In the Recovery Room, a Nurse and a member of our physician staff will review this information with you and answer any specific questions you may have. Activity You will be instructed not to drive a vehicle for twenty-four hours after your implant, because you have received anesthesia. Heavy lifting and straining, bicycle riding and horseback riding should be avoided for two weeks to prevent any bleeding or movement of the seeds. You may bathe or shower any time after your implant. Warm baths may be used to ease any perineal discomfort that you may experience Diet A regular diet is suggested unless you are on a special diet for some other reason. The nurse can provide you with information about items that may have an effect on bladder irritation. While it is not necessary to eliminate these items completely, you may wish to decrease the amounts consumed, especially if you are experiencing bladder symptoms. Medications that may be prescribed after your implant Please note that these prescriptions will need to be filled and the medications started the day of your implant. Antibiotics: e.g. Cipro, Bactrim, or others, are given to prevent infection, and they should be taken until they are gone, usually for about one week. Occasionally, an allergic reaction may occur. Call your Urologist if you develop a rash or any unusual reaction. Anti-inflammatory drugs: e.g. Aleve, Toradol, Celebrex, or Medrol, help to reduce the inflammation and swelling in the prostate to improve urine flow and may help to relieve any discomfort you may experience. Aleve and some others are over-the-counter medications that you may need to take for several weeks or more to help with urinary symptoms. You will be given instructions regarding how much and how often you will need to take this medication. Other anti-inflammatory medications, such as Toradol, Celebrex, or Medrol, may be prescribed by your physician. Any anti-inflammatory medication may upset the stomach and should therefore be taken with food. If you develop stomach or abdominal pain or have black stools after use of this medication, discontinue it and inform your physician. For these and any other pain relievers, if you generally consume three or more alcoholic drinks per day, you should notify your physician for advice on when and how you should take the medication. Medications to improve urinary flow: e.g. Hytrin, Cardura, or Flomax, help to relax the muscles in the bladder and around the urethra to improve urinary flow. A possible side effect of this medication is the lowering of your blood pressure that may, initially, cause you to feel lightheaded or dizzy. Should this occur, sit or lie down immediately until the sensation passes. Once your body adjusts to the medication, dizziness and lightheadedness should no longer occur. Be aware that a lowering of blood pressure may be accentuated by hot weather, alcohol, and exercise. If dizziness is severe, contact your physician immediately. This medication is usually taken for several months. Do not discontinue use of this medication without first consulting your urologist. Mild Pain Relievers: e.g. Tylenol 325 mg, or Tylenol Extra Strength 500 mg., are over-the-counter pain relievers. You may take 1-2 tablets every four hours as needed for pain. This medication may be taken with Aleve. Note: Aleve can be used for both pain and inflammation. Implant Side Effects - Needle Puncture Sites The perineum may be tender, swollen, bruised, and may bleed slightly. You may notice swelling and bruising on the penis and scrotum as well. This is quite normal and will resolve usually within the first week to ten (10) days after your implant. Implant Side Effects - Urinary Symptoms After a prostate implant, it is common to experience some difficulty with urination. You may experience some burning when you pass urine and notice some blood in the urine. Any bleeding usually resolves within 48 hours. If it should persist beyond that, notify your urologist. Other common urinary symptoms are: frequency (a need to urinate more often), urgency (a strong desire to urinate), a decreased force of the urinary stream, and difficulty starting the urinary stream. Rarely, a complete blockage of urine may occur. If this should happen, you will need to see your urologist or go to the emergency room to have a catheter placed in your bladder to allow the urine to flow. In most cases, the urinary side effects are moderate and resolve in a few weeks up to a few months. The initial urinary side effects are caused by inflammation and swelling from the implant. Delayed urinary symptoms often begin 7-10 days after the implant, and are due to the effects of the radiation. Urinary symptoms may last for several months. Most symptoms, however, are completely resolved by 6-12 months. Urinary symptoms will decrease in intensity as the seeds lose their strength. Some patients (5-10%) require a catheter for several days and very few patients require catheterization for a week or more. Implant Side Effects: Rectal Symptoms Rectal symptoms are relatively uncommon. Occasionally some constipation, diarrhea, or small amounts of blood may occur. If these symptoms become bothersome, call your physician. It is a good idea to keep your bowel movements soft. Drink plenty of fluids, eat fresh fruits and vegetables, and include foods high in fiber in your diet. You may take Metamucil, Milk of Magnesia, or other over-the-counter laxatives if needed. These symptoms usually resolve as the radiation in the seeds decays. If you are experiencing rectal burning, you can use Anusol suppositories that can be purchased over-the-counter. If your symptoms worsen or persist, call your radiation oncologist. Implant Side Effects: Sexual Side Effects · Sometimes initial ejaculations may feel different or painful and the ejaculate may be temporarily discolored dark brown or black. It is recommended that you wear a condom for the first two (2) weeks following the implant for sexual activity. These changes will resolve over time, however the amount of ejaculate will diminish after the implant. Some men can develop problems with erections after the implant. Please feel free to discuss any concerns you have with your urologist regarding erectile dysfunction. Radiation Safety Precautions Seeds typically produce radiation levels well within the safety guidelines from the Nuclear Regulatory Commission. The amount of time small children spend on your lap should be limited. Pregnant women should stay at least one meter away. At this distance, there is no limit on the time they can spend with you. You and your partner may continue to sleep in the same bed. You may resume intercourse when ready, with the recommendation that a condom is used for the first two weeks following the implant. There are no precautions for the general public and pets. FYI: Radiation seed implantation does not cause hair loss, weight loss, or extreme fatigue associated with some forms of radiation therapy. Follow Up You should have a follow-up visit with your urologist and radiation oncologist according to their recommendations. This information will be included in your discharge instructions. The day after the implant, you will have a CT Scan (computerized tomography) done in the Radiation Oncology Department at the Lucy Curci Cancer Center. The CT Scan is performed as a follow-up to your implant. You will not receive a report for the CT scan as you would if it were done for testing purposes. The information from the CT scan is used to compare the original plan for placement of the seeds with the actual location of the seeds in your prostate. Both our physics staff as well as your Radiation Oncologist will review the films. This information will become a part of your permanent record and will be available for follow-up visits. FYI: There is no preparation required for this follow-up test.