Those of us who have completed proton beam therapy for prostate cancer know it’s not the scary proposition we thought it—or any treatment—might be before we took the plunge. But think back: despite your research, weren’t there at least a few surprises? New guys following in our footsteps naturally turn to us to ask what it’s like, and we have a responsibility to explain it in an accurate manner.
But merely laying out the bare facts of the technique can sound at least a little odd. Beanless diets, empty, drink, wait, lie down, roll over, “how’s it going … have a balloon,” repeat, repeat, repeat? If you’re not careful, this can sound a little strange—especially to a guy who may already be slightly off his mental game, still coming to terms with his recent diagnosis.
Beanless diets, empty, drink, wait, lie down, roll over, “how’s it going … have a balloon,” repeat, repeat, repeat? If you’re not careful, this can sound at least a little strange …
Some aspects of proton therapy are easy to explain: the painless proton beams, short visits, patient camaraderie, incredible staff, and so on. But other parts of the experience are more challenging to accurately convey with clarity and compassion. To help you describe the proton therapy experience to prostate cancer newbies in a way that can seem more plausible, and to avoid unintentionally leaving them feeling like you’re just pulling their leg a bit with bizarre exaggerations, I have outlined some helpful tips. Keep them in mind when you are contacted as a reference or when you speak to a group about this sensitive subject.
Let’s tackle the big one first—the infamous balloon. This discussion will require referencing our rear-facing bodily orifice that goes by many names, most not fit for a blog and some too clinical for a comfortable conversation. So I’ll just call it the budoosky and trust that you’ll know what I mean.
So, how do you tell a guy that a compassionate, caring, competent pretty young lady or handsome young man will carefully insert a balloon into his budoosky on a daily basis during treatment? The picture this conjures is simply not plausible, and he will probably not believe you. The direct approach for offering this information will likely result in little more than a raised eyebrow, a smirk, and a dismissive quip like, “Yeah, right. Like I’m gonna believe that!”
… how do you tell a guy that a compassionate, caring, competent pretty young lady or handsome young man will carefully insert a balloon into his budoosky …
A better approach is to use the magician’s technique of misdirection. Don’t focus your conversation directly on the balloon. Focus instead on the balloon’s two-pronged task of stabilizing the prostate and protecting the rectal wall. Just explain that these critical objectives are most easily managed by a special (ahem) device, easily placed in proper position via the budoosky in such a way as to apply pressure to support the prostate while pulling most of the adjacent rectal wall away from it.
That will probably be sufficient, and you should move on to other topics as fast as you can. But if he happens to ask how they blow up the balloon, you must remember what he is picturing at that moment and put it to rest immediately. A quick “Hahaha, they don’t blow it up! They just fill it with a little saline” response will get you off the hook, and again, move on.
Empty and drink
You will no doubt fondly recall the ritual of emptying and refilling your bladder before each trip to the treatment gantry, commonly referred to as “empty and drink.” Like the balloon, it sounds a bit ridiculous to a newbie and again, the direct explanation will not get much traction. “Just prior to each treatment you will be kindly asked to completely empty your bladder in the usual manner, and then drink lots of water to refill it and wait thirty minutes to an hour before taking your turn in the gantry.” Really? How silly does that sound?
Here is where you can really shine and show off your technical expertise. Having already blasted through the balloon challenge, you can now expand on the prostate stabilization objective. Tell your audience that stabilization is accomplished not only via the badoosky, but also via the bladder. Consistently fill it to a predictably sufficient level and achieve a second double objective from the other side of the prostate. A full bladder applies additional stabilizing pressure from above, while pulling the bladder away from the battleground. Just like the balloon, only from a second vantage.
The military angle
Speaking of battlefields, some men facing prostate cancer treatment have a military background. They will naturally appreciate and relate well to the dual strategic objectives of stabilization and tissue protection on multiple battle fronts simultaneously. The balloon pushes up from the south, while the bladder applies pressure from the north. This effective combination could perhaps be called a pressure-and-protect strategy.
If you also happen to have a military history, take an occasional break from proton talk and digress into tales of trying times on other battlefields. This will help your prospect keep a proper perspective on the current battle at hand.
There are multiple reasons why we would want to keep a lid on gaseousness while under treatment. First and foremost, excessive internal gas can make the prostate move around even more than usual. You’ve already explained other efforts to help keep it still, so by now your prospect should understand that a moving target is not helpful and hence, neither is gas.
… there are primarily two things on our mind while lying there: bladder control and passing wind …
Thankfully, you no longer have to explain that too much gas in the tank can provide a compression problem during balloon insertion, as it might have during the early days of proton. Modern budoosky balloons have a built-in gas release mechanism eliminating most of that issue. Although it might not be so great for the radiation therapist on the exhaust side of the balloon’s tailpipe, it is fortunate that you can now take this off your list when explaining beanlessness to a proton prospect.
But there is another reason to avoid beans or any gas-inducing food. It relates not to medicine, but to dignity. While lying on the slab waiting to receive the proton beam, it is ironically not the radiation that concerns us. There are primarily two things on our mind while lying there: bladder control (as stated above, our bladder is full), and as you may have guessed, passing wind. If that occurs there is no recourse. You can’t point your finger and say “it wasn’t me” because you’re the only player on that stage.
While the bladder concern rarely becomes an actual problem, the release of unwanted aromas with the usual accompanying sound effects can be a real threat. However, it is manageable through diet, so be sure to provide a reminder about eating properly. And be clear that it’s not about the beans, per se, but about the gaseousness and flatulence. It could be peppers, onions, or spices as well as beans. Know thyself, and take appropriate measures.
Whether you are privately preparing one man for proton therapy, speaking to him and his loved ones together, or making a presentation to a group of both men and women, be delicate. You’ve been there and done that, and it all seems easy to you in hindsight. But to those yet to get the beam it can be daunting, so be gentle with them. Practice your delivery and be well-prepared to use techniques like those above when the need arises.
What did I miss? If you are proton veteran send me your additional ideas for conveying the protons-for-prostate experience in a clear but sensitive manner. Maybe I can cobble together a follow-up article. If you are just wondering about the proton experience and have a question, send it directly to me for a personal reply.