This newsletter is for the express purpose of entertaining and educating
of my immediate male relatives and friends. The information provided is
believed to be accurate but it is always wise to check with your own doctor(s).
| Next
Newsletter | Back to Ranger BoB |
Day 42 – The last day!
Day 41 – One day to go!
Sixteenth IMRT session. Met with Glover and nurse afterwards for "discharge"
instruction – keep doing what I am doing – all should be "normal"
in 2 to 4 weeks. I see Glover in two weeks.
Rode to the college and back via PG.
Day 40
Fifteenth IMRT session. No readjustment today, just calibration brays
and treatment. Two more treatments to go!!
Rode to the college and back via PG. Climbing out of the saddle.
Day 39
Standard IMRT session. After treatment met with Cathy and Glover. Same
questions: diarrhea - no, bleeding - no, energy level - very slight decrease,
barely noticeable. Inspection of radiated area - no problems. Radiation
proctitis still there but slowly improving. Weight 180.3
Walked with BB in the AM. Rode to college and back through PG.
Day 38
The last week of treatments! Doug was back from vacation today. The time
in the treatment suite is about 20 minutes.
Rode to the college and back through PG today. Still feeling great!
Day 37
Twelfth IMRT boost session. Eric assisted Connie today. Five treatments
to go!
No exercise today – went to visit eldest son and family. Proctitis continues, sometimes very slight.
Day 36
Eleventh IMRT boost session. Getting to be a very routine procedure: measure,
readjust my position, treat. Julie helped Connie today. Six treatments
to go!
Rode to the college and back via PG. Radiation proctitis is stable at about a 2 or 3 on a scale of 1 to 10. Slept on ear. Students noticed that ear and nose are healed.
Day 35
Tenth IMRT boost session. Measure, readjust my position, treat.
Walked with BB in the AM and rode to college and back through PG and my favorite bike shop. Feeling great.
Day 34
Ninth IMRT boost session. Measure, readjust my position, treat.
Walked with BB in the AM and rode to college and back through PG.
Met with Glover today. Nothing unusual to report. Some fatigue in the afternoon but worked till midnight on DVD project. Weight 179.0
Day 33
Eighth IMRT boost session. Amie helped Connie today. Measure, readjust
my position, treat.
Rode to the college and back via PG.
Felt like taking a nap this afternoon, but after an apple instead. Then almost faded while watching British Antique Road Show but got my second wind and worked on a video project.
Day 32
Seventh IMRT boost session. Just 25 minutes. Position, measure, treat,
no adjustments required today. Susie from the treatment suite next door
assisted Connie today. Ten treatments to go!
Did floor exercises today. Going to SF and SJ to visit grandsons today and tomorrow. Feeling great!
Day 31
Sixth IMRT boost session. Doug is on vacation so the team of Connie and
Julie did the work. Measure, then adjust, then treat.
Saw Dr. Brad Tamler today (Glover is off this week). He explained that
what I had was not just 3D conformal treatment but "small field"
3D conformal. Small field 3d
conformal is also CT scan "guided" (planned) and together
with IMRT boost they provide the best results without prostate stabilization (read balloon up the rectum – which some centers claim further reduces side effects). Weight 178.3
No exercise today – just plain slothful – did some house plumbing repair instead. Feeling fine. Fun in class. Proctitis continues to improve. Nose healed!! Ear coming along.
Day 30
Fifth IMRT in the "boost" phase. Doug is leaving for 10 days
of vacation! Julie came by to check out my nose and ear. Both areas improving!
Dressed and went to visit Eric and Dave in dosimetery. Dave's workstation (computer) screen is on the right. It contains a summary of my prostate radiation dose planning data/images. To see close ups of several of these views, click on the image or here.
Rode to the college and back home via PG. Fog or rain coming in from the southwest.
Day 29
Fourth IMRT session. Seemed to go faster today, but maybe I am just getting
used to the program. On the right is a little diagram of the number of
clicks (not actually seconds) at each of the five angles from which I
am getting radiation. This is very imprecise but gives a rough approximation
of what is happening during each session.
Rode
to the college and back via PG so I could do errands in PG. Beautiful
warm day. Feeling good. Proctitis slowly subsiding. Nose and ear scabs
slowly disappearing.
Day 28
Third IMRT session. Took a while longer today. When they took the calibrating
images they found I was 2mm out of position. So the moved me and fired
away.
After the session, Eric met me and took me in to meet Dave, the dosimetry
expert. Dave gave me a tour of my internal anatomy and the outline of
the treatment area. They map
the radiation intensity over the anatomy. Reading what look
like contour lines, one can see how the intensity tapers off as you get outside the primary target area, the prostate. In addition they can control intensity on a pixel by pixel level within the target area to provide the desired dose to the parts of the organ that most need it. I hope to get some pictures later in the week.
Day 27
Second IMRT session. They took pictures (x-rays) at 90 degrees and zero
degrees – first through the radiation aperture and then the full
field to get the surrounding anatomy.
No exercise today – to many errands. Rode to the college and back around the point yesterday. Saturday rode to
Marina and met BB at the deli (12.5 miles in 55 minutes), beautiful weather!
Friday another incident with blood on the toilet tissue and a fair amount of burning – probably due to very spicy chili dip before dinner. No problems on Saturday.
Day 26
First IMRT session. IMRT (Intensity Modulated Radiation Treatment) is
a complex system of involving more computer control of the radiation intensity
and location or field.
Each day they will take x-rays to calibrate me to the system. The radiation is then applied from 5 different angles which were computed based on my body geometry and prostate configuration. I didn't get the exact angles but they seemed to be about zero (straight on from the front), from 80 degrees left and right and from 160 degrees left and right. The radiation periods at each position are longer than before because the radiation intensity and field at each angle are modulated during the treatment. To give you an idea of what is happening during the treatment at each of the five angles, click on the picture of the field monitor on the right.
The little slide show on the right is made up of 6 snap shots of the field monitor in Command Center taken by Eric during one of my five treatments today. Thank you Eric!!
 |
As you can see, the green shape (treatment area) is moved and
shaped dynamically during each treatment to apply more radiation
in some areas than others. Also the maximum field is more closely
tailored to the prostate. Fun stuff! I will provide more info as
I learn more |
Day 25
Last 3D conformal treatement! Begin IMRT tomorrow. I am 60% complete,
timewise. 17 IMRT treatments to go!
Rode to college and home around Pt. Pinos. Windy! But feeling great and a beautiful day. Went to PC group and heard very comphrensive talk on ED and lots of remedies.
Day 24
Standard rad routine today. Doug and Connie want me to come earlier beginning
Thursday, that's when we begin the IMRT Boost Phase! It will take longer
to apply.
Weekly visit with Glover. He looked at the nose, inside and out, and ear. Healing is progressing. Developing scabs on both nose and ear. Discussed my radiaition proctitis. He prescribed Anucort-HC suppositories. Began using them in the PM (to be used 2x daily.)
Glover discussed the pros and cons of rectal balloon during IMRT. Stanford is not using them. My particular geometry does not appear to need the balloon, so we will not use it. The IMRT will use 5 angles (instead of 6, because of hip replacement.)
No exercise today, too many errands and got flu shot. Took first nap since beginning radiation.
Day 23
Standard radiation routine.
Rode to the college and back via PG to do errands.
Blood on toilet tissue today. Anal fissure may be back. Consulted with Cathy.
Day 22
Three more days of the current standard program. Doug says that the IMRT
routine with be different in that they will be applying radiation from
more angles. IMRT should start on day 26. Ear and nose getting very scabby.
Went to SF this afternoon to ride in the tenth anniversary of Critical Mass and attend the SF symphony. I have ridden with Wiley in many Critical Masses over the years, including the London Critical Mass.
And while participating in Critical Mass and listening to Mahler's 3rd symphony I became critically aware of my increasing urinary frequency. During Part II of the 3rd symphony I had to go and left during a loud section. As I went into the men's room a well dressed gent exited saying "Mahler requires uncommon continence, which I don't have!"
Day 21
The standard, prostate routine goes fast.
Taking Carafate and radiation proctitis very slowly abating. Dose may not have been full 10cc - got new measuring cup.
Rode to the college and back today. Town bike rolls really well after maintenance! Finished next week's Monterey Views tape.
Day 20
Standard prostate rad today. From home to CHOMP and
back was 25 minutes, including talking to Cathy about drug interactions
(Warfrin and Carafate - none).
BB and I walked today. Very cloudy/foggy, bay calm. Drove to the college and bike shop. Picked up town bike, needed
crank bearings due to lots of use and no maintenance 
Asked class if they wondered what was going on with the nose and ear. They were! Explained the cancer and radiation. Chris (student) says "Your a walking ad for sun screen."
Day 19
This was calibration x-ray and "doctor day." Prostate cancer
rad only today – ear and nose complete and showing it 
After radiation I met with nurse Cathy and Dr. Glover. I let them know
I was having pain with bowel movements but otherwise all was going fine.
Glover prescribed Carafate, an ulcer med. Turns out it will coat the rectum and relieve the irritation from the radiation.
Cathy will supply a "sitz bath" tomorrow for additional relief for my "transom problem" (radiation proctitis).
Then it was off to have blood drawn for INR/PT.
We walked this AM, beautiful morning on the bay. No bike today, its getting a thorough lube job.
Day 18
Last treatment for the ear! The upper rim (where the cancer is) is quite
tender if one hits it with a comb, very red and starting to peel in spots.
Otherwise, not a problem. Eric did the last treatment as Julie was engaged
with a new patient. Standard routine for the prostate.
Seven treatments left before IMRT begins.
Rode to the college and back to my favorite bike shop, where I left my town bike for maintenance.
Day 17
Doug and Connie were backed up so Julie did the ear first, then back to
the main event and a standard prostate treatment.
I dressed and then took photos in the 
.
I was up early and rode my usual circuit around Point Pinos before radiation today. Still feeling good!
On Saturday, September 21, I participated in the San Luis Obispo Bicycle Club's Lighthouse Century. More on this ride soon – but I rode 67.4 miles in 4 hours and 40 minutes.
Day 16
Last treatment for the nose! Unless Glover examines it and decides more
are required Otherwise,
a standard day for treatments. Two more to go for the ear.
After my "superficial" treatments Julie and Eric asked me about the pix of the prostate treatment room. That led to them asking if I would take pictures of the sim room and maybe some other areas – so, coming soon, a virtual tour of the cancer center.
BB and I walked this AM. Wow, classic beautiful fall morning in Monterey, wind calm, bay placid, very pleasant. Get outside!
Rode to the college and after class back around Point Pinos to home. Feeling great, climbing well.
I am now experiencing some anal burning during and for a few minutes after a bowel movement.
Day 15
Standard routing plus x-rays from the front and left side for calibration
check. Doug says this to be done once a week (it usually has been on Monday).
When they do the pictures a special glass plate goes on the front of the
x-ray head. This plate contains a grid to assist them in taking measurements.
Went out early to get pictures of the visiting cruise ship but visibility was and is about 200 feet as it is very foggy in Monterey today. Later I rode to the college and home via Point Pinos. The fog cleared in time for the ride home so I took pictures of our visitor (the cruise ship).
Day 14
Standard routine, well almost. Julie was busy doing a sim on a new patient
so Eric (head tech) filled in and did her "superficial patient."
The work on my nose and ear are considered superficial radiation. I am
sure my nose and ear don't think its superficial.
Then it was on to a conference with Glover. He looked at the nose and says "it looks the way it should" (bright red in the rad area with some scaling). The ear is also quite red. Neither is very sore or tender, but starting to itch. The nose bleeds at the drop of a hard blow. Glover says to continue to use the saline nose spray and Vaseline."It will get better!" he says.
I reported that the only plumbing related problem is occasional itchy anus. He says warm baths will help. It is
not really much of a problem, just a minor irritation and only occasional.
We also talked diet. Bottom line, since we are restricted by BB's problems, I should eat what I want and if and when diarrhea appears it can be easily controlled.
He then inspected my skin in the prostate radiation areas and pronounced that all was well.
Walked with BB today. No riding as I had to go to CHOMP right after my class. Paul and George and I did a facility check for our PC group meeting with Dr. Mark Moyad. That meeting will be held in the CHOMP auditorium.
Day 13
Standard routine - 25 minutes at the hospital today.
Three days to go on the nose. Its getting pretty red. I have had several nose bleeds from blowing too energetically.
Rode to and from the college including errands in PG. Still feeling great
and the plumbing seems to holding its own.
Day 12Julie checked my records and the nose ends next Thursday, day 16 (ear and nose started on day 2) and ear ends the following Monday, day 18.
No exercise today :-( combination of lazy, mucho errands, and a "Broadcast News" day (I turned in next week's program at 4:59 PM today.
Still feeling fine, all systems nominal!
Go to | yesterday | tomorrow
| Top |
Day 11
Standard routine. Takes about 45 minutes from the
time I leave home till I am back home.
I am working with some very experienced folks. Doug has been to doing his job for 30 years! When not working he is a
Shields sailor out of MBYC (Monterey that is). Connie has 10 years on the job. Nothing like working with pros!
Walked with BB this AM. Rode to the college and home via Point Pinos. Sunny in Monterey, overcast in Pacific Grove.
Day 10
Standard routine. We are about one quarter of the way there with the prostate
(total of 42 treatments) and 2/3 there for the nose (15 treatments).
Chatted with a Lisa, dietitian, today about trying to mesh Barbara's low potassium/protein diet with the soft/low residue
radiation diet (to which I am not yet adhering). Looks like there is not much of a match.
Barbara and I walked early this AM and I rode to and from the college. Still feeling great.
Day 9
Standard routine (14 clicks of radiation front, 12 back and 10 from
each side) with the addition of x-rays from the back and right side
to check alignment, and on to the ear and nose.
Conferred with doctor Glover and nurse Cathy. Everything going smoothly. Nose beginning to show color and ridges in rad area - ear, no signs - plumbing function normal.
Walked with BB this AM. Took car in for service and rode to college and back. Feeling good!
Had a bit of a nose bleed on the right side yesterday evening. Took a while to stop, probably because of the blood thinners I am taking.
The boost will be 17 treatments. Thus my last prostate treatment will be October 25, the Friday before we go off daylight savings time. Party time!
Day 8
Half way there on the nose and ear!
Standard routine – rad prostate area then ear and nose.
I was up early and went riding around Point Pinos. Such a beautiful blue day! Feeling stronger on the hills on the way home. Lupron wearing off, I suppose.
This was
another topic that came up yesterday in my conference with the doctor
and last week with the nurse. Here again, controversy. Some say, load
up on antioxidants to prevent damage by the radiation. But the
radiators are saying that too many antioxidants may interfere with the radiation's ability to kill the cancer.
So I went researching to see if I could find support or data that might support one or the other view. The CAM (Complimentary and Alternative Medicine) site supports the "don't load up" point of view. Also it looks like the speaker for our November group meeting also agrees. So in this case I am going to follow directions. I am holding my C at 500 mg and cutting E to 400 IU for the duration of radiation.
Day 7
Standard routine - rad prostate area then ear and nose. Takes about 15
minutes, total!
Today I had a conference with one of the radiation oncologists, not Glover – he is due back Monday. We reviewed the potential side effects, fatigue, and bowel problems. Out of this discussion and my questions came the following:
As an avid
cyclist the doc encouraged me to continue to exercise but to cut my distance
in half once the fatigue appears. It is most likely to appear about three
weeks into the program, just when I am to ride 60 miles of the SLO Lighthouse
ride. So, stay tuned.
Earlier
in the week I met with the nurse and we went over a Soft/Low Residue Diet.
This diet is designed to make life easy for the bowels. But there seems
to be two points of
view. (1) Do the diet; (2) Don't do the diet – changing ones diet
may cause more bowel problems than continuing on one's normal diet –
in our case, largely vegetarian (not necessarily soft (nuts and seeds)
or low residue (wheat bread, granola, and a number of veggies and fruits
are in this category). So for the time being I am continuing on our normal
diet. Time will tell
Finally, 
By starting with 3D conformal they can "flood" the pelvic region
(even though they use a prostate shaped mask for the radiation) and make
sure there are no cancer cells in the lymph nodes associated with the
prostate gland. 4500 rads in the area will take care of that problem.
Then using IMRT to pinpoint parts of the prostate with additional radiation
will insure that they kill the bugger.
Day 6
Standard routine – rad prostate area then ear and nose.
As promised, the picture on the right is Julie and the machine that is
used to treat my nose and ear (her left hand is moving, not deformed
As you can see, this machine is much smaller than the one used for the
prostate (click on the picture for a larger version).
My nose will receive 4500 rads in 15 sessions. My ear will receive 5100 rads in 17 sessions. Today was session 5 as the ear and nose started on day 2.
To the right, below Julie and her machine, is the ear set up. Notice the lead shield around the ear. Below is the nose setup. The blue gismos are lead plugs. Dig the lead shades!
Day 5
Getting to be a pretty standard routine: Doug ushers me in, Doug and Connie
position me, then the treatment (see Day 4), and I am on my way to see
Julie – except today, I took pictures
The picture on the right is the command and control center for the radiation area in which my prostate is treated. The screen on the right (green figure) is the display for the radiation beam mask. Its green because they are ready to shoot me from the front. The light area in the center of the green is the shape that will be radiated. The dark hood in the center of the counter covers a TV monitor in which the operator can view my every move.
Below is the radiation room and equipment. I lie down on the table (head to the left). The table slides to the left till my pelvic area is under the x-ray head. The table and I are moved into exact position so the beam coming through the mast hits the desired target. The x-ray head then rotates to
the next position, usually 180 degrees (6 o'clock) so that it can shoot
from the back side, then to 90 degrees left (3 o'clock in this view) and
then 90 degrees right (9 o'clock). Doug reappears and moves that table
back to this position and I am off to see Julie. You will see Juile and
her machine tomorrow.
After I dressed I met with Kathy, an RN assigned to go over the care and
feeding of me and my radiation areas. This took the better part of an
hour and was very informative. More details over the next few days.
Cycled to the college and back, including several errands. Feeling great!
Went to PC group meeting, good discussion about various treatment protocols
this evening.
Let me know if you have questions. Go to | yesterday | tomorrow | Top |
Day 4
Not much to report – very routine day, well almost.
The prostate rad went off as usual – first they took a film (x-ray) from the front to insure that the alignment was on target, then 14 "clicks" (flashes of the red "we are zapping you light", then 12 from the rear. Next a film from the left side, then 10 clicks of rad from the left followed by 10 clicks from the right.
On my way out I was met by Julie, the tech that did my prostate set up. She had been on vacation when I started the nose and ear and will take over from Eric.
She went carefully and thoroughly through the ear set up and did the treatment. Then it was nose set up and treatment.
Tuesday was supposed to be the day when I conference with Glover. Sad news, his dad died over the week end so he will be gone for a while. More on this as it develops.
Cycled to the college and back home. Still feeling good, maybe a tad stronger
climbing hills on the bike.
Day 3
It beginning to feel like I know how to do this dance. Changing clothes
and the prostate radiation took less than 20 minutes from the time I arrived
until I was back in the waiting area looking for Eric (nose and ear rad
tech).
After a brief wait Eric arrived and we went to his vault. This was his first time through the whole process (Doug did the setup on the ear) so he was very careful to get the alignments right. All treatments completed and on the road after 55 minutes at CHOMP.
If you are dying to see the prostate radiation area and command center, you can visit any day while I am being positioned. Also, on Tuesday, I will take pictures of the area and add them to this page. Now to answer questions that I have received:
Just Monday through Friday (not holidays) for 25 treatments or days for
the prostate. That will deliver 4500 rads to the
organ. Then we move into the IMRT boost phase till we deliver a total of 8000+ rads. More on this Tuesday after my weekly conference with Glover.
Intensity Modulated Radiation Treatment. This technique allows the application
of more rads to some parts of the radiation field (like the center of
each prostate lobe) which allows for a higher total dose with less damage/side
effects.
The following may occur, everyone responds differently: loss of
energy, increase in frequency of urination at night, and diarrhea. You
will know as soon as I do .
I still feel great! Rode to the PG PO and around Pt. Pinos, Asilomar and
home (7 miles, 45 minutes).
Day 2
I arrived at 8:10 AM. I was advised that I no longer needed to check in.
Each day I am to get undressed (waist down), put a gown on, and have a
seat in the waiting area. I following the directions and sure enough Doug
came out and lead me in promptly at 8:15.
Today I noticed that we walked past the command center on the way into the radiation room. The control center has several computer screens on the wall at eye level when standing. In front of them is an elevated counter (comfortable to write on while standing). Buried in the counter is a video monitor for the radiation area/room and other controls/keyboards.
It was into the rad area, on to the table, with a red laser line down the middle. Connie and Doug maneuvered me into position until Connie again pronounced my position "perfect."
Today it was about 10 seconds from the front, a nearly equal amount from the rear (under me), about half of that on each side (1080 rads total).
On my way out I asked Doug about one of the displays in the command center. Turned out that his answer would prepare me to respond to Wiley's question about something in yesterday's diary regarding sound:
What do you mean, SMALL NOISES? (Wiley wrote) like a screw loose in a
transmission kinda sound or small noises like 'click' on-off.
The noises were clicks and short whirrs -- there are a bunch of "leaves" inside the x-ray head that move in and out of the radiation field - they are lined up in two columns, down the sides of the x-ray aperture. They are moved in toward the center to form a mask in the shape and size of the area to be treated. The x-rays go through the unmasked area in
the center and not through the mask. Leaf positioning is computer controlled and individualized to the patient's anatomy. On a screen in the command area they formed a small heart shape, with the bottom tip slightly skewed to one side - the shape of my prostate.
Doug was aware that I was scheduled to be set up to do a spot on the tip
of my left ear and another spot on the right side of my nose – skin
cancers. He had paged Glover in an effort to get the work done so I wouldn't
have to return in a couple of hours.
For this process we moved into a very different environment. Cream colored room, no decoration, and big heavy powered doors – very vault like, small, and the machine looked well maintained but low tech.
After I was fitted with a lead shield around my ear, it took a while for Glover to compute the dosage. Then Glover guided the moving of my ear and the cone on the x-ray head (smaller than a dental x-ray head) into contact with my ear. Photos were taken so the set up can be replicated. Then the first treatment of 300 rads – no noise, no feeling, just hold still.
Eric, a new technician, arrived and took over for the nose portion of the set up and treatment. For this I get lead nose plugs and a lead eye shield. More photos and 80 rads.
Day two done. Back tomorrow. First prostate, then ear and nose.
I still feel great! Bike commuted to the college and back through Pacific
Grove. Now its out to dinner with the Renaissance Bike Club.
Today was THE day! The first day.
I arrived at the CHOMP Cancer Center at about 12:25 PM. I was told to change (remove all clothing below the waist and put on a gown – this is a wrap around affair with three arm holes – covers one well, no strings to tie).
Promptly at 12:30, Doug came out of the radiation area and introduced himself. I followed him into an indirectly lighted room, about 20 by 20 feet, with the x-ray machine the sole piece of furniture centered in this very pleasant space.
I was introduced to Connie and invited to lie on the narrow table. There were several red lasers and a couple of computer screens positioned around the room – slight space ship feeling. The ceiling was partially filled with a back lighted photo of a scene from Pebble Beach.
Motors whirred and I was positioned with my pelvic area under the x-ray head, a cylindrical shape about 30" in diameter with a square glass face about a foot square facing my body.
Connie and Doug pushed and rolled me gently aligning my tattoos with the lasers. At one point Connie exclaimed, "Perfect", to which I replied: "That's what I want to hear!"
The plan was to x-ray me with this machine and compare my body positioning with the set up x-rays to insure that the two match. Everyone left the room, except me, a buzzer sounded, a red light flashed on the wall across the room and the machine made a few small noises.
Connie returned to inform me that the new x-ray matched the setup, so they were going to do my treatment from the front. She then left the room. The x-ray head made a few more clicking noises (shutters moving into place to shape the beam). The buzzer sounded and the red light flashed for about 10 seconds. I felt nothing.
Connie returned and rotated the x-ray head 90 degrees to my left, now shooting across my body.
Same process, first an x-ray, confirmation that it matched the setup, then a treatment from the left – this one only about 5 seconds long.
The machine was then rotated 180 degrees so it was shooting for my right side. This time, just the 5 second treatment. Again, no sensation.
On questioning, Connie explained that I am getting a total of 180 rads per day. My guess is I got about 90 rads from the front and 45 from each side, but that's just a guess. More detail after I talk to Glover.
We will continue this process (minus the confirming x-rays) for 25 treatments (days) at which point I will have had 4500 rads. Then we go to IMRT "boost."
I feel great! I left the hospital at 12:55 PM and went right to my class
(starts at 1:10 PM) where the students and I carried on as if nothing
had happened. Go to | tomorrow
| Top |
| Back to the top |Previous Newsletter | Next Newsletter | Back to Ranger Bob |