Taking Charge of Your Health

I went to the doctor to have a check – a prostate check and I took the blood sample and I had a high PSA appointments were made for me here at Oxford where I’ve had the gold implants inserted gold marker (fiducial) seeds are implanted into the prostate they’re about the size of a grain of rice so they’re very small and put in with a the little injection Gold is very dense it shows up very well on our x-rays and allows us to be able to see that so by matching to our gold markers that we can see we know we are exactly where we want to be treating within 2 millimeters about 3 to 4 days before a patient comes for their first planning CT scan the patient needs to start getting themselves really well hydrated we recommend they start drinking about 2 liters of fluid every day this can be water juice decaffeinated teas or herbal teas we would advise them to reduce how much caffeine and alcohol they are starting to drink as this will cause them to be more dehydrated this will help them throughout the treatment as well whenever a patient has treatment either the CT scan or the radiotherapy treatment they need to have the full bladder and bowel preparation the patient should arrive an hour before every one of their appointments You come in on the first day with your letter you stop at the reception desk and report that you’ve arrived they issue you with a card you check yourself in and they know that you’ve arrived the bladder and bowel preparation is the same every time you have an enema the micro enema has a little cap that needs to be removed they then need to insert it into the back passage and squeeze it like a tube of toothpaste if they can then hold the tube while they remove it otherwise the gel will get sucked back into the tube some patients do react quicker to micro enema than others we recommend that they try to hold for 10 to 15 minutes but if it works quicker for that patient they can go to the toilet and release themselves as needed after that they need to drink four cups of water and wait for thirty minutes before their CT scan they also need to do this for the radiotherapy appointments the idea there is that you empty your bowel and you fill your bladder and this is helpful by lifting parts of the body away from the prostate so that when they give the radiotherapy it hits the prostate and not other parts if patients find they desperately need to go to the bathroom they should come and speak to a member of the radiotherapy team we do need them to have a full bladder for their CT scan or their radiotherapy appointment so if they had to go to the bathroom we’d have to start the whole procedure again and they’d have to drink some more water if you can’t wait then obviously you have to go because sometimes the machines are running late and then what you have to do as soon as you’ve gone is notify them that this has happened and drink more water as they’re running late they can probably move somebody forward a little bit and you’ll take their place later down the line when the patient arrives for their CT procedure they need to arrive an hour before their appointment time at this point they will see a radiotherapist who will discuss with them what they need to do when you arrive for your pretreatment scan if you just come to the reception and they’ll check you in and let the radiographers know you’ve arrived they’ll talk a bit about what’s going to happen that day and they’ll also give you a chance to ask any questions that you might have thought of since seeing the doctor it’s not a diagnostic scan we’re not looking for anything the point of the scan is to see all your insides so we can plan your treatment the bed you lie on is quite hard you’ll have a cushion under your head under your knees and under your feet these will stay the same every day for your treatment they are used to replicate your position if you’re uncomfortable let us know because there are some things we can do but we need to know before you have your scan after the CT scan you’ll be given some permanent radiotherapy tattoo dots they are very tiny you might not be able to see them but they’ll definitely be there the tattoos shouldn’t hurt you’ll just feel the sharp scratch while they are being done on the CT scans where they check the implants and put your tattoos on they also do an ultrasound on your bladder to make sure that your bladder is actually full while they’re doing it we use the tattoo dots in the treatment rooms we have some lasers that come out of the wall which we use to put the center of the lasers in line with your tattoo dots and this is so we know we’re treating the right area before we deliver a radiotherapy treatment the patient will have an x-ray taken that allows us to be able to match the patient’s position with their CT scans patient’s position for each day’s treatment and it allows us then to compare the two positions for the gold (fiducial) seeds and the difference between them allows us to adjust for that position each day as you enter into the treatment room we will be asking you to confirm your name and date of birth this is because we want to make sure that we are taking the right patient through and also we want to verify we are holding the right paperwork in our hand we ask you to remove your shoes and your trousers you are absolutely fine to wear anything on your top we ask you to leave your underpants on if you are wearing a metal belt we can’t see the fiducial markers (gold seeds) where we want to focus on that’s the reason we don’t want any metal part in that region you lay on the table pull your underpants down to just a decent level lift your shirt up and they then manoeuvre you on the table to line up on the XY axis and the center lines to get your body in the same position every time for when you have your treatment once you lie down on the bed what you need to do is you need to keep still but breathe normally during your positioning as well as your treatment you don’t need to hold your breath for this particular treatment it’s all mechanical it’s very smooth you’re raised up into the air and you hardly even know its moving you know you you’re lying on the bed and you somebody speaks at your ear you look to the side the nurses head is level with you so you’ve gone up in the air but you don’t really feel it or I don’t feel it even moving you’ll be hearing us reading some numbers ignore the numbers again this is a technical number we are reading from your paperwork basically from the marker we are moving the couch or the bed to where we want to treat they explain what they’re doing they’re lining you up on your tattoo marks some arms that come out on the machine that are like x-ray arms they take an x-ray or a picture of where you are and if they have to adjust the bed for the machine and your implants then the bed will adjust itself I can’t feel anything you can hear a few buzzes and noises you need to be in the treatment position for approximately 15 minutes however the actual treatment will last approximately two minutes this treatment it’s absolutely painless treatment you won’t feel or sense anything you may hear some buzzing noise as the treatment get delivered apart from that you will not notice anything the treatment time as well as treatment dose remain exactly the same throughout the course of your treatment there is no change in that one so from day one to end of your treatment same amount of treatment dose as well as the same amount of treatment time will be taken the radiographer doesn’t stay in the room they all leave the room they press the last man out button that gives a siren warning and they all leave and they don’t return till the treatments finished if you’re uncomfortable you can’t something’s not quite right you can raise your arm and they can see you on camera and they will stop the treatment and come back in after treatment you’re not going to be radioactive so you’re absolutely fine to move continue your social life and you can spend time with your family we’d like to see patients about midway through their treatment to discuss any side effects or symptoms that might be occurring and we also like to see you at the end of your radiotherapy to talk about what to expect following your treatment and discuss any symptoms or side effects we often give patients a pre appointment questionnaire which identifies any toxicities might which might be occurring during the treatment the radiographer may give you this the day before and then we’ll discuss any concerns that are highlighted you do get a questionnaire which is a tick-box questionnaire and yes she ran through all the how I was feeling how my bladder was my Bowel have I got any problems etc which I discussed with her the common side effects from radiotherapy treatment of the prostate can include altered bowel habits you might be more loose or constipated you might also experience sensitive bladder with urine symptoms of frequency urgency or stinging or burning your skin might feel more sensitive in the radiotherapy treatment area we recommend you use a basic moisturizer you may notice that you feel quite tired and fatigued during your radiotherapy treatments we do advise that you take rest as needed and plan your activities around your energy levels if you’re experiencing blood in your urine or unable to pass urine or extreme pain we need to know immediately so that we can help you these symptoms are quite uncommon but if you let us know of any concerns or symptoms we can give you advice basically everything has worked out as the oncologist described to me how the treatment would be how long it would take the number of weeks it would go on for everybody really is kind and treats you really well you feel like you’re in good hands the system runs very smoothly and no problems whatsoever my tip is just carry on as normal do whatever you normally do

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