Day Two of radiation treatment. Questions about diet, gas, exercise.

The important thing is reproducibility between the simulation (initial CT scan) and the treatment. During the simulation, they no doubt made sure the rectum was empty (that is standard) so and enema is a good way to do that.

I "shopped around" at 4 different hospitals and these were protocols for 2 of them:
→ enema 2 hours before at home (these are unpleasant!) , and then empty the bladder and drink 300ml water 1 hour before.

→ arrive at the hospital 1 hour before (they provide a laxative suppository) and then empty bladder and drink some water (forgot how much).

Some hospitals do not say to use an enema but personally I would anyway just to make sure the rectum is empty. I think microlax is not in the US but fleet is probably similar, a pharmacist can advise on what is best.

As for the technicians (nurses at my hospital) having a bad day, I had the same thoughts, but there is not much you an do about it except try to be as friendly as possible!
After a while I knew there was nothing to worry about, they were really professional and concerned about the patients welfare. Also with two it is less likely anyway.

💡A tip: each time ask if the bladder and bowel were OK, and if you should do anything differently. They will see that it is important to you and so will tend to make sure it is OK each time.

Exercise is good and given you have already a lot of experience with it, I think getting back into it gradually shouldn't be an issue even with treatment, personally I'd try it in your place as well. Without much Testosterone muscle building will be slow though.

For the filling the bladder part initially I oscillated between too much (very uncomfortable when in the MRLinac for an hour! ) to not enough (needing to swap my appointment with the person before me).

Even with the directions, my hydration was never consistent. In the end I drank more than enough and had quite a full bladder just before appointment time and let out enough to be comfortable for treatment (not so easy) in the toilet.

They are typically very punctual (I always asked if they had any delays).

This is all interesting. For my 20 rounds of SBRT to the prostate in spring 2022, the only rule was to arrive with a full bladder for each session. I had a brochure about which foods might cause me discomfort (none did at the time), but no rules about what I could eat or when, and no need for an enema or laxative.

Pretty much the same with me. Full bladder for each session. "Try" to empty bowels before treatment. Eliminate foods that cause gas (everything healthy). And I got the brochure.
But in my first consultation with doc, which just happens to occur every Wed which was after my very first session, he gave HIS recommendations on diet and exercise because I inquired.

When I was doing the 29 sessions of Proton Therapy at UFHPTI, I made sure to be drinking plenty of water, adding electrolytes, eating a low-gas diet, and taking a probiotic once or twice a day. I also made sure to have some Gas-X handy.

I find the probiotic prevents diarrhea from eating sketchy foods (while traveling or anywhere outside of the home). My probiotic of choice is Culturelle, ( has Lactobacillus rhamnosus GG) which you can buy at Costco, BJs, or Sams Club in 80 capsule packs (regularly on sale). My wife and I have been taking this probiotic for about 20 years now and my personal opinion is that it is a lifesaver (another story). I would never leave home without it.

I had the endorectal balloon before each treatment because the spacer gel was canceled during the insertion procedure. The daily protocol required you to have a bowel movement before treatment. It didn't seem to matter if this occurred minutes or hours prior to treatment.

I also made sure to take some magnesium daily to keep me "regular" with the bowel movements, as they discouraged multi-vitamins at all during treatment. I have found, especially living in Florida where you can perspire more and drink lots of water, that running low on electrolytes is easily done, so I watch for muscle cramps and take an electrolyte called Medi-Lyte, usually along with some salt (yes, the evil salt). This stops muscle cramping almost immediately and if you take it regularly as needed, prevents it. While consuming more water than usual during this treatment period, I found adding electrolytes was essential.

I remember driving back from Jacksonville on my way home and a couple hours in my fingers started cramping to where I couldn't grip the steering wheel. It was very painful and that had never occurred before - finger muscle cramping where my hands turned into painful, useless claws. I was low on salt and needed to stop and take some, which cured my claw syndrome almost immediately so now I carry some 1 gram Sodium Chloride tablets with me for emergencies. Your mileage may vary and you should consult your physician due to blood pressure monitoring, other health issues, etc.

The last thing I wanted was muscle cramping in my legs during the treatment when I'm trying to hold still. I never had to miss a treatment due to gas, empty bladder, diarrhea or otherwise. My Proton sessions consisted of showing up an hour ahead of time in case the gantry times were running early. A half hour before the gantry time, I would drain my bladder and then would drink 16 oz. of water. At Gantry time, changing into a gown and getting the treatment took all of 20-25 minutes, including the balloon (in and out).

Good luck.

Sounds like yoru doing the right things. I ate everything . While taking my 22 sessions of Salvage / External Beam Radiation ( EBRT) , I didnt have a huge appetite , but I ate everything at the Cancer Lodge ( which is free Hotel like accommodations at the Victoria Hospital area ) . There food was free and plentiful . The Chef I noticed used Organic foods so much and made things for certain types of cancer patients . He said he didnt have a specific for me Per Se after the first 3 sessions , he did ask me if the dr prescribed anti-gas pills. I confirmed yes , then he indicated I could eat most everything his crew made. The anti Gas pills were for 3-4 days and I was not supposed to eat prior to sessions . My sessions were 3 blocks from the Victoria Hospital , from the Vancouver Island Cancer lodge ( wonderful place where I got a nice room, great food, Counciling , and various Dr visits to see how I was doing - all paid for through my tax dollars being Gov't insurance . This was 2 years ago now. At first my PSA didnt really move from 0.14 , where I entered Hospital at , but after 10 months or so , it started to come down from 0.14, then to 0.11 , then to 0.076 , then to 0.052 , now at 0.041 ( one week ago) . Had operation 3 years ago for 3+4 = 7 , then radiation 2 years ago with no ADT and 22 sessions . The radiation was slow to work but is certainly working now . God Bless - James on Vancouver Island .

I had finger cramping around the time of my radiation, but I assumed it was from my spinal injury, not the SBRT. Some mornings it took me 30 seconds just to unclench and straighten my fingers (I was usually ok after that). It went away before long.

I was just starting to drive a little again when I did my SBRT (still in a wheelchair, but enough leg control to work the pedals and clutch), so I never considered driving myself to the treatments. Is there anyone else who could drive you, so that you don't have the extra hassle? My spouse and son-in-law split the trips (but also, it was just across town).

I laughed out loud reading your thoughts on the knuckleheads Calibrating these very precise, sophisticated machines. You probably shrugged off some of their laxness or devil may care attitudes since it wasn’t you being treated, right?
I am Reminded of the scene in Annie Hall where Christopher Walken is painfully describing to Woody Allen his suicidal urges while driving to just suddenly veer into oncoming traffic and end it all. Allen just rolls his eyes and with a smirk mumbles ‘what a loser’……until he finds himself in the passenger seat of the car Walken is driving and the look of terror on his face is priceless!! That was YOU!😂😂

My suggestion (from experience) is to stay away from beverages that can irritate the bladder; especially citrus drinks or anything containing citrus juices. Strong coffee or carbonated beverages might also cause some issues. It also might help to get some Flowmax to help with your urine stream.