Did anyone have sedation for vaginal brachytherapy?

Posted by cmc1 @cmc1, Mar 13 8:41am

Had surgery for grade 1 stage 1 endometrial cancer in 2023 (at Rochester Mayo), followed by 3 brachy therapy sessions (without sedation). I was told this was "curative" (famous last words). Cancer returned in Jan 2026 (I found blood on toilet paper after wiping). I had a recurrence in my vagina, just below where the earlier brachy radiation stopped. I had just had an exam in Dec, and nothing was noticed (I feel it was missed). I am now having 25 external radiation treatment (pelvic) and go today for number 13 (on Friday the 13th)! So far not having much for side effects but have tried to prepare for anything. Near the end of the external radiation, I will start the 3 vaginal brachy sessions (again!). They will be intertwined with the external. I was just informed by the oncology nurse where my external treatments are being done, that the Dr doing the brachy has me scheduled to be "put to sleep" for the 3 brachy treatments. This has me VERY upset! I recently had major eye surgery for glaucoma and was only given light to mild sedation, and when I had vaginal brachy in 2023, at the same hospital, I did not have sedation, in fact it wasn't even an option. A few weeks ago, I met with the Dr. who will be doing the brachy and she never mentioned sedation to my face. HAVE OTHERS HAD SEDATION WITH BRACHY THERAPY? I have to eat a little something right away in the morning as it helps settle my stomach and if I am going to be "put to sleep" I probably can't eat and that won't be good.

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Profile picture for cmc1 @cmc1

Stage 1 grade 1 slow growing endometrial cancer is what I was told. I had genetic testing and it was negative. I never used any kind of body powder (they never asked me if I did). I was menopausal for many years and I started spotting. Yes, they did brachy to the vaginal cuff in 2023 after a hysterectomy with tubes, ovaries and cervix removed. I am currently in the middle of 25 external radiation treatments. The brachy is going to be "aimed" mainly at the lesion just inside the opening of my vagina. Apparently the 2023 brachy missed that area. The upper portion and top of the cylinder will be covered with a shield to protect the rest of the vagina from the radiation. I live in southern Minnesota and have been going to Mayo in Rochester, MN, about an hour from where I live. I started in my hometown and was sent to Rochester by a doctor here. The radiation doctor where I am having the external (about 30 minutes from my home, at another Mayo facility) said that brachy goes better when the patient is relaxed and it is easier for the doctor who is performing the brachy treatment. He is all for sedation. I did not have sedation withe the 2023 brachy and I was very tense, but I got through it without too much of a problem, despite having a cold and seemingly uncaring radiation dr. I do not have him this time.

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@cmc1
I also had the recurrence in the vaginal cuff and at the first brachy I was in so much pain I begged for sedation!!!
I researched like crazy to find a facility that would sedate me and couldn’t find one
Fearing the next session I begged for at least pain meds so they gave me a Percocet and Valium an hour before and they changed the insertion tube to a smaller one and it really helped however I found entire procedure long, uncomfortable and extremely difficult and pray I never need it again. Now I am on immunotherapy

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Dear cmc1: I had sedation for the pelvic brachy surgical implant and was in the hospital almost 3 days (2 1/2) for 4 radiation treatments. I had to be in hospital, not outpatient, due to anotomical differences substantial enough to require inpatient care. I was under full sedation for some hours while the OncRad doc planned his treatment - it was hybrid tandem-needle, although this was already anticipated need from scans. I'm wondering when you mention sedation are you referring to the implant or the actual radiation? It may be that the tools being used on this recurrence are different due to issues with your previous treatment?
I didn't have trouble with the full sedation, and I'm glad I was out like a light for it. I had a morphine drip the first day, and this got me through the worst of it. By that same evening I had no tolerance for the morph and stopped it completely, taking cherry flavored liquid tylenol every 6 hours. And I did have to stay flat on my back in bed 3 days. Strangely, morphine makes time pass quickly and you have no idea, yet the slow drip doesn't make you feel drugged. It would've been an easier way to pass 3 days without movement.
We're all worried about recurrences. Some of us, myself included, have had extensive treatments - pelvic brachy certainly means just that. Also 25 external beam before the brachy & 10wks taxol-carbo & cicplaitin.
There are so many symptoms after treatment - side effects and complications that we're not told about. I keep seeing the phrase (used even here by patients at times) "Late Effects". This is medical jargon, It means side effect or complication, but is mystifying and designed to sound benign. We have surgery sometimes for these "Late Effects". But think of it: nobody every died from Late Effects. People die from complications, side effects of illness or treatments. I"ve never seen the term "Late Effects" used anywhere else in medical journals, and I've read them for years from my course of studies. Late Effects can be permanent or temporary changes in bowel or bladder, minor or major in nature. (and why hasn't the needle moved on this aspect after decades?) Some side effects require surgery to repair, fitsulas being the obvious one - painful, non cancerous growths.
A radiology NP recently told me that radiation fibrosis usually sets in 6 to 12 mths after the treatment. This is ANTICIPATED. But nobody told me, but I did read that it could occur (online, google searches). It's actually expected, not a mere possibility. Wow. There's surely a list of things that are anticipated after treatment, but the patients aren't being told, and symptoms aren't tracked that well from what I've read in NIH articles - patients get relief from different doctors oftehtimes. And nobody gives us the survey to fill out. I've never gotten a survey about any of my symptoms from any practicioner - and this includes prescription drugs. Doctors are the ones who submit the data, and if they don't collect it - or don't think it's important - it never shows up on RX data or medical journals.
One NIH study of cancer patients and their doctors asked about side effects from treatments (chemo): about 85% of patients identified side effects. But only 5% of doctors did so. Same population of docs and patients. The disparity was significant. It doesn't mean the side effects are all strong by any means, but patients usually tell the nurses (chemo nurses) as well, so those nurses have the "inventories", but are not the official reporters of the side effects of treatments.

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Profile picture for longevityride @longevityride

Dear cmc1: I had sedation for the pelvic brachy surgical implant and was in the hospital almost 3 days (2 1/2) for 4 radiation treatments. I had to be in hospital, not outpatient, due to anotomical differences substantial enough to require inpatient care. I was under full sedation for some hours while the OncRad doc planned his treatment - it was hybrid tandem-needle, although this was already anticipated need from scans. I'm wondering when you mention sedation are you referring to the implant or the actual radiation? It may be that the tools being used on this recurrence are different due to issues with your previous treatment?
I didn't have trouble with the full sedation, and I'm glad I was out like a light for it. I had a morphine drip the first day, and this got me through the worst of it. By that same evening I had no tolerance for the morph and stopped it completely, taking cherry flavored liquid tylenol every 6 hours. And I did have to stay flat on my back in bed 3 days. Strangely, morphine makes time pass quickly and you have no idea, yet the slow drip doesn't make you feel drugged. It would've been an easier way to pass 3 days without movement.
We're all worried about recurrences. Some of us, myself included, have had extensive treatments - pelvic brachy certainly means just that. Also 25 external beam before the brachy & 10wks taxol-carbo & cicplaitin.
There are so many symptoms after treatment - side effects and complications that we're not told about. I keep seeing the phrase (used even here by patients at times) "Late Effects". This is medical jargon, It means side effect or complication, but is mystifying and designed to sound benign. We have surgery sometimes for these "Late Effects". But think of it: nobody every died from Late Effects. People die from complications, side effects of illness or treatments. I"ve never seen the term "Late Effects" used anywhere else in medical journals, and I've read them for years from my course of studies. Late Effects can be permanent or temporary changes in bowel or bladder, minor or major in nature. (and why hasn't the needle moved on this aspect after decades?) Some side effects require surgery to repair, fitsulas being the obvious one - painful, non cancerous growths.
A radiology NP recently told me that radiation fibrosis usually sets in 6 to 12 mths after the treatment. This is ANTICIPATED. But nobody told me, but I did read that it could occur (online, google searches). It's actually expected, not a mere possibility. Wow. There's surely a list of things that are anticipated after treatment, but the patients aren't being told, and symptoms aren't tracked that well from what I've read in NIH articles - patients get relief from different doctors oftehtimes. And nobody gives us the survey to fill out. I've never gotten a survey about any of my symptoms from any practicioner - and this includes prescription drugs. Doctors are the ones who submit the data, and if they don't collect it - or don't think it's important - it never shows up on RX data or medical journals.
One NIH study of cancer patients and their doctors asked about side effects from treatments (chemo): about 85% of patients identified side effects. But only 5% of doctors did so. Same population of docs and patients. The disparity was significant. It doesn't mean the side effects are all strong by any means, but patients usually tell the nurses (chemo nurses) as well, so those nurses have the "inventories", but are not the official reporters of the side effects of treatments.

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@longevityride thank you for the response. very interesting. The brachy I will be having is outpatient and I had it in 2023. The top and sides of the cylinder will be covered to protect the vaginal tissue that rec'd radiation in 2023. It's just supposed to be aimed at the new lesion in the vagina. I have never had chemo but worry about the aftereffects of so much radiation. In 2023 they did tell me that they give far less radiation now than was given in the past. Hopefully that means fewer side effects. I was given all of the possible side effects but told a few were "rare". I sure hope so. They ask me about side effects every day when I go for treatment. I mentioned something kind of 'off the cuff' the other day and at the end of my treatment an oncology doctor was standing over me to talk about what I had told the girls. At least they are taking things seriously, or so it seems.

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Profile picture for cmc1 @cmc1

@longevityride thank you for the response. very interesting. The brachy I will be having is outpatient and I had it in 2023. The top and sides of the cylinder will be covered to protect the vaginal tissue that rec'd radiation in 2023. It's just supposed to be aimed at the new lesion in the vagina. I have never had chemo but worry about the aftereffects of so much radiation. In 2023 they did tell me that they give far less radiation now than was given in the past. Hopefully that means fewer side effects. I was given all of the possible side effects but told a few were "rare". I sure hope so. They ask me about side effects every day when I go for treatment. I mentioned something kind of 'off the cuff' the other day and at the end of my treatment an oncology doctor was standing over me to talk about what I had told the girls. At least they are taking things seriously, or so it seems.

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@cmc1 I'm relieved to know that your cancer care team and especially the radiation oncologist are listening to you.

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