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Brachytherapy Pre/Post Schedule

Prostate Cancer Awareness Week (pcaw.org) has compiled the following information on the schedule I was asked to follow prior to and following my seed implants. This information was gathered from numorous pieces of paper supplied by my Healthcare Provider. I put in into this format so that I would have an easy-to-follow schedule. It worked for me and maybe it will work for you. Replace the "Day One" With the actual calendar date. My calendar started 14 days before surgery.

14 Days Before Surgery

You may be asked to start taking medication as much as 2 weeks before surgery. This may include one - 1 mg pill of Hytrain or Flomax (Terazosin) at bedtime thereafter to hellp with urinary outflow.

You may be asked to discontinue or avoid taking products containing aspirin (aspirin, buffered aspirin, Bufferin, regular Anacin, Fiorinal, Easprin, aspirin with codeine, Darvon compound, Soma compound, and all Alka Seltzer produfcts and non-steroidal anti-inflammatory medications Nuprin, Advil, Motrin (ibuprofrn), Indocin, Naprosyn, Meclomen, Clinorila,Feldene, and Relefen. You should also stop over the counter products that thin your blood such as Ginko BViloba, Vitamin E, Feverfew, and concentrated green tea capsules. All these medications can thin your blood increasing the risk of blood loss during the procedure. See list of drugs, supplements, vitamins and herbs to avoid prior to surgery.

If you are taking or need pain medication during this time, the folllowsing products may be used: Tylenol, Anacin IV, Datril, Panadol, Vicodin, Darvocet and Tylenol with codeine.

If you are on any of these medications for a medical condition, talk with your surgeon before discontinuying use. Ask your surgeon if you should stop taking your regular medications before your operatoin. Plese bring along a list of medications you are currently taking.

If you have problems with your bowels such as constipation, you should use stool softeners and drink two to three quarts of fluid a day.

13 Days Before

One - 1 mg pill of Hytrain (Terazosin) at bedtime thereafter

12 Days Before

One - 1 mg pill of Hytrain (Terazosin) at bedtime thereafter

11 Days Before

One - 1 mg pill of Hytrain (Terazosin) at bedtime thereafter

10 Days Before

One - 1 mg pill of Hytrain (Terazosin) at bedtime thereafter

9 Days Before

One - 1 mg pill of Hytrain (Terazosin) at bedtime thereafter

8 Days Before

One - 1 mg pill of Hytrain (Terazosin) at bedtime thereafter

7 Days Before

Have all lab work and the EKG done the week prior to surgery but no later than 2 working days prior to surgery.

Increase dosage to 2 - 1 mg pills of Hytrain (Terazosin) at bedtime thereafter

6 Days Before

Increase dosage to 2 - 1 mg pills of Hytrain (Terazosin) at bedtime thereafter

5 Days Before

Increase dosage to 2 - 1 mg pills of Hytrain (Terazosin) at bedtime thereafter

4 Days Before

Increase dosage to 2 - 1 mg pills of Hytrain (Terazosin) at bedtime thereafter

3 Days Before

Increase dosage to 2 - 1 mg pills of Hytrain (Terazosin) at bedtime thereafter

2 Days Before

Increase dosage to 2 - 1 mg pills of Hytrain (Terazosin) at bedtime thereafter.

48 hours prior to your procedure, refrain from all dairy products. They can cuase too much gas, which could interfere with the ultrasound image.

Purchase a 3 oz. bottle of Fleets Phospho Soda Oral Laxative as well as one Fleets Rectal Enema. I fyou have Kidney problems or congestive heart failure, you may not be able to take this preparation. Check with your healthcare professional.

6am - Mix 8 oz of ginger ale or 7up with one tablespoon of Phospho Soda and drink.

6:10am - Mix 8 oz of ginger ale or 7up with one tablespoon of Phospho Soda and drink.

6:20am - Mix 8 oz of ginger ale or 7up with one tablespoon of Phospho Soda and drink.

Follow this with at least 4-8 cups of water or non-caffeinated drinks.

11am - Mix 8 oz of ginger ale or 7up with one tablespoon of Phospho Soda and drink.

11:10am - Mix 8 oz of ginger ale or 7up with one tablespoon of Phospho Soda and drink.

11:20am - Mix 8 oz of ginger ale or 7up with one tablespoon of Phospho Soda and drink.

Follow this with as much water and other liquids as you can drink. The more you drink, the better flushed out your system will be.

1 Day Before

May have a pre-op physical and a class on pre and post care. If you feel ill, have a fever, cough or "cold-like symptoms before the day of surgery please call your surgeon's office.

The day before your procedure you should have no solid food and drink lots of fliuids. Your breakfast, lunch and dinner should be all liquid. You may have juice, water, tea, coffee, broth and Jell-O. Do not eat or drink anything 12 hours prior to your procedure. No chewing gum, mints, cough drops, ice chips, coffee or water. Your surgery could be cancelled.

Increase dosage to 2 - 1 mg pills of Hytrain (Terazosin) at bedtime thereafter

Day of Surgery

Do not eat or drink anything 12 hours prior to your procedure. No chewing gum, mints, cough drops, ice chips, coffee or water. Your surgery could be cancelled.

1 Fleets Rectal Enema 1 hour before leaving home the day of the procedure

You must have a responsible person (i.e., not a cab driver) pick you up and take you home. They should be handy for the next 24 hours. Rest. If prescribed and there is excessive pain, one Vicodin pill may be taken every 8 hours as needed.

No ejaculations for two weeks.

What to Expect After Surgery
Signs and Symptoms to Call Your Doctor
Radiation Precautions
Follow-up Visits

Day 1 after Surgery

If prescribed, take one Septra DS and or Cipro (Ciprofloxacin) in the morning on an empty stomach and one at bedtime. This is an antibiotic.

Return to one - 1 mg pill of Hytrain (Terazosin) at bedtime.

No ejaculations for two weeks.

Day 2

Take one Septra DS and or Cipro (Ciprofloxacin) in the morning on an empty stomach and one at bedtime.

No ejaculations for two weeks.

Day 3

Take one Septra DS and or Cipro (Ciprofloxacin) in the morning on an empty stomach and one at bedtime.

No ejaculations for two weeks.

Day 4

Take one Septra DS and or Cipro (Ciprofloxacin) in the morning on an empty stomach and one at bedtime.

No ejaculations for two weeks.

Day 5

Take one Septra DS and or Cipro (Ciprofloxacin) in the morning on an empty stomach and one at bedtime.

No ejaculations for two weeks.

Day 6

Take one Septra DS and or Cipro (Ciprofloxacin) in the morning on an empty stomach and one at bedtime.

No ejaculations for two weeks.

Day 7

Take one Septra DS and or Cipro (Ciprofloxacin) in the morning on an empty stomach and one at bedtime. Continue until prescription has run out.

No ejaculations for two weeks.

Day 8

No ejaculations for two weeks.

Day 9

No ejaculations for two weeks.

Day 10

No ejaculations for two weeks.

Day 11

No ejaculations for two weeks.

Day 12

No ejaculations for two weeks.

Day 13

No ejaculations for two weeks.

Day 14

No ejaculations. Starting tomorrow, you may masturbate into a container or have intercourse with the use of a condom, examining the contents for seeds, afterward. for the next two months.

Follow-up Visits

After your implant, you will need regular PSA follow-up visits. It is important to have regular check ups to monitor the prostate cancer treatment and take care of any problems that may arise. The schedule below is recommend for the next few years. It will be possible to adjust this schedule to meet your needs. If you live out of town, this follow-up schedule can be provided by your referring urologist or phsysician.

If you do not have a corresponing appointment, be sure to get a lab slip from the office or your referring physician's office when PSAs are due. Check-up visits:

• Urology doctor - As scheduled
• At 4-6 weeks - CT Scan
• At 3 months - Brachytherapy Team Doctor or Nurse Practitioner - PSA
• At 6 months - Brachytherapy Team Doctor or Nurse Practitioner - PSA
• At 12 months - Brachytherapy Team Doctor or Nurse Practitioner - PSA
• Every 6 months for five more years - Brachytherapy Team Doctor or Nurse Practitioner - PSA
• Every year for life - Brachytherapy Team Doctor or Nurse Practitioner - PSA
  

What to Expect After Surgery

• Your urine may be bloody at first, but this will eventually clear, as it did with your biopsy.
• You may develop burising and swelling of the perineal and scrotal area (area of implantation)> This is normal and will resolve in 2-3 weeks.
• You may be going home after your procedure with a Foley catheter in your bladder (60% of cases). The catheter will remain in place until you return to your urologist's office in a few days. An appointment should be made for this before your leave the hospital. Bring with you all urine bags you have used.
• Do not allow anyone to remove your catheter without first notifying your urologist.
• If any unforeseen problems arise over the weekend or after hours after your procedure go to the Emergency Room for evaluation.
• You will strain your urine for two weeks after the procedure. It is possible that you may lose seeds through urination or in the ejaculate during sexual intercourse or masturbation. The seeds are silver in color and are the sixe of a grain of rise or pencil lead. If you notice a seed, you should retrieve it is possible and place it in a lead container using tweezers. Then return the lead container to your urologist's office of the Radiation Oncology Deparmtnet at your next appointment.
• If you have not used your lead container after a month, return it at your next appointment.
• Eat a well balanced diaet that includes a variety of fruits and begetables.
• Avoid constipation because large and firm stools may put pressure on your prostate and cause added discomfort. The use of stool softeners and increased fluid intake (1-2 quarts per day) is suggested (unless your doctor has placed you on restricted fluids.) Metamucil or other similar agents work well.
• Remember, you still can have your routine flexible sigmoidoscopies and colonoscopies, but please inform your doctor that you ahve had an implant and that if there is anything that needs to have a biopsy, have them call your brachytherapist prior to any biopsy.
• If you are having burning or discomfort in your urethra, your physician may prescribe Pyridium or 800 mg of Motrin for this. You should know that Pyridium will turn your urine orange and stain your clothes if you get urine on them. You may want to wear a pad for protection during this time.
• If you have swelling, avoid sitting for long periods ot time. Recline, then get up and walk around the house every hour or two. If your scrotum is swollen, you may elecate it on a rolled towel. Ice packs may provide additional relief.
• Avoid heavy lifting or strenuous physical activitiy for the first few days. After that you may return to your normal activity level. Occasionally, vigorous activity may cause some minor blood in the urine. If this happens you should rest and drink plenty of fluids for 24 hours.
• You may climb stairs and go for short walks. Move your legs and feet frequently to promote good dirculation.
  

Signs and Symptoms to Call Your Doctor

If these five things happen within three (3) days of surgery, contact your urologist immediately.

• Fever over 100.5
• Chills
• Pain unrelieved by rest and medication
• Low back pain
• A change to cloudy or odorous urine.
• Burning where catheter enters your body.
• Swelling of one or both legs - with or without pain
• Shortness of breath or chest pain
• Increased blood or clots in urine that do not clear with rest and drinking fluid
• Blockage of catheter

You will feel sensation of fullness over the bladder or pain over the bladder.

You will see decreased or no drainage from catheter

First check catheter and tubing for kinds. Check position of drainage bags. Get up and walk around.

If urine does not start to flow then call the advice nurse, doctor's office or go to the Emergency Room.

Doctor's Name______________Phone Number (___ ) _________

Radiation Precautions

Since the I-125 seeds emit very low energy X-rays, there is very little radiation hazard associated with these implants. After the seeds have been placed in the prostate, the body acts as a partial shield considerably reducing exposure to others. Objects that you tough or use are NOT radioactive. In order to ensure that those around you are protected from unnecessary radiation, you should follow the precautions listed below for six months:

• Pregnant or possibly pregnant women should avoid close contact with you for the first six months after the implant. She can greet you briefly and then move to a distance of at least four or five feet (to protect the fetus).
• Children should not be allowed to sit in your lap for long periods of time during the first six months following implantation. Pets may sit on your lap on a pillow. Children and pregnant women are safe to be around you indefinitely if they are 3 feet away.
• You may sit at the dinner table, ride short distance in the car, and give a brief hug to a pregnant woman or small child.
• Sexual intercourse may be resumed 2 weeks after the implantation with use of a condom only. You must wear a condom afwith intercourse for 2 months. You will need to examine the contents of the condom after ejaculations for seeds. If a seed is lost, you should handle it the same way you handle seeds in the urine.
• Your semen may be discolored and dark drown for a while dure to the release of old blood left from bleeding during the implantation. At first, sexual intercourse may cause pain or burning. Use your comfort level when deciding to resume.

Four Important Things to Remember before Getting Tested

1. Be sure that you're rested.
2. No sexual activity for 72 hours before the test.
3. Got a cold? Put it on hold.
4. Either have your PSA test before the DRE or delay taking a PSA test for 48 hours AFTER you have had your DRE test.

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