It was a bit of a struggle with urinary urgency issues, but I made it through my radiation simulation on June 17th and got my three tiny freckle tattoos used for body positioning. The following is basically a data dump to my URO so that he could plan the next investigations into my urgency issue:
"This morning, even though a good scan was acquired for radiation planning with my RO, the simulation was not without urinary issues. I had to fully empty my bladder upon arriving at the cancer center, I had to partially empty my bladder twice while waiting in the exam room and I had to struggle to hold it while the scan was being run. The urgency issue is still there after the completion of the antibiotics for the bladder infection.
Let me back up a little in the day, so that there is some information on activities and food and fluid intake before my simulation appointment. Woke up about 5AM both nervous and excited. Did a couple of sets of PT exercises for core and pelvic floor. Walked the dog about one mile. Ate breakfast: apple danish and a bowl of oatmeal with blueberries and about 4 ounces of milk (NO coffee). Emptied and reloaded the dishwasher. At about 7:15AM, I took my calcium+D3 supplement and my morning celecoxib. I drank about 16 ounces of water to prep my bladder for the simulation. Showered and dressed. Left about 7:45AM to drive my daughter to school and headed from school to the cancer center. While on a street nearing the interstate, my bladder started saying it was full. As instructed by my PT, I did a few gentle stair-step kegels and some belly breathing and it calmed it down for a short while -- this had worked quite well on the flights that I took about a week ago while on a weekend trip to Arizona (padfree the whole time and only very minor leakage once while doing some strenuous yard work). More attempts at calming my bladder as I drove on the interstate and the exit and road to the cancer center. After parking in the garage, I couldn't wait any longer and hurried into the cancer center and used the restroom and fully emptied my bladder. With a glum look on my face, I met my wife in the lobby and we went to sign in at the Radiation desk at about 8:45AM. My wife had a water bottle with her, so I started drinking some to hopefully reprime my bladder -- I estimate that I drank about 12 ounces. We were brought back to an exam room where we reviewed forms and information while waiting for my RO. My bladder was screaming at me once again and the PT exercises could not quiet it for long. When the conversation with my RO finished, she said that I could partially empty my bladder to relieve some pressure, so I used the restroom and did. Still in the exam room and waiting for my turn for scanning, once again my bladder needed partial relief -- at most 10 minutes after the prior time. A nurse/tech eventually came and took me to the CT scan room while my wife went to the waiting area. Laying on the table wasn't bad at first, but then my bladder called once again, especially after the contrast agent was pushed into my urethra. The staff said to try to relax and make it through the scan, since there was less than ten minutes to go. With slow, steady, relaxed breathing (no kegels during a scan) I made it to the end of the procedure. My RO came into the room and said that my bladder looked very full on the scan and wondered if it was emptying completely during urination. After the tattoos, I was immediately escorted to a restroom. With my radiation schedule in hand, we left the cancer center about 10:15AM and as I hugged my wife goodby in the parking lot, I asked with watery eyes, "When will things go smoothly?"
After my May 31 PT appointment, I was walking around with a big smile on my face, since my dribbling was gone and I was easily handling the three hours at my son's baseball games and the trip to Dairy Queen afterwards. All I had to do was anticipate when a movement/action could cause leakage and kegel to prevent it -- I had told my PT that it was working and that I had scheduled my radiation simulation. Since then . . .
I had finished the last of the second month of celecoxib that PA had prescribed and was about a week into being off of it when it seemed that the osteitis pubis symptoms were reappearing and 800mg ibuprofen three times per day wasn't handling it. I consulted my PCP and he wrote a prescription for celecoxib on 6/12 and said that he would like to evaluate me at the end of a month. I let my PT know and she added more core exercises and hit a couple of pelvic floor musculature release points that could help. It's now there just slightly in the background at times, but it hasn't limited my mobility or activity level. I have had some nocturia and been up 3-5 times per night to urinate. You are aware of the bladder infection that you recently diagnosed. Urine flow seems okay, but volume can be quite variable. I experience urgency, but without leakage. I can't think of any other information, but please ask any questions that you may have.
Please let me know if you can help me, since I don't know if I could handle all of the radiation treatment sessions going as roughly as the simulation. My first ART is scheduled for July 1."
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Ultrasound of bladder indicates that it is empty after urination and urine culture comes back negative. Need to look into over-active bladder and/or bladder retraining via timed voiding.
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farmanerd
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I have a laparoscopic cholecystectomy with partial hepatectomy scheduled for July 9 due to these MRI results:
EXAMINATION: Abdominal MRI without and with contrast
HISTORY: Liver lesion, <1cm, normal liver, no known malignancy
TECHNIQUE: Multiplanar, multisequence images were obtained through the abdomen before and after the uneventful administration of 15 mL of ProHance gadolinium contrast according to routine protocol.
COMPARISON: CT urogram performed 3/19/2019
FINDINGS: Evaluation is degraded by respiratory motion artifact on the dynamic postcontrast images.
Liver:
Parenchyma: No evidence of hepatic steatosis. No evidence of cirrhosis.
Focal lesions: An ill-defined T1 hypointense, hypoenhancing area in the periphery of segment five abutting the gallbladder fossa measuring approximately 11 mm in diameter with overlying capsular retraction and mild peripheral biliary ductal dilatation. There is subtle peripheral delayed enhancement, overall suspicious for an intrahepatic cholangiocarcinoma.
No other focal lesions are identified..
Vasculature: There is classic hepatic arterial anatomy. The hepatic veins are normal. The portal veins are normal.
Biliary tree: Otherwise nondilated.
Gallbladder: Normal.
Spleen: Normal.
Pancreas: Normal.
Adrenal glands: Normal.
Kidneys: Other than a few tiny cysts, the kidneys are normal.
Additional findings: None significant.
IMPRESSION:
1. An 11 mm lesion in hepatic segment 5 suspicious for intrahepatic cholangiocarcinoma.
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Please let it be benign or please give me and my family strength to deal with any other diagnosis. ART has been postponed and the wait for surgery and pathology results begins again.
The spot may have been a damned spot, but I'm NOT damned! Pathology: NO EVIDENCE OF MALIGNANCY! What a huge relief (and that is a serious understatement)!
__________
From the report:
FINAL DIAGNOSIS
Gallbladder plus liver mass, laparoscopic cholecystectomy with partial hepatectomy:
- 1-cm capsular fibrosis and elastosis with vascular proliferation and no evidence of malignancy, see microscopic.
- Gallbladder with cholesterolosis and no evidence of malignancy.
MICROSCOPIC DESCRIPTION
Sections of liver mass reveal a 1 cm focus of capsular fibrosis, elastosis and vascular proliferation, suggestive of segmental atrophy. There is no evidence of malignancy. Congo red stain is negative for amyloid. The remainder of liver parenchyma shows mild steatosis with no hepatocyte ballooning or Mallory's hyaline. Sections of the gallbladder reveal infiltration of foamy histiocytes into the tips with no evidence of dysplasia or malignancy.
Slides are shown at the pathology intradepartmental case review conference.
__________
Surgical recovery is going well with long walks 2-3 times a day and a lot of movement around the house -- bedroom is on the third floor and it is where I escape for short naps. Not even Tylenol today and feeling great and I can finally sleep comfortably flat on my back -- no pillow wedge -- or on my left side. Started up some of the more basic pelvic floor PT exercises this morning and will slowly add more difficulty (core exercises). Next Eligard injection is Monday and I should be getting back into the ART queue with first treatment 7/22. Need to talk with URO to see if he has any recommendations on intermittent urinary urgency issues. Still need to work on ED issues -- tadalafil on the way. Weight has dropped a bit purposefully due to exercise and cleaning up my diet a bit: 153.8 lbs and 5'8'. Ahhhhhhh! Sorry I'm babbling, but I am just sooooo happy about this pathology result!
I'm walking on sunshine!
There is some interesting reading on segmental atrophy, but I need to get the links off of my phone.
Thank you for your thoughts, prayers and wishes. Best wishes to all! Time for another GOOD night's sleep.
Urinary Tract Infections can be problematic. Negative Urine Cultures are far from conclusive. If the infection has "taken up residence" in your prostate treatment may be a long term situation. The anatomy and natural defense mechanisms of the prostate make it difficult for antibiotics and the immune system to destroy pathogens.
You may need to find an Infectious Disease Specialist and have the prostate "expressed" ( via Digital Rectal method) with a urine sample immediately thereafter tested for leukocytes, evidence of infection.
Just want to say oatmeal and a danish are sugar. Bladder infections love sugar. No grains, sugar or fruit along with the meds has helped me along with d-mannose capsules.
I don’t know what your PSA is or what stage you are but mine started at 6.1 and went it to 13.1 within 1year l was on stage 2 to cut it short l went to Prague for proton treatment only had 5 fractions am now on Zoladex for 2 years after treatment which is almost 2years now when you have proton treatment you need to keep very still but it is all over in 2 mins ( on the table ) no pain from protons no incontinence l don’t regret having proton treatment l have never felt go good l remember before treatment it sounds like what you are going through l am a bus driver and l was in incredible pain until l went to Prague while having treatment l was so relaxed because they gave me confidence they could help which consultant in UK didn’t l haven’t regretted going my life is so much more comfortable now l did change my diet before treatment and l still up hold it now one important thing is try to reduce you sugar to almost zero my Chinese doctor gave me a lecture that cancer loves sugar so l staved it from this luxury it is hard but you get used to it as well as the diet change good luck for the future l hope this helps you
It's weird, today seems not too bad so far -- even having a full mug of coffee and oatmeal with bananas and cinnamon for breakfast. A week of dietary and bladder logging may point at a possible cause/solution?
This is not a cure but some help.... Have a piss bottle (wide neck like Gatorade bottle) next to your bed. Use it when you get the urge during your sleep and get back into bed right away... (wash your hands in the morning before your oatmeal)
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