. I worried. I could not afford to stuff this up. I tried to phone ahead but no one answered in radiology. When I finally got there I was told it was okay.
Wednesday, 14 march 2007: 2.40pm radiation. I again saw Dr Jo. He gave me tablets to stop the gastric but advised against them because they made it painful to poo. The nurse had previously given me a useful sheet on foods to avoid - no more breakfast cereal for awhile.
But I've not made it to the toilet a couple of times at home. I just had to cough and something comes out. My bowels had become an area of preoccupation. I now had to plan ahead regarding toilet locations if I was going out.
Monday, 19 March 2007: Gastric now really bad. Daniel asked if I'd seen the nutritionist, but I replied that he hadn't arranged the appointment as he said he would.
Tuesday, 20 March 2007: 11.30am radiation. Radiology staff all changing again. Problem finally fixed with the machine. Very simple technical issue, but meant there were no longer the delays up til now. Sometimes I'm now seen early.
Wednesday, 21 March 2007: 2.40pm radiation. Also saw prof Y. I explained I only took my first anti-gastric tablet today. I didn't want an accident while on the table with a lot of young women attendants. I told Prof Y I trusted him and felt that I was in good hands. This pleased him.
That night I felt relieved. This was a new feeling. I thought I had turned a corner and the cancer was being beaten, broken.
Monday, 26 march 2007: 11.40 radiation. I was getting sore down there. Prof Y said that the radiation irritated the organs and bowel lining. He said that the white stuff that I was shitting was mucous.
Wednesday, 28 March 2007: 2.00pm radiation. My last visit with Prof Y before the brachytherapy. Even he was confused when the radiology would finish because of the public holiday. A good thing the appointment system appeared to work. He said that I might see my private urologist Dr W at the hospital - three months about with him (or his proxy). I love Prof Y and said that I didn't want to lose him. (Actually I said that I didn't mind whom I went to for treatment.)
Friday, 30 March 2007: 2:00pm radiation. Made appointment with GP for my next Zoladek injection - no way out of that.
Monday, 2 April 2007: A big day. Pre-op preparation at 8.30am, and then radiology at 12pm.
Had to wait as usual - various stages to go through. See the clerk - sit down - see the nurse - basic checks - see the anaesthetist (he didn't know if it was to be a general or spinal?), says he probably wont be my anaesthetist on the day. The anaesthetist talked about the robot that would be delivering my treatment - now used for a lot of cancers (e.g., throat and lung) - where ever can be got to easily.
Given information on preparing for admission - 2 enemas the night before, 2 enemas in the morning. Ring the day before to find out when to go in. Saw a registrar who did a general check then up to another level of the hospital for an EEG - all good. Didn't take long. Said that I was very healthy. Hah!
Tuesday, 3 April 2007: 12pm radiation. Final. Got a little badge from the Anti-Cancer Foundation. Thanked everyone, Fed up with it but there'll be parts I'll miss. 

The slow process of getting treatment

I was not prepared for what happened after my diagnosis of prostate cancer. I took time to realize the reality of having an aggressive cancer. Then there was the frustration of repeated tests, endless interviews, and lack of treatment. The way I dealt with my frustration around September 2006 was to get angry. My belief that the establishment is self-serving really came to the fore with respect to the medical industry. (I realize that this distrust of authority is a theme in a lot of my writing.) Fortunately I was also doing some major work at home at the time, mainly around building a new fence, which involved a lot of physical labour and frustration with contractors with whom I could legitimately get angry without dire consequences.  Monday, 11 September: Unscheduled appointment with Dr Y arranged by Dr Wan, who phoned me to tell me to come in. Dr Wan had instructed me that Dr Y's correct title is Assistant Professor.
Prof Y made clear that there was still doubt about my being accepted into the brachytherapy program, usually reserved for men with a Gleason score of 7 to 8. My Gleason score was 9, the highest obtainable. Nice to think I finally excelled in something.
Prof Y corrected me on my pronunciation of Dr Wan's name, and told me he had tried and failed to get my MRI appointment brought forward. I also tried and could only get it brought forward a day, but just before my original (now next) appointment with Prof Y on the 20th.
I'm not sure why Prof Y wanted to see me early. Maybe he needed to decide if there was a point in proceeding with the brachytherapy or he needed a subject for one of his students. He gave me the most thorough internal examination of my prostate I'd had so far, feeling it from every angle. He had an attractive young blonde student doctor with him and invited her to have a feel. At least she said for me to tell her if she hurt. She made a rhythmic tapping on the cheek of my bum while she prodded around inside - I could not understand why, and it didn't seem appropriate to ask. I can't deny there was a certain amount of pleasure with her examination, perhaps especially after the rougher handling of Prof Y. Later we made forced conversation while Prof Y made phone calls and whatever in the adjoining room.
I was supposed to see Prof Y at 12:20pm, but saw him an hour later. I was dismissed at 3pm. A nurse commented that he was very thorough but not very good at keeping time.
I was handed over to another nurse for a blood test  for the infamous PSA, though the nurse had to finish her afternoon tea, and there was some talk about it being too late in the day. I found out from my GP that the result of this PSA test was 26 compared with my original test at 16.9 in June. My GP suggested that it could have been abnormally high because it followed Prof Y's aggressive examination.
I walked home and next day loaded a skip with cement and other rubbish and worried about the erection of my new fence ever happening.
9am Monday, 18 September 2006: Appointment for the volume estimation test - volume of the prostate. Around 10am the doctor arrived but they had the wrong machine - ultrasound. Another delay was they did not have my file. This had to be couried from Urology - another hour or two. The doctor complained that they could have done the test in Urology.
While I waited by myself in a small room I noticed a lot of nurses, including friendly nurse from my earlier visit and two Malaysian nurses wandering around observing. They wore the full Islamic headgear. I took off my clothes and was put in a gown and waited.
When it came to the examination I had quite an audience, including the Malaysian nurses. Friendly nurse had to tell them to stop looking (gaping) at my exposed bottom with the probe coming out of it and look at the image of my prostate on the monitor. I was given prints of the images to add to my collection.
11:45am, 19 September 2006: Appointment for an MRI of my pelvis at St Andrews Private Hospital. I had a lot of tooing and froing over this between the MRI people and my private insurer, Health Partners. Private insurance wouldn't pay (Dr Wan and Prof Y thought it would) because there was no associated Medicare number. It didn't matter if I was an inpatient or outpatient. The cost was around $500. Eventually the health Partners representative said she would agree to their making an exgratia payment. She was sympathetic and said she would take it up with the Commonwealth government as a gap in the system. I realized that I was probably saving thousands of dollars having the HDR (high dose radiation) brachytherapy public at the RAH.
I remember having difficulty keeping still as I was rolled into the MRI machine. The process seemed to take forever but I had enough time to go home for some lunch and keep an appointment at 3:45 pm with the skin specialist, Dr Ly, to cut out a couple of suspicious growths on my arms. The referral to her had been my original reason for seeing the GP and led to the identification of prostate cancer.
I just had time to meet good friend and cousin Andrew at the Hilton Hotel at 5:30pm. Andrew had his own battle with a brain tumour and was a useful diversion and very supportive. He had been in Adelaide to give a presentation and stayed with us for one night.
3:30pm Wednesday, 20 September 2006: After going back to the private hospital to collect my MRI scans and report as instructed, I finally had my scheduled appointment with Prof Y. Andrew waited with me until 4:15pm (Prof Y running last) but then had to catch a taxi to the airport.
Prof Y asked to keep all my test results, scans et cetera. I wonder if they ended up as a teaching aid with medical students. Dr W had said that I should keep all my results, and joked that the hospital would only lose them. He said he would get my GP to give me injections of Zoladek, a hormone treatment, and suggested that I see Dr B the following week.
At my first interview Prof Y stated that I should be on hormone treatment for 3 years. (Dr W had earlier said it was possible I could go on hormone treatment for 6 months.) My father had been prepared to have his gonads removed rather than go on hormone treatment, and I was a little apprehensive. Prof Y said there might be a compromise, that the three year treatment recommendation had been from a study that only combined with external beam radiation, which I was having high dose brachytherapy as well.
Prof Y did not think it had been established that natural therapies were of any use, except perhaps for cooked tomatoes. He smiled as he told me that these had been found useful in a study with rats. He also warned that some studies of anti-oxidants showed that they decreased the effects of radiotherapy.
Prof Y tried to reassure me at the end of our interview by saying, "We'll give you our best shot". I left feeling depressed over this statement, perhaps I was hoping for more. He also gave me another referral for a blood test for PSA. This had to be dated the 1 December because medicare only allows for one test in every three months.
4pm Thursday, 21 September 2006: Appointment with Dr B, GP. I asked about the injection (hormone treatment) but he still had not had the referral from Prof Y, and arranged another appointment for the following week. But he had a lot of other reports, for example, the PSA reading of 26. I was also able to ask about my other results from my check-up back in June - the PSA had then dominated everything else. I had a low blood count but a follow-up test showed that was clear. He also said my good cholesterol levels were too low. I asked about having a colon/bowel check-up but he said "no" unless I had some indication of a problem. "Anyway let's get through this first." Dr B suggested that I phone ahead to see if the script was ready for me to get the injection.
Thursday, 28 September 2006: Phoned GP's surgery. The nurse said she'd ask Dr B and phoned back for me to go in. Dr B called me in early. He had sought advice from Dr W about correct injection timetables (Prof Y had left flexible) - decided on three months. He also had to phone authorities in Canberra to write a script for Zoladek.
Dr B said he could not give an injection that day. I had to take tablets for a week beforehand and then a week after. At first Zoladek had a paradoxical effect, that is it actually increased the production of testosterone at first.
Friday, 29 September 2006: The chemist suggested that I come back for cheaper generic tablets. Another delay.
2pm Thursday, 5 October: Dr B took me to the clinic area near the kitchen to give me the injection in the stomach of the slow release medication. A short interview - he did not appear to want to talk.
The medication took time to take effect. I could still get an erection and ejaculate for the first few weeks.