Bob and Dr. Holick discuss their experiences with radiation therapy, sharing practical strategies for managing treatment and reducing side effects. They highlight the importance of preparation, understanding potential short- and long-term effects, and working closely with the care team to support recovery.
Bob Hollander:
The first day, the very first day of radiation, it was a little challenging. I guess I got acute radiation nausea. So I was radiated at 7:30, 8:00. My teaching round started at 9:00, they went from 9:00 to 11:00. And at 11:15 I was puking in one of the bathrooms. I got a prescription that afternoon for Zofran, ondansetron, oral tablet, which worked remarkably well. And I was able to go about my business after that without puking. Anorexia, loss of appetite from the radiation, was a serious thing, which was actually sort of a mixed blessing because I had gained substantial weight from the androgen deprivation. And this was in spite of me cycling like hour and a half to two hours a day. I had put on 25 pounds, which really freaked and grossed me out.
So it was like, "Oh yeah, anorexia from radiation. Let's lose some weight." And, again, that was sort of a mixed blessing. Monday through Friday was really unpleasant and it was kind of nice on the weekends to have a break. I'll add one more thing about radiation is I've had some long-term side effects. I've got this predilection now for skin infections around my perineum, which is most certainly exacerbated by my cycling. It was never an issue before the radiation and it happens a couple of times a year after radiation.
It's not that much of a big deal. Some oral antibiotics takes care of it. But the other issue that I've had to deal with, and this first started about three or four years ago, is small bowel obstructions. So one of the potential consequences of radiation is inflammation, low level inflammation inside the abdomen in the peritoneal cavity, which can cause fibrosis, scar tissue, to build up inside the abdomen. And sometimes the scar tissue can cause a loop of bowel to get trapped causing bowel obstructions. Yeah, so it was a bowel obstruction. And it turned out that radiation therapy is a common enough risk factor pathway to bowel obstructions in me. So I learned something.
I've had about four or five other bouts since then, but I've dealt with them at home. The management to a bowel obstruction is really pretty simple, nothing by mouth and then fluid metabolic support by vein until the obstruction resolves. So I'm obviously not giving myself IV therapy at home, but I would just deal with it at home, hoping that it would resolve before I show the clinical signs of dehydration. So I would follow my urine output and heart rate looking for evidence of volume depletion. And fortunately, it never happened. The obstruction would resolve after like six to eight hours. Anyway, the point being is that was just one of the other complications that I'll probably continue to have as a result of the radiation. And I've been lucky so far in that each bout has so far resolved spontaneously. Maybe I'll never have another one.
Dr. Michael Holick:
So, again, my thinking was that how can you help mitigate or prevent many of these? Well, one of the ways of course is, and that they recommend is that you go on MiraLax. And so what it does is it's a material that when you're swallowing it, you don't absorb it, but it absorbs water in your colon so that it makes your stool very kind of loose. And so when you go for the radiation therapy that your colon is not really full so that when you're getting blasted by radiation therapy, you're not affecting it as much. Less likely to have GI complications including pain and GI bleeding. And then I thought you have to also take 16 ounces of water before you have your therapy because what you want to do is have a full bladder. Now you would think if you have a full bladder that that would even make it worse.
But no, what it does is it actually raises your bladder. And so as a result, when you're being irradiated around the pelvis, the prostate and the lymph nodes, then the bladder being elevated minimizes the complications associated with it. Well, what I did was I took it to the next step because my thinking was, A, if I walk about five to eight miles, which I did every morning, so I got to the hospital at Brigham and Women's Hospital around 5:00 in the morning. I was scheduled at 8:30 in the morning. So I walked for two hours around the campus or, when it was snowing outside, in the hospital. It does two things. One is it actually increases bowel movement activity. I also took an hour before, not 16 ounces, but 32 ounces of water because I wanted to make sure my bladder was completely full.
And so 10 minutes before my appointment, I would then have complete elimination of my colon and have a very full bladder. So I started going through radiation therapy. And what they have is that you meet a radiation oncologist once a week and you have to fill out all of what symptoms that you're experiencing as a result of the radiation therapy. And I said, "I don't have any symptoms at all," first week and second week and third week, fourth week, fifth week. And so the final meeting, he said, "It's amazing that you've not had any symptoms. You really sailed through this very well." And I said, "Wait a second. Are you sure that you turned the machine on?" And he said, "Oh, don't you know? Your insurance company doesn't cover that. You have to pay extra for that."
And so that was kind of the joke, but I had zero complications from the radiation therapy. And I think it's because I was fully prepared every day. And so as a result, for men thinking about the consequences of radiation therapy, which are really, when you listen to these, can be quite severe, at least for me, I was able to get through this.