High Dose Rate Brachiotherapy, the gory details.

Some people may find this post distasteful but I think it useful to record my experience. Don't read it whilst eating your breakfast and if you wish to avoid references to peeing, pooing and bleeding, stop here.

After a pleasant early tram and bus ride I arrived at the Christie a little after 7AM for my 7.30 appointment. I was annoyed that I had forgotten my reading glasses and I had brought 2 books to while away the hours. I found the correct ward but it was still locked up. A couple a little older than me were sitting on some easy chairs nearby. I decided to go for a stroll along the hospital corridors. When I returned they had opened up and the couple were sitting waiting inside the reception area of the ward. I joined them and we exchanged nervous smiles. After a short while the wife left and me and Bob introduced ourselves. He was there for the same treatment. Apparently they do 4 a day, 2 in the morning and 2 after lunch. After a while we were led down a corridor and shown into a room with two high tech beds.

We were introduced to our dedicated nurse, Karolina. She was I would guess in her late twenties, slim and beautiful but much more important, cheerful, chatty and amusing. Her Polish accent was not strong and we discovered later in conversation that she had spent perhaps half her life in Britain as her parents had moved to Morecambe when she was much younger. Bob and I chose beds and he kindly lent me his reading glasses. He had to take out his contact lenses for the operation, which meant that he could read without glasses. We were asked to undress and put on back to front hospital gowns. We did this and got into bed.

The anaethsetist came to interview me. He was concerned that I had used St Johns Wort to control my depression and clearly disapproved of the practise, of which he doubted the efficacy. I begged to differ but assured him that, on advice, I'd had none for a week.

I was selected to go in first and a nice mixed race nurse, I didn't register her name, only that her only experience of Ashton was Ikea. came to check me over, blood pressure, temperature. She then asked me to turn on my side so that she could give me an enema.

This is where things start getting messy, so, if you want to stop reading now I'll understand.

This was a first for me. My nearest previous experience was when my mum administered laxative chocolate when I was a kid. The nurse produced a scarily huge syringe full of liquid which she proceeded to insert and empty. I had a huge feeling of fullness but was advised to hold on for as long as possible. Eventually it all got too much and I ran into the bathroom and deposited loads of unpleasant liquid into the toilet, not a moment too soon.

Soon afterwards I was led down long corridors to the operating theatre. After checking my identity and that I'd signed a consent form in an ante room  I was taken in and asked to climb on to the operating table, positioning myself precisely where they wanted me. The anaethsetist arrived and, after a scratch on my hand I was out.

I woke as they were putting me back into my bed. I was in great distress. I had a drip putting saline solution into a vein in my left hand and a catheter leading from my penis through a very red tube to a very red plastic bag on a stand on the floor. I felt like I was about to burst, perhaps how waterboarding victims feel, being full of liquid that can't get out. I expressed my concerns loudly and was assured that it would soon get better.

The procedure that I had undergone, high dose rate brachiotherapy, has similarities with the mediaeval torture method of shoving a red hot poker up the arse.

Let me explain some of the biology, of which I was ignorant until this business started. The prostate is involved in making sperm, so if you don't want more babies (and, for goodness sake, there's enough of us on this planet already) then you don't need it. It surrounds the urethra, which is the tube connecting the bladder to the (in men) penis. As men get older it tends to expand which can cause the tube to get constricted. If it develops a tumour, one of the most common forms of cancer, then this exacerbates the situation. Many tumours are relatively benign and can be controlled with hormone therapy which depletes the body of the testosterone on which they feed. This has side effects similar to the female menopause. I believe that something like 1 in 3  eighty year old men have some form of prostate tumour. I'm pleased to say that it's a problem of living well beyond our design life.

Mine, of course, is one of the most aggressive variety. I don't do things by halves!

Back to mediaeval torture. There are differences of course. The ancient procedure resulted in a protracted and agonising death. The modern one will, I hope, prevent that. The modern procedure does not enter via the anus but is a fine hollow needle inserted nearby. The heat in the middle ages was provided by preheating the poker in a fire, nowadays it is a highly radioactive isotope which is moved about inside the needle, which is inside the prostate, with the object of searing away the cells that are misbehaving. The body however, reacts in a similar way, by going into panic mode.

The needle and the radiation don't just zap the tumour. Like the mediaeval procedure they damage surrounding tissue. The modern method causes a lot of blood to leak into the bladder. Just to complicate matters, the body's natural repair mechanisms cause swelling in the area, restricting the ability of the unwanted liquid to escape. That's how I understand it anyway. Some of the details may be wrong.

The discomfort (a mild word for it) that I was suffering was because my bladder was bloated with blood which was having difficulty finding a way out. The catheter was to drain it out in a controlled way, rather than me peeing blood all over the place, and the drip was to keep my body over supplied with water so that large amounts of urine would dilute the blood and flush it out. We were also encouraged to keep drinking water and sometimes offered hot drinks. The panic inducing feeling did gradually subside but it took a long time.

While I was still getting used to my situation, Bob was brought in. He suffered similar problems as he woke up. We soon struck up a conversation and an instant friendship, perhaps akin to what, so I'm told, soldiers thrown together under fire experience. Bob is very different from me. I think he gave his birth date as 1947, which would make him 72. Apparently pretty fit, he loves sport, a keen golfer, and cars. I didn't feel it was the time or place to point out how much damage his huge 4X4 was doing to our planet. He is a retired taxman and ended his career doing detective work to unearth those who were avoiding their rightful contributions. We eased our difficulties by swapping entertaining anecdotes. From time to time Karolina popped in to have a chat and check on our progress and our blood pressures and temperatures were regularly checked. I was constantly setting off the alarm chimes on my drip by waving my left hand about too much and stopping the flow. Each time a nurse would come to reset it.

We were given a menu for our tea. I was appalled to see that the only option for pudding was bonoffee pie. Don't they know that cancer feeds on sugar. As I'm on an anti cancer diet set by Emuna (she's researched it very carefully) I was a bit stumped by the choices. I decided to have vegetable soup followed by shepherds pie with green beans with no pudding. Bob chose the same. This was as close as I could get to staying on the diet. The food was welcome (note to readers in other countries, it was also free) but hardly cordon bleu.

We carried on chatting. Every now and then I would read a couple of pages of my book but I couldn't concentrate for too long. This all sounds very pleasant, but we were both experiencing pain and discomfort. This was alleviated occasionally by paracetamol, but there's a limit to how much of this you can have. The flow down the tube from my willy stayed very red. The beds were very adjustable, using a control panel that was in easy reach, but I struggled to find a comfortable position.

Our nurse for the night was a pleasant Scot called David. I think it was him who suggested at some point that it was time for lights out. I was certainly tired but was dreading trying to sleep with my prick tethered like that. I was also concerned about what was happening to the food I had eaten. My stomach was undergoing uncomfortable gyrations. After a while I summoned a nurse and she helped me into the bathroom, complete with catheter and drip. I sat on the toilet and she left. I deposited another load of diarrheah into the pan, along with a drip of blood. I made my own way back and carefully climbed into bed.


After a little while the nurse returned, worried that I hadn't yet summoned her to help me back into bed. I'm obnoxiously independent sometimes. Bob, who was also still awake, warned me that i could cause myself some damage if I tripped over, which was very true. When David came to check on us I told him about the blood. He seemed worried about this and told me that if I went again he wanted a sample. He issued me with a papier mache pot to do it in.

My stomach gyrations got worse and turned into repetitive very painful cramps. I felt like I needed the bathroom again so  I carefully climbed out of bed. The drip machine had been plugged into the mains  to charge the battery and I struggled to reach the plug, knocking something over in the process. I dragged my anchors into the bathroom and squatted over the pot,  letting  forth the most enormous explosive fart of my life which sprayed diarreah all over the floor and my gown, very little landing in the pot. Embarrassed I pulled the red cord and soon David appeared. He said matter of factly that it must be the remains from the enema and it was OK as there was no blood (I now think that the drop of blood in the toilet had leaked out from my penis). He cleaned up and issued me with a clean gown then left.

 I felt like I still needed to go so I sat on the loo and strained. I was shocked to see a jet of blood squirt out past the catheter all over the floor. I pulled the red cord again and David reappeared. He said the catheter must be blocked and he would have to flush it out. He cleaned up and helped me back to bed then fetched a syringe of saline, took off the catheter tube and pumped the syringe full through the catheter, then drew it out again. This wasn't as horrible as it sounds, though I wouldn't do it for fun. He said that it was probably a blood clot that blocked it and this was a good sign.

With the catheter re-assembled I lay down and tried to sleep. Bob asked if I was OK. I said I was. The cramps continued but I decided that I wasn't moving again and if I messed the bed so be it. In fact they turned into a series of dry farts. After a while I heard Bob begin to snore. I envied him his sleep. I normally would toss and turn until I found a comfortable position but, restrained as I was, this was impossible.

One of my Facebook friends told me her husband had to spend a whole week with a catheter. It must have been torture.

Time passed, Bob snored. Every now and then I seemed to be drifting off until the discomfort, or somebody checking my blood pressure, brought me back to full wakefulness. I would look at the time and be dismayed about how little of it had passed since I last looked. I adjusted the bed to try to get more comfort and began the cycle once more.

I gave up at about 4AM and got out my book .Its called "Why Life Speeds Up As You Get Older", or, as I sometimes put it, when you reach 35 why does some bugger go round speeding up all the clocks?  In fact it goes into all kinds of aspects of memory, something that fascinates me. I'm very aware that I'm struggling to accurately recount the events of the last few days. I may well have made some mistakes and have already had to go back and correct some errors (or was I perverting a true account!?)

I became very aware that my lower back was not happy about my posture (it continued to ache for the rest of the day). David checked my catheter and said he was pleased as it was running clear, though it still looked fairly bloody to me. He said he would remove it soon. I said I really wasn't looking forward to that. I would, of course, be pleased to be rid of it but the actual process of taking it out sounded like it would be unpleasant. He told me it was easier than putting it in, but I pointed out that I had been unconscious when that was done. It actually felt odd but not too bad when he did it.

The day shift took over and the wonderful Karolina came to check on us. We were offered breakfast. Trying to keep as close as possible to my diet I opted for porridge and dry toast. I don't recall what Bob had. With our impedimenta removed we were told that we should shower and dress. Before we left we both had to produce 300ml of urine and bottles were handed out to catch it in. I tried but could only muster a dribble. As I was in the bathroom trying to produce a flow there was a sudden jet of blood from my hand. I had accidentally knocked off the dressing where the drip had been attached. I pressed the blood soaked cotton wool back into place and summoned Karolina, who re-dressed it and cleaned up.

Bob marched confidently into the bathroom for his turn and I heard a sound like a tap turned on. He emerged beaming and handed his bottle to Karolina for measuring. He looked crestfallen when she returned to announce that it was only 70ml.

Bob went in for a shower and I changed into my nightgown as I wanted to cover my backside but didn't want to dress until I too had showered. When he emerged I went in with my bottle but, again, only managed a few drops.

Karolina arrived to announce that there had been a change of plan and we would have to move to another part of the hospital as our beds were needed for more patients. We would need to dress. I had a bright idea and asked for more paracetamol, which was quickly provided.

Some time ago I had begun to get concerned about the possibility of prostate trouble, partly because I was peeing a lot, but particularly because of an unpleasant night time phenomenon which was happening with increasing frequency. I would wake up in the night absolutely bursting, but when I got to the toilet I could hardly pass a drop and the feeling would get worse. The first time this happened I got quite panicky but I soon devised a strategy. I would go downstairs and find a suitable container such as an empty bottle or jar. I would then march in circles until the movement started a flow. Sometimes Emuna would awake and call "are you alright" to which I would reply "I'm fine, leave me alone". Sometimes this would happen more than once in the night but my morning coffee would stimulate a poo. After that I had the opposite problem as I started work of having to suddenly and frequently  rush to any place where I could discreetly have a pee. If this sounds familiar, dear reader, please go and see your doctor.

Now I know a bit about the male plumbing my theory is that the enlarged prostate was combining with extra pressure from a developing stool to completely close up the urethra. There simply wasn't enough room for everything in my pelvic area. The movement of walking about would briefly open it again allowing the urine to escape in dribs and drabs.

My pain was now not too bad, but I was aware that as well as relieving pain, paracetamol would reduce inflammation. I guessed that the radioactive assault on my prostate, though it would reduce its size in the long run, would have caused inflammation that could be  impeding my ability to pass water. I took my painkillers with coffee and dressed. I went into the bathroom with my bottle and produced 50ml. It felt like a competition. Bob was in the lead but I was now catching him up. We agreed that it was like peeing razor blades.

 We were then escorted down long corridors to a room where several people were sitting, bored, watching morning TV. I had missed my chance of a shower but, after the long walk I was able to produce a further 150ml, only 100 to go. Bob had another try and he was told he only had 80 to go. He was still in the lead but not by much. He went off to meet his wife in the coffee bar. I alternately watched rubbish on TV and marched up and down the corridor.

A man came round with a trolley offering sandwiches, snacks, parsnip soup and, amazingly, fruit. I asked for a banana and a big cup of soup. This appeared to be home made. It was lovely, but incredibly salty. I don't worry too much about salt as my blood pressure tends to be a bit on the low side, but many people are the opposite, especially in a stressful place like a hospital. Again, don't they know?

The nurse in charge of this department was a pleasant solid lady in her 50s or 60s called Sue. I went into the toilet to try some more and then handed her the bottle containing the result. After measuring it she sought me out in the television room and gave me a double thumbs up. I'd won and I was free to go. Shortly afterwards Bob returned and was also able to hit his target. We shook hands and wished each other well, then he left to join his wife for the drive home to Bury. I hope he didn't have the problems that cropped up later on my journey home.

Plan A had been that Emuna would come to collect me in a taxi. When I mentioned this to Karolina she said she could arrange transport home for me. I thought this would be better as Emuna suffers from M E (or CFS, Chronic Fatigue Syndrome) and it seemed a bad idea for her to be making unnecessary journeys. I asked about this and eventually found that it had been booked for 2PM. It was now about half eleven. Sue did her best to get it speeded up but pointed out that as it was snowing outside there may be delays.

I had drunk far more than 300ml in my efforts to win the peeing race. It was now building up inside me but the paracetamol had worn off and I was unable to get more than the occasional dribble out. I continued marching up and down, then sitting watching TV for a while.

In the corner sat a tall, thin, grey, lugubrious man in his sixties. He started a conversation about the quality of television programmes. It turned out that we were both keen radio 4 listeners. He asked me what kind of cancer I had. I told him. He ventured that his was pancreatic, "incurable". "Oh dear" I said. He continued that he was on so called palliative care, but really it was just torture. I felt sorry for him. I don't know how I'd cope with that situation but I did have a feeling that his eeyore like mindset was doing him no favours. He then explained that he was in for some experimental treatment but first he had to have a blood transfusion to prepare him. Shortly afterwards Sue came in to start setting up his transfusion.

About 2.30PM a small young woman ambulance driver appeared. She had short hair and a brisk no nonsense manner. I think she had been searching the hospital for me. She picked up my bag and told me to follow her. We marched smartly down the corridors. She told me that there was another patient in the ambulance who had to go to Stockport, which is pretty much on the way.

As soon as we started going over speed bumps and potholes I realised that I was going to have a problem. By the time we reached the other man's house down a little cul de sac I was absolutely bursting. I told the driver of my predicament. She said that she normally carried bottles for just such a problem but was sorry that she had none today. She gave me a pad to stuff down my pants. I really didn't want to pee myself, pad or no pad. I suggested stopping at a supermarket. We drove along the main A6 and she pulled into a petrol station so that I could ask if they had a toilet. They firmly told me that they had no public toilet and I couldn't use their staff toilet. Bastards! We have no public toilet in our charity shop but occasionally people who are in desperate  need are given access, sometimes with a sentry posted lest it be a ploy to get into our stockroom.

Back at the ambulance the driver had found a small bowl. I nearly filled it then she stuffed another incontinence pad in it and put it in a yellow biohazard bag. We set off again and were soon bowling along the M60. The same problem began to recur. By the time we reached the junction for Ashton I was desperate again. I suggested she pull over just after leaving the motorway as there is a fairly secluded footpath there between the motorway and the retail park. She didn't go for that but pulled off by Ashton Moss tram stop. By then I'd soaked my pad but had a bit left for the bowl once I'd got it out of the bag. Talk about undignified!

On the move again and the same problem again. Luckily we were nearly home and I started giving directions lest the satnav take us a stupid way. When we stopped outside our house I quickly unloaded myself, thanked the driver, unlocked the front door and rushed past Emuna and upstairs into the bathroom.

It was nearly teatime and Emuna brought me a wonderful, tasty cancer busting meal in bed. In discussing the situation she told me that anaesthetics tend to promote constipation. I was unaware of this but was already concerned about what was happening to the food that I had been eating. My first poo, in the early hours of the morning, was quite small but very painful. Later on Wednesday I had to go again. I will leave to your imagination the pain of passing a turd with the volume and viscosity of a house brick through a radiation singed rectum. It briefly blocked the toilet.

I'm writing this on Thursday evening, 3 and a bit days after the operation . My plumbing is gradually settling down but still quite painful. I don't usually write such earthy posts but I thought that being honest and straightforward about my experience would be instructive.