What's Wrong with Healthcare?

Thinking inside and outside of the healthcare box. After 41 years of family practice, what's happened to Canada's healthcare system?

Sunday, September 09, 2007

Incredible Medical Avances

Chapter Three: Searching For Information.
I find the starting of a project is always by far the most challenging (where to start?). Yes, I know you can go to the internet and find reams of material, but two problems arise; the first is to know the validity of the information obtained, and the second is to obtain the most recent available information. I basically took three approaches:
1) I combed the medical literature, not just for neuroendocrine tumors and their treatments, but the treatment of cancers, in general, spread to the liver, and the liver lesions themselves, since I still felt that reducing “tumor load” in this patients’ case, was key to his longevity.
2) I looked at pharmaceutical sites and reviewed the research that they were doing in various fields,
3) And I contacted a specialist in respiratory diseases that I knew and respected. It certainly was an advantage that he also sat on several international committees that dealt with respiratory disease and therefore knew which centers were highly regarded for treating lung cancer.
Meanwhile another physician friend of my patient did some medical searching as well and forwarded me huge numbers of trials which I reviewed. Unfortunately, most of these trials had been completed in 2002 and 2003, and therefore had been started several years prior, thus making them considerably outdated.
My main concern on the short term was from the effects of the hormones on the heart so an echocardiogram was arranged and reported as normal. The second concern was of a major pulmonary bleed, since my patient was coughing up significant amounts of blood at this time. A referral was made to an excellent interventional respiratory specialist (not the surgeon seen at the cancer clinic previously) and a bronchoscopy was performed and appropriate cauterization done. The patient tolerated the procedure well and was much improved from a coughing blood perspective. I contacted one of the specialists at Calgary’s “specialist” hospital and was quoted a mortality rate of five percent with embolization of this patients’ primary liver tumor. I requested a meeting with the physician in question and was told that the risks would be discussed with the patient prior to doing the procedure and a meeting was not necessary. Mr. L.D. did not accept these risks without a meeting and time to consider, and I concurred. This ended my resources within our public system.
As a physician I am probably more aware of the amazing things happening in medicine than the average person, but I must say, the research going on around the world is phenomenal, even to a physician. Some research and a researcher in Frankfurt Germany were written up in an issue of the Medical post. He was treating liver cancers with a laser probe. I was able to obtain his E-Mail address from the internet and sent him some of the info on my patient. Within 30 minutes I had a response to my enquires along with three research studies that he had done consisting of 700 plus patients. In these studies many patients had 18 months added to their life expectancy. Unfortunately, the largest tumors treated in these studies were eight centimeters in diameter and, as previously mentioned, my patients’ main liver tumor was 18 by 20 centimeters and far too large to treat in this fashion. He did mention that a fellow researcher of his did chemo-embolization and often would shrink the tumors down to a size that could then be laser treated. He forwarded additional research information. Instead of obstruction the arteries to the liver tumors completely, this protocol identified the artery supplying the tumor, injected chemotherapy into the artery (and thus the tumor), and then injected a sludge like substance that would clog the small arteries of the liver tumor and delay the exit of the chemotherapeutic agent. Using this technique a tumor reduction of up to 70% was obtained in some patients. Interestingly, the mortality rate was a fraction of one percent.
At the end of a considerable amount of literature review by myself and Mr. L.D.s’ other physician friend, and upon the advise of my internationally recognized respiratory specialist friend, arrangements were made to consult with the Anderson Cancer Center in Houston Texas. Information between me and a physician at the clinic was exchanged and test results including C.T.s, X-rays, blood work, etc was forwarded on with the consent of my patient and they felt they could offer him some realistic hope. An appointment was arranged.

Next Edition: Some surprising information.

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