Prognosis: expect diarrhea

February 8, 2017 the consult

Hi, Tracy.

According to dictionary.com, the word "diarrhea" traces its roots to Middle English, Late Latin and Greek. I've been told the tendency toward it is inherited--you can find it in your genes (spelled j-e-a-n-s). It's something I can look forward to, along with reinvigorated hot flashes, including night sweats, which until now had been diminishing. How serious will the diarrhea be? Depends.

The Middle English use of the term literally means "flow through," which is what my future  meals may do when they hit the far end of the alimentary canal, starting with the Sigmoid Colon depicted in the image immediately above.

Diarrhea can be an outcome of radiation. This my fifth session on the block. It's a Wednesday, and I met with my treatment team following today's irradiation of my prostate, which took about 10-13 minutes.

Lotsa liquids

I prepped for it by drinking a cup of hot raspberry Jello first thing, to put some heat in my chest along with some sweetness to prompt my salivary glands to kick out some fluid to loosen the phlem from the cold I acquired after my trip to Mazatlan. That was followed by four cups of lemonade (easier to drink than water) and then probably at least 2-3 more cups of liquid I sucked from my hiker's Platypus on the 15-minute walk to radiology. All that water and the hike gave me the opportunity to learn that I can clear my bowel at the clinic without draining my bladder, which they want as inflated as possible. That helps to push the bowel out of the way and also reposition the bladder so that it receives less x-ray.

Regarding the colon

The colon will take a hit. After enough radiation, it will experience a diminished ability to retrieve water. When food and liquid leave the stomach, the small intestine performs yoeman service in transferring liquid to the kidneys; it's the job of the large intestine to collect the rest, and if it doesn't, stools may be quite liquid. Things may get interesting.

Diet

To limit the interest, I may be changing my diet -- reducing roughage. This will depend on the effects with my particular treatment. Right now I'm dieting to take off weight -- I've gained 20 pounds over the weight I prefer: 185 pounds. I've focused on low-calorie foods and vegetables as well, bringing my weight down a few pounds. That reliance on vegetables may diminish to temper any diarrhea I have.

Night sweats

One of the staff members referred to my night sweats and hot flashes as "manopause." They  have been diminishing in frequency and intensity. I though it was the bicalutimide pills I've been taking that caused them, but today I learned that the major cause of my temperature swings is probably the lupron shot that blocked my testosteron, and I'm due for another one, so I think I'm going to be experiencing a manopause rebound in a week or so after that shot.

End of sweats

Fortunately, when the radiation treatments stop, the hormone blocking will stop as well, and my temperature regulating system will settle down and stop exaggerating its response to the extra-body heat and cold stimuli.

Also is to be expected:

My prostate, which is about 87 cc's in size, and which is already shrinking, will continue to diminish in size. Of course, it may start increasing again gradually once treatments end. The smaller prostate will mean easier urination, but the radiation may scar the urethra, meaning more difficulty, and the necessity of clearing out the scar tissue at a later date.

My PSA (prostate specific antigen) will be way down. "Normal" is a score of 2-4. My first biopsy over 10 years ago was about 6, and it continued to grow slowly until it was in the range of 13, and then the score accelerated to 16 and finally 19 the last time it was checked. My radiologist expects my score may drop to to as low as 0.5 following treatments, with very diminished growth afterward over time. They will measure it about two months after treatment, and then every six months.

While the PSA isn't necessarily a trustworthy indicator for the general male population, once it's associated with cancer it becomes a more relevant indicator -- possibly because other explanation for high PSA get ruled out. So my understanding is that tracking it will become the gold standard for determining whether I am cancer-free.

Love,
Dad