Aquarius, Please Bear With Us
Managing Hydration During Prostate Cancer Radiation Therapy
“Are you ready?” every one of us hears in the waiting room of the prostate radiation treatment center. “Do you feel the urge?” the nurses frequently ask, trying to sound sympathetic but within earshot of everyone in the waiting room. And when these guys are older and their hearing is failing, these beleaguered medical professionals have to repeat themselves even louder. Then it sounds like an exasperated parent dealing with their three year old who is in-between meltdowns with an eminent bladder accident.
“Are you ready?” even the receptionist asks the guy standing before her who is leaning against her sign-in counter, with his eyes nervously darting back and forth from her face to the therapy room door beyond.
That’s what we are all reduced to in the mandatory task of keeping our bladder filled with water in order to tighten it up with water in order to keep it from sagging down over the prostate during the radiation delivery.
We never saw that coming and there aren’t even Cliff’s Notes or “Hydration Preparation for Dummies.” Since grade school when we were frantically waiving our hand, trying to get our teacher’s attention for permission to pee, it has always been the same. Through the years, we’ve rarely got caught short, having to urinate but having no place to go. Whenever we felt the call, we just went to the nearest restroom. Like our ‘videos on demand,’ we are used to urination upon demand.
Now, having been told to drink one-and-a-half 25 ounce plastic containers of water one hour before your therapy, it seems like a setup for failure. Through the years, we have had no practice in ‘holding it.’ We’ve always just gone when we’ve had to go. That’s why every building structure in our society invests in ample restroom facilities. ‘When you to to do, you got to go.’
So suddenly, within one week’s time of being told that you’ve got a diagnosis of prostate cancer, you’ve got to learn how, for the first time in your life, to make yourself have a full bladder and not urinate through your pants and look like a complete idiot. Every guy going through radiation therapy for prostate cancer finds himself in this predicament. You’ve got to do this for the initial cat scan and MRI alignment of the radiation equipment. You’ve got to do this every day for each of the ensuing 45 days of treatment. Every day! Rain or shine, snow or hail.
So this is a new experience for us with no prior training. We essentially have one week from the diagnosis to the initial equipment setup to get this right.
On the day of diagnosis, we’re told, by a cheerful and well-experienced nurse practitioner, that “my guys drink one-and-a-half these containers one hour before treatment; . . . you want to feel the urge before you go into treatment.”
As you hear her refer to “my guys” it sounds endearing. It sounds somewhat comforting, like a nurturing hen gently but confidently gathering her chicks under her protective wings. And when you’re getting used to your new cancer diagnosis, perhaps even “intermediate” or “advanced” cancer diagnosis, you’ll take all the nurturing that’s available.
But that’s essentially it in terms of instruction. Having heard the level of fluid you’re supposed to down, you want to be like the rest of “her guys” so you put that in your daily check list. But you have no idea what it means “feel the urge” other than feeling the need to urinate.
The first time you try it, you discover there is a range of “feeling the urge” from ‘Oh my gosh, I better be near a bathroom’ to ‘Holy shit, how am I supposed to not wet myself in front of all these people?’
This is totally new ground. You wonder if they did this to prisoners of war to break them down. No matter how accomplished you’ve been in your career; no matter how close you are and have been to your friends and loved ones, you are now forced to be in a miserable and potentially socially embarrassing circumstance seemingly beyond your control. <em>Make yourself have to pee but you can’t and you’ll have to wait!</em>
One thing that lurks in the back of your mind is if you don’t have enough water suspending your bladder up away from your prostate, the radiation could burn your bladder if it didn’t have enough water and sagged down in the way of the radiation beams aimed at your prostate.
Actually, this fear is unfounded, I’m told by Chris, the radiation technician. “We can see how full your bladder is as we begin and we simply wouldn’t do it if you were not hydrated. We’d make you go out and drink some water in the waiting room so you’re always safe.” (Which happened to me at my 3<sup>rd</sup> treatment.) But more on that in a minute.
Having to drink more water before therapy begins apparently happens so frequently, that they’ve got a water cooler in every waiting area. We are the water bearers — this is the age of Aquarius — at least for next several weeks.
This, of course, is better this than a slow and miserable death, some years later, by prostate cancer that has metastasized to your vital organs — right when you were starting to enjoy your relationships, your life, dance at your kid’s weddings and attend your grandchildren’s graduations.
So what are the tricks to “mastering” your bladder control for the sake of your radiation therapy?
If you ever participated in a competitive sport, you’re in luck. You had to do a lot of things to make the team and thrive on the team. You had to:
- Get in shape and exercise
- Pay attention to your diet
- Practice, practice, practice
- Keep it constantly in your head that you can’t do it alone but are on a team that functions interdependently
Here are some straight-forward bits of advice that embody the above four tips.
Whatever shape you are in is what you’ve got. Remember, you have a matter of days from the time you’re diagnosed until you’ve got to get used to having enough water in your bladder to push it up out of the way of the instrumentation. But regardless of your physical condition, at least start walking. Get your muscles and body, in general, to the point of having oxygen and blood going through it to get as good a circulation as possible. You already know you should have been doing this for years but start now if you haven’t already. It makes a difference on a number of levels. Our bodies are complex chemical and nutritional exchanges, all of which helps every bodily, emotional and intellectual function that makes up who we are.
You already know what irritates your bladder — coffee and any drink that has caffeine. There’s caffeine in chocolate. Immediately eliminate all of them from your diet (at least until after you’re cancer-free). Get a grip and take aspirin if you get caffeine-withdrawal headaches but discipline yourself to do it. It makes a huge difference in helping you go through this therapy.
The practice part of it has to start immediately. Being told to drink 1.5 bottles of water one hour before therapy is almost no help unless you put yourself on a timed schedule and record how many oz. you drink; what time you drank it, what time you first realized you felt you have to urinate and at what time you could no longer hold it. That’s three points in time.
You almost have to do this once a day as an experiment because you can’t really do this two or three times in one day. You’ll be hydrated from your first try and any time you try it later that day will not be helpful in your calculations. It will probably take you 4 or 5 days to figure out how long it takes you to feel your bladder full, how many ounces it takes and how long you can hold it until you must relieve yourself.
This obviously takes a disciplined focus and commitment to learning how your body handles water. Each of us are different and it has to do with our level of exercise, when we drink the water, our weight and our level of anxiety.
For my particular body weighing in at around 170, it took me 7 days to find out that if I drank 28 ounces of water, in 40 minutes it would trickle down and my bladder would feel full and I could hold it for another 30 minutes.
The Breakthrough Fact About Hydration
One time early in my therapy, I was waiting for my turn and I absolutely couldn’t hold it any longer and went into the restroom and let out what I thought was most all of my bladder. I fully expected they’d tell me to go back out to the waiting room and drink 3 cups of water and wait for about 15 minutes. But they didn’t.
They had me come in and get on the table and they could see how much water was in me with their imagery equipment. It was enough, even though I thought I had urinated out everything that was in my bladder.
“It’s because you were hydrated enough. And don’t forget, it takes a while for what you drink to make its way down to your bladder.”
“You were hydrated enough” was the pivotal phrase that turned everything around for me. This is because at the beginning, all I thought was involved was drinking a certain number of ounces of water so many minutes before the therapy. Instead, it’s about hydration. It’s about getting your body hydrated, having enough fluid running throughout your system so that when you begin drinking your water at a certain time (before the therapy), you will not be starting from zero hydration.
That’s why they say that most of the time, guys come in there on Mondays, after a weekend of not drinking their usual daily fluid for therapy, they are less hydrated than the rest of week when they’ve been consciously drinking for their therapy sessions. Mondays see the most incidences of patients being sent back out to the waiting room to drink more water.
So how to you maintain hydration? In your experimentation, drink other fluids earlier in the day before you drink your water before therapy. You might ordinarily have a protein-blueberry shake at breakfast. You might have a glass of water or green tea with you your eggs or cereal. Whatever you drink at the start of the day, keep doing it and also practice drinking your pre-therapy container of water.
Ideally, by the time you go in for your first session where they calibrate the radiation machine, you should have a pretty decent sense that when they do it, you will be in the zone where your bladder has a lot of water in it but you’re not going crazy trying to hold it. You should be hydrated and that you could hold it another ten minutes or so.
And suppose you can’t? Suppose you have to urinate and you just do?
No problem. If you’ve been drinking fluids throughout the day, you’re already hydrated. IT ALL DOESN’T ONLY DEPEND ON THE WATER YOU DRANK IN THE LAST HOUR TO FILL YOUR BLADDER.
This was startling new information to me that I didn’t get when I was initially told to drink so many ounces of water so minutes before the therapy. After a while, I confidently urinated right before my therapy time and because I was hydrated enough, it was usually determined that I had enough water in my bladder for the treatments.
But I got to this point only with help from the radiation technology team. If you are not hydrated enough, they’ll send you out for a few drinks of water and a few minutes wait. But in the process of experimenting, perhaps by the 2<sup>nd</sup> or third treatment, you’ll learn exactly how much water (or liquid) before treatment you’ll need and the timing. Learning to fine-tune this process truly takes a team effort. It is a training task that you, primarily, have to do yourself but you have to have the radiation technicians helping you make those final adjustments.
That’s why I’ve used the sports analogy. Most all of it is on you to get in shape and discipline and do what you have to do in order to get hydrated and be in touch with your own bladder. But you need the team around you to make it happen.