Feeds:
Posts
Comments

Posts Tagged ‘lung cancer’

As a follow-up for all the overseasradio.com radio listeners (and all my loyal readers) I have posted some additional information on the topics covered during the radio program with Ilene Little from Traveling for Health.com including contact information for several of the physicians mentioned.

in the Operating Room at New Bocagrande Hospital

Thoracic Surgery

Esophageal cancer – during the segment we highlighted the importance of seeking surgical treatment for esophageal cancer at a high-volume center.  One of the centers we mentioned was the University of Pennsylvania Medical Center in Pittsburgh, PA – and the work of Dr. Benny Weksler, MD.

Dr. Benny Weksler*, MD

Hillman Cancer Center

5115 Centre Avenue

Pittsburgh, PA 15232

Phone: (412) 648-6271

He is an Associate Professor in Cardiothoracic Surgery and Chief of Thoracic Surgery at UPMC and the UPMC Cancer Center.  (For more information on Dr. Weksler, esophageal cancer, and issues in thoracic surgery – see my sister site, Cirugia de Torax.org)

(To schedule an appointment via UPMC on-line click here).

We also briefly mentioned Dr. Daniela Molena*, MD at John Hopkins in Baltimore, Maryland.

The Johns Hopkins Hospital

600 N. Wolfe Street

Baltimore, MD 21287

Phone: 410-614-3891

Appointment Phone: 410-933-1233

(The link above will take readers to the John Hopkins site where they can also make an appointment.)

* I would like to note that I have not observed either of these physicians (Weksler or Molena) in the operating room.

We also talked about several of the thoracic surgeons that I have interviewed and observed numerous times, including both Dr. Rafael Beltran, MD & Dr. Ricardo Buitrago, MD at the National Cancer Institute in Bogotá, Colombia.  These guys are doing some pretty amazing work, on a daily basis – including surgery and research on the treatment of some very aggressive cancers.

in the operating room with Dr. Rafael Beltran

Dr. Rafael Beltran is the Director of the Thoracic Surgery division, and has published several papers on tracheal surgery.   He’s an amazing surgeon, but primarily speaks Spanish, but his colleague Dr. Buitrago (equally excellent) is fully fluent in English.

Now the National Institute website is in Spanish, but Dr. Buitrago is happy to help, and both he and Dr. Beltran welcome overseas patients.

Dr. Buitrago recently introduced RATS (robot assisted thoracic surgery) to the city of Bogotá.

Now, I’ve written about these two surgeons several times (including two books) after spending a lot of time with both of them during the months I lived and researched surgery in Bogotá, so I have included some links here to the on-line journal I kept while researching the Bogotá book.  It’s not as precise, detailed or as lengthy as the book content (more like a diary of my schedule while working on the book), but I thought readers might enjoy it.

In the Operating Room with Dr. Beltran

There are a lot of other great surgeons on the Bogotá website, and in the Bogotá book – even if they didn’t get mentioned on the show, so take a look around, if you are interested.

in the operating room with Dr. Ricardo Buitrago

Contact information:

Dr. Ricardo Buitrago, MD 

Email: buitago77us@yahoo.com

please put “medical tourist” or “overseas patient for thoracic surgery” in the subject line.

We talked about Dr. Carlos Ochoa, MD – the thoracic surgeon I am currently studying with here in Mexicali, MX.  I’ve posted all sorts of interviews and stories about working with him – here at Cartagena Surgery under the “Mexicali tab” and over at Cirugia de Torax.org as well.  (Full disclosure – I assisted Dr. Ochoa in writing some of the English content of his site.)

out from behind the camera with Dr. Ayala (left) and Dr. Carlos Ochoa

He is easily reached – either through the website, www.drcarlosochoa.com or by email at drcarlosochoa@yahoo.com.mx

HIPEC / Treatment for Advanced Abdominal Cancers

I don’t think I even got to mention Dr. Fernando Arias’ name on the program, but we did talk about HIPEC or intra-operative chemotherapy, so I have posted some links to give everyone a little more information about both.

HIPEC archives at Bogotá Surgery.org – listing of articles about HIPEC, and Dr. Arias.  (I recommend starting from oldest to most recent.)

Dr. Fernando Arias

Oncologic Surgeon at the Fundacion Santa Fe de Bogotá in Bogotá, Colombia.  You can either email him directly at farias00@hotmail.com or contact the International Patient Center at the hospital.  (The international patient center will help you arrange all of your appointments, travel, etc.)

Fundacion Santa Fe de Bogota

   www.fsfb.org.co

Ms. Ana Maria Gonzalez Rojas, RN

Chief of the International Services Department

Calle 119 No 7- 75

Bogota, Colombia

Tele: 603 0303 ext. 5895

ana.gonzalez@fsfb.org.co  or info@fsfb.org.co

Now – one thing I would like to caution people is that email communications are treated very differently in Mexico and Colombia, meaning that you may not get a response for a day or two.  (They treat it more like we treat regular postal mail.  If something is really important, people tend to use the phone/ text.)

Of course, I should probably include a link to the books over on Amazon.com – and remind readers that while the Mexicali ‘mini-book’ isn’t finished yet – when it is – I’ll have it available on-line for free pdf downloads.

Advertisements

Read Full Post »

Not all conditions are curable, and not all treatments are curative. Some treatments are based on improving quality of life, and alleviating symptoms. This is a hallmark of patient centered care – doing what we can to make the patient feel better even when we can’t ‘fix’ or cure the underlying disease. No where is this more evident than in the treatment of malignant effusions.

By definition, a Malignant Effusion is the development of fluid in the space next to the lungs related to an underlying (and sometimes previously undiagnosed) malignancy. Malignant effusions can be seen with several different kinds of cancers, most commonly lung and breast cancers. The development of a malignant effusion is a poor prognostic sign as it is an indicator of metastasis to the pleural tissue/ space.

The development of a malignant effusion usually presents with symptoms of shortness of breath. While the treatment of the underlying cancer may vary, the primary goal of treatment of an effusion is palliative (or symptom relief). The best way to relieve symptoms is by removing the fluid.

This can be done several ways – but each has its own drawbacks.

Thoracentesis:
The fluid can be drawn out with a needle (thoracentesis) either bedside or under fluoroscopy. The potential drawbacks with this treatment strategy are two-fold:

1. There is a chance that during the procedure, the needle will ‘poke’ or ‘pop’ the lung, causing a pneumothorax (or collapse of the lung). This then requires a chest tube to be placed so the lung can re-expand while it heals. However, if the procedure is performed uneventfully, (like it usually does) the patient can go home the same day.

2. The other complication – is rapid re – accumulation – since you haven’t treated the underlying cause, but have only removed the fluid. This also happens when the cause of the effusion (nonmalignant) is from congestive heart failure. This means the fluid (and symptoms of shortness of breath) may return quickly, requiring the patient to return to the hospital – which is hard of the patient and their family.

Video- Assisted Thoracoscopy:
Malignant effusions can also be treated by VATS – this is a good option if we are uncertain of the etiology (or the reason) for the effusion. While all fluid removed is routinely sent for cytopathology (when removed during surgery, thoracentesis or chest tube placement) – for cytopathology can be nortoriously inaccurate with false negative reports, because the diagnosis is dependent on the pathologist actually seeing cancer cells in the fluid). I have had cases in the operating room (VATS) where the surgeon actually sees the tumor(s)** with the camera but the fluid comes back as negative.

** in these cases, we send biopsies of the tumor tissue – which is much more accurate and definitive.

But a VATS procedure requires an operation, chest tube placement and several days in the hospital.

Chest tube placement:
Another option is chest tube placement – which also requires several days in the hospital..

During both chest tube placement and VATS, a procedure called pleurodesis can be performed to try to prevent the fluid from re-accumulating.

But what if we know it’s a malignant effusion? What are the other options for treatment?

Catheter based treatments:
(note: catheter means a small tube – a foley catheter is the type used to drain urine, but other types are used for many things – even an IV is a catheter.)
One of the options used in our practice was pleur X (brand) catheter placement. This catheter was a small flexible tube that could be placed under local anesthesia – either in the office or the operating room – as an ambulatory procedure. After some patient teaching, including a short video, most family members felt comfortable emptying the catheter every two or three days at home, to prevent fluid  re -accumulation (and allowing the patient to continue normal activities, at home.)

Sometimes a visiting nurse would go out and empty the catheter, and in several cases, patients would come to the office, where I would do the same thing – it was a nice way to relieve the patient’s symptoms without requiring hospitalization, and several studies have shown that repeated drainage often caused spontaneous pleurodesis (fluid no longer accumulated.) We would then take the catheter out in the office.. Now, like any procedure, there is a chance for problems with this therapy as well, infection, catheter can clog, etc..

But here’s another study, showing that even frail patients benefit from home-based therapy – which is important when we go back and consider our original treatment goals:
-Improving quality of life
-Relieving symptoms

In the article, the authors used talc with the catheters and then applied a heimlich valve, which is another technique very similar to pleurX catheter placement.  (Sterile talc is used for the pleurodesis procedure – which we will talk about in more detail in the future.)

Read Full Post »

As many of you know, this site was originally developed to help promote my first book, and to talk about medical tourism. But since the completion of this book – we’ve begun posting articles, and discussions on different medical topics, some related to medical tourism, some not. I’ve tried to include pertinent medical research, and we’ve talked about popular medical topics in the mainstream press. I hope that these discussions have been informative, and helpful.
Much of it has been cardiac surgery and cardiology related, since that is my background. But my other true interest is lung surgery, and the treatment of lung diseases.

The responses I’ve gotten from readers have been great. So, I would like to ask that readers participate in some of my new polls, so I know where your interests lie, and what you want to hear about, if and what your questions are.

I also want to know, is there a need or an interest in a new Lung surgery portal – to focus on and talk about topics related to Lung Surgery; from new and emerging research and procedures, to pre & post operative care, and all points in between. So either drop me a comment or participate in the new polls to let me know what you think.

Read Full Post »