Any tips on alternative to MD Anderson?

Max Former Hodgkins Stage 3 said:

Centers

Shady, among cancer centers in the southeastern United States, Emory is among the best. It's were President Carter went for his brain tumor a few years ago. You mentiond Duke, also outstanding.  But I'd way rather be treated in the Duke area than in Atlanta, which is an endless ghetto sprawl.

The closest thing to a world-class oncology center near the Dakotas is probably The Mayo Clinic in Rochester, Minnesota.

The Moffitt Cancer Center, Tampa, is also world-class and a leader in research.

It is in Los Angeles, but City of Hope is also an elite resource; they are the people who developed Rituxan.

 

I am pretty much aware of those places except for Moffit. a former relative is an MD and is checking out something at Vanderbilt.What I would really prefer is just to pay a good doctor to spend a a couple of hours going through my mountain of records and looking for something not so obvious. I am not interested in a bunch of tests followed by a 10-minute office visit. I am in quite a bit of pain and cannot sleep which my doc says is probably from overdoing it with travel and outdoor activities. My last chemo was in late June so I am assuming its not that. Anyway, Virginia has an early 3-day bear season October 1-3 and my grandaughters birthday is tomorrow. I plan to participate in both rather vigorously. Getting a bear is not important, getting outdoors is.

Max Former Hodgkins Stage 3 said:

Gators

Shady,

The first gator season in NC in 40 years is about to end. So far, not one gator taken.  The hunters say there aren't any. NC DNR is not sure why, but the hurricane is suspected to have had some sort of effect; maybe they are just not active.

SC is swarming with gators, just exploding.

I'm a serious Second Amendment guy, but not much of a hunter.  I don't think I could or would ever kill a bear.   Enjoy that time in the forest.     Three Dog Night's Out in the Country is one of my favorite songs, ever.  Look it up and play on YouTube if interested.  Two of the lead, founding members died of cancer, one of Lymphoma, in the last few years -- sort of increased my bond with them.

max

Tons of bears around. They are very pesky at my place in the mountains. Back in May I had one climb into the bed of my pickup. They have broken into my screened in porch twice. They recently broke into the pen and ate 9 of my neighbors rabbits. We have two 3-legged dogs in the area from bear encounters. As my wife says, at our place when things go bump in the night, its probably NOT your imagination. Some of these guys are biiiiig! However my feeble attempt at hunting was in a different state, Virginia (https://www.dgif.virginia.gov/wma/highland/). VA and NC have the largest black bears in the world. They are especially large in coastal NC. I normally don’t hunt bear. Since Virginia had a special early 3-day season to try thin them out I decided to go out. Except for Alaska I hunt only muzzleloader and always hunt alone so I only shoot close to the truck. So imagine a cancer patient with 1/2 inch long hair and armed with a single shot muzzle loader sitting in a folding chair on the side of a mountain waiting for a bear to walk by. As I said the bears are relatively safe! Serious bear hunters own dogs. Could have easily gotten a deer though but the season is closed. Please forgive the off topic rambling. In the future I will PM this type of conversation.

edited for typos

PBL said:

Rituxan

Shady,

I don't think it is possible to OD on Rituxan, since it is a chimaeric monoclonal antibody produced by cultured hamster cells, not per se a "drug". As you well know, it targets CD20-expressing lymphocytes. It does not differenciate cancerous/non cancerous cells - it just attaches to the CD20 on the surface of all CD20-expressing lymphocytes and assists in their destruction. In so doing, it helps improve and prolong response to chemotherapy- which is why it is so precious for indolent lymphoma patients: it delays relapse.

However, repeated infusions/injections can end up causing immune system imbalance, which is why it is rarely administered ad infinitum.  As with "traditional" chemotherapy drugs, doctors have to arbitrate between benefits and risks for the patient.

I have not had nearly as many Rituxan doses as Leslie (or yourself, if I remember correctly), but each dose was immediately followed by painful skin symptoms, and my IgG level was too low, making me prone to shingles - for which I was kept on Valacyclovir for many months while on post-R-CHOP maintenance.

Now, six months after my last maintenance Rituxan injection, my IgG level is rising, and I have hopes that it will become normal at some point; my skin issues are subsiding; and I remain in remission from my Follicular Primary Bone Lymphoma. 

Not all is rosy, since my original lesions are still pretty much the same on imaging, and I am still struggling with pain and fatigue. But I believe it was worthwhile to go through the two-year maintenance, if only to consolidate treatment response and afford me some time to regain strength before the next round.

Kind regards.

PBL

i understand what rituxan is and what it does to lymphocytes expressing CD20. The question to me is what else does it do? There is no clear answer that I have seen to that question.

i cannot disagree with anything you say. However I believe we always have choices in that there are now several similar treatments to Rituxan. I have to wonder how they compare regarding side effects. Are there any ill effects from switching from one to the other? I know that Rituxan improves quality of life, I am certain of that. However, even though progression free survival increases, every study I have seen shows little or no improvement in overall survival. I take that to me mean that lifespan is minimally improved but quality of that life is enhanced. A very good thing.