Two articles of interest
Comments
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Follow Up Article on MD Anderson Adverse Event
I thought some of you might be interested to know more about the adverse incident at MD Anderson which was the subject of BluebirdOne's first article above. Here is a link to the follow-up article:
https://www.nbcnews.com/news/us-news/no-one-should-die-blood-transfusion-so-why-did-it-n1021506
Here is an excerpt from the article:
"In early December, a nurse at the University of Texas MD Anderson Cancer Center gave a 23-year-old leukemia patient a blood transfusion that, unbeknownst to the medical staff, had become contaminated with bacteria.
The patient’s blood pressure soon plummeted, but there’s no evidence anyone at the nation’s top-ranked cancer hospital was actively monitoring her vital signs in the crucial moments during and after the procedure, a federal investigation found. She died a little more than a day later.
The potentially preventable death drew a harsh rebuke from the Centers for Medicare and Medicaid Services, whose subsequent investigation, made public Monday, uncovered systemic safety lapses at the hospital. Nurses were not properly monitoring patients’ vital signs while administering blood transfusions, not only in the case of the patient who died, but also in 18 out of 33 other cases examined, the investigation found.
Since receiving the federal report this month, the hospital’s leaders have made changes to improve training for nurses and require hourly checks on patients during transfusions."
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Provocative article
Thanks MoeKay. It's quite a provacative article that gets me up on my soap box (sorry!) about how hospitals are the least safe place to be when you are seriously ill, but what other choice do we have?
One's first inclination is to blame frontline caregivers who weren't practicing as they were taught to do in school, but if you understood the working conditions they have to contend with, it's hard to blame just them. All of the bureaucracy involved with health care is just as much a part of the problem as workers cutting corners to keep up with what's demanded of them. Hospitals and outside labs cut more corners than they should in the name of frugality, especially when they employ lesser qualified personnel to perform tasks that they are minimally educated or on-the-job trained for. It just makes my blood boil where they say patients bear some responsibility when they've been given instruction on what to look for while recieving a transfusion. What?!! When patients need to be relied on to assist in high risk care they aren't qualified to self-administer, it's a big, fat red flag that administration is not adequately staffing their hospital. Workers do the best they can, but this is when bad things happen.
My own experience for my hysterectomy is an example of how widespread substandard health care in a hospital setting is. I had very caring people doing the best they could, but I still developed a preventable complication and was needlessly exposed to another serious one while I was a patient because staffing is minimal and some tasks are delegated to inadequately trained assistants who don't appreciate the implications of not doing a job correctly. Computerization has not helped at all; it just consumes a lot of time and impedes needed hands-on care and regular professional patient evaluation.
Health care in this country is such a complicated, overly expensive mess that just seems to keep getting worse instead of better in spite of all of the discoveries and advances that get made. It makes me wish I had that magic wand I could wave to make a do-over of where it all went so wrong, but I'm not sure exactly when or where that happened. In any case, do whatever it takes to get out of a hospital as quick as you can whenever you have to go in.
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I had seen this but wasn'tMoeKay said:Follow Up Article on MD Anderson Adverse Event
I thought some of you might be interested to know more about the adverse incident at MD Anderson which was the subject of BluebirdOne's first article above. Here is a link to the follow-up article:
https://www.nbcnews.com/news/us-news/no-one-should-die-blood-transfusion-so-why-did-it-n1021506
Here is an excerpt from the article:
"In early December, a nurse at the University of Texas MD Anderson Cancer Center gave a 23-year-old leukemia patient a blood transfusion that, unbeknownst to the medical staff, had become contaminated with bacteria.
The patient’s blood pressure soon plummeted, but there’s no evidence anyone at the nation’s top-ranked cancer hospital was actively monitoring her vital signs in the crucial moments during and after the procedure, a federal investigation found. She died a little more than a day later.
The potentially preventable death drew a harsh rebuke from the Centers for Medicare and Medicaid Services, whose subsequent investigation, made public Monday, uncovered systemic safety lapses at the hospital. Nurses were not properly monitoring patients’ vital signs while administering blood transfusions, not only in the case of the patient who died, but also in 18 out of 33 other cases examined, the investigation found.
Since receiving the federal report this month, the hospital’s leaders have made changes to improve training for nurses and require hourly checks on patients during transfusions."
I had seen this but wasn't sure if it was the same incident. My first thought when i read it was that this was surely the result of understaffing. Therefore, further nurse training, alone, is not going to solve the problem.
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Training isn't a cureLisaPizza said:I had seen this but wasn't
I had seen this but wasn't sure if it was the same incident. My first thought when i read it was that this was surely the result of understaffing. Therefore, further nurse training, alone, is not going to solve the problem.
I agree, training alone isn't going to cure anything. My recent hospital stay was hellish, with some of the worst nurses I have ever had in my life...and on an oncology ward, at that! If I started going into the details my post would cover an entire page,but my take-away was that my hospital was horribly run and mismanaged. The majority of nurses were burnt out/acting out/ and/or unsuited for their chosen line of work. One example (there are others): I couldn't move my bowels. I was offered no options until, finally when I was in tears and had been in the bathroom for an hour, I was handed a pair of gloves and a packet of KY jelly. Self-extraction worked at that particular point (sorry for TMI) but there was still, ahem, unfinished business. Every time the doctor came in and nurse reported shift change, she told him I'd had a BM. I'd pipe up to say what had happened but she continued to repeat the fiction. Unfortunately the hardened stool was causing extreme muscle pain, racheting up my need for pain killers. Finally after 3 days, I asked my oncologist about it when he was on rounds. He popped a cork: they had charted that I was having regular BM's ! Finally he ordered maximum-strength laxitives and an enema, which resolved the issue. To add insult to injury, a nurse came in later to chastise me: she'd been reprimanded by the doc for incorrect charting, and it was all my fault because I'd lied to her and said I'd had a BM. Just rereading this brings it back to me, and it ain't good. I think the major issue is the 12-hour day, which seems to be endemic. No human being is productive after about 10 hours, if that, and the 8-hour workday was set for a reason. You could tell some of them had been decent professionals at one time but were just burnt out, and that's NOT the kind of thing that "training" can fix. And, yes, I've worked in the public sector my whole life and have had to respond to investigations, and "training" is always the standard answer. But, as Connie said, the idea that you wouldn't KNOW to check someone, as part of your education and training, is unfathomable to me.
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What an awful experience! I'mderMaus said:Training isn't a cure
I agree, training alone isn't going to cure anything. My recent hospital stay was hellish, with some of the worst nurses I have ever had in my life...and on an oncology ward, at that! If I started going into the details my post would cover an entire page,but my take-away was that my hospital was horribly run and mismanaged. The majority of nurses were burnt out/acting out/ and/or unsuited for their chosen line of work. One example (there are others): I couldn't move my bowels. I was offered no options until, finally when I was in tears and had been in the bathroom for an hour, I was handed a pair of gloves and a packet of KY jelly. Self-extraction worked at that particular point (sorry for TMI) but there was still, ahem, unfinished business. Every time the doctor came in and nurse reported shift change, she told him I'd had a BM. I'd pipe up to say what had happened but she continued to repeat the fiction. Unfortunately the hardened stool was causing extreme muscle pain, racheting up my need for pain killers. Finally after 3 days, I asked my oncologist about it when he was on rounds. He popped a cork: they had charted that I was having regular BM's ! Finally he ordered maximum-strength laxitives and an enema, which resolved the issue. To add insult to injury, a nurse came in later to chastise me: she'd been reprimanded by the doc for incorrect charting, and it was all my fault because I'd lied to her and said I'd had a BM. Just rereading this brings it back to me, and it ain't good. I think the major issue is the 12-hour day, which seems to be endemic. No human being is productive after about 10 hours, if that, and the 8-hour workday was set for a reason. You could tell some of them had been decent professionals at one time but were just burnt out, and that's NOT the kind of thing that "training" can fix. And, yes, I've worked in the public sector my whole life and have had to respond to investigations, and "training" is always the standard answer. But, as Connie said, the idea that you wouldn't KNOW to check someone, as part of your education and training, is unfathomable to me.
What an awful experience! I'm so sorry you had to go thru that.
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I have workedMAbound said:Provocative article
Thanks MoeKay. It's quite a provacative article that gets me up on my soap box (sorry!) about how hospitals are the least safe place to be when you are seriously ill, but what other choice do we have?
One's first inclination is to blame frontline caregivers who weren't practicing as they were taught to do in school, but if you understood the working conditions they have to contend with, it's hard to blame just them. All of the bureaucracy involved with health care is just as much a part of the problem as workers cutting corners to keep up with what's demanded of them. Hospitals and outside labs cut more corners than they should in the name of frugality, especially when they employ lesser qualified personnel to perform tasks that they are minimally educated or on-the-job trained for. It just makes my blood boil where they say patients bear some responsibility when they've been given instruction on what to look for while recieving a transfusion. What?!! When patients need to be relied on to assist in high risk care they aren't qualified to self-administer, it's a big, fat red flag that administration is not adequately staffing their hospital. Workers do the best they can, but this is when bad things happen.
My own experience for my hysterectomy is an example of how widespread substandard health care in a hospital setting is. I had very caring people doing the best they could, but I still developed a preventable complication and was needlessly exposed to another serious one while I was a patient because staffing is minimal and some tasks are delegated to inadequately trained assistants who don't appreciate the implications of not doing a job correctly. Computerization has not helped at all; it just consumes a lot of time and impedes needed hands-on care and regular professional patient evaluation.
Health care in this country is such a complicated, overly expensive mess that just seems to keep getting worse instead of better in spite of all of the discoveries and advances that get made. It makes me wish I had that magic wand I could wave to make a do-over of where it all went so wrong, but I'm not sure exactly when or where that happened. In any case, do whatever it takes to get out of a hospital as quick as you can whenever you have to go in.
in the Canadian, and British, and US medical systems as an RN. You are receiving the best medical care in the world. Sometimes we forget that perfection is not a human quality. There will always be things that go wrong. It is a tragedy that this mistake happened while giving a blood transfusion. I don't know any of the details. But millions of transfusions are given safely too.
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Your carederMaus said:Training isn't a cure
I agree, training alone isn't going to cure anything. My recent hospital stay was hellish, with some of the worst nurses I have ever had in my life...and on an oncology ward, at that! If I started going into the details my post would cover an entire page,but my take-away was that my hospital was horribly run and mismanaged. The majority of nurses were burnt out/acting out/ and/or unsuited for their chosen line of work. One example (there are others): I couldn't move my bowels. I was offered no options until, finally when I was in tears and had been in the bathroom for an hour, I was handed a pair of gloves and a packet of KY jelly. Self-extraction worked at that particular point (sorry for TMI) but there was still, ahem, unfinished business. Every time the doctor came in and nurse reported shift change, she told him I'd had a BM. I'd pipe up to say what had happened but she continued to repeat the fiction. Unfortunately the hardened stool was causing extreme muscle pain, racheting up my need for pain killers. Finally after 3 days, I asked my oncologist about it when he was on rounds. He popped a cork: they had charted that I was having regular BM's ! Finally he ordered maximum-strength laxitives and an enema, which resolved the issue. To add insult to injury, a nurse came in later to chastise me: she'd been reprimanded by the doc for incorrect charting, and it was all my fault because I'd lied to her and said I'd had a BM. Just rereading this brings it back to me, and it ain't good. I think the major issue is the 12-hour day, which seems to be endemic. No human being is productive after about 10 hours, if that, and the 8-hour workday was set for a reason. You could tell some of them had been decent professionals at one time but were just burnt out, and that's NOT the kind of thing that "training" can fix. And, yes, I've worked in the public sector my whole life and have had to respond to investigations, and "training" is always the standard answer. But, as Connie said, the idea that you wouldn't KNOW to check someone, as part of your education and training, is unfathomable to me.
sounds like malpractice to me. Giving treatment ( a glove and KY Jelly and instructions to self extract) and not entering it in the chart is very serious. That the nurse then felt threatening you was ok makes me agree that the management of the hospital is incompetent. They are not monitoring their staff. I would go higher up and report the chastisement by the nurse. But I am that way. I am an RN and would report this. NOt acceptable. I am so sorry to hear you had care like this on top of everything else.
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You'd thinkForherself said:I have worked
in the Canadian, and British, and US medical systems as an RN. You are receiving the best medical care in the world. Sometimes we forget that perfection is not a human quality. There will always be things that go wrong. It is a tragedy that this mistake happened while giving a blood transfusion. I don't know any of the details. But millions of transfusions are given safely too.
For what medical care costs in this country you'd think we'd have the best in the world, but I can't find anything to back up that claim. We're in fact no where near the top.
Human error is one thing and on an individual, but habitual cutting of corners is another. It's the system as it currently exists that impels institutional practices that put patients at risk. The nurse Bobbi had is dishonest and shouldn't be practicing, but Bobbi has a big point about the 12 hour shifts and what's reasonable to expect of a person who works in such a physically, emotionally, and intellectually demanding job.
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I agree Bobbi's nurseMAbound said:You'd think
For what medical care costs in this country you'd think we'd have the best in the world, but I can't find anything to back up that claim. We're in fact no where near the top.
Human error is one thing and on an individual, but habitual cutting of corners is another. It's the system as it currently exists that impels institutional practices that put patients at risk. The nurse Bobbi had is dishonest and shouldn't be practicing, but Bobbi has a big point about the 12 hour shifts and what's reasonable to expect of a person who works in such a physically, emotionally, and intellectually demanding job.
was not incompetent but not following nursing practice, and should be reported to management of the hospital, especially for coming in after and telling her she should not talk to her doctor about her care. But your article is about health care systems. And they like socialiazed systems. The US has the highest obesity rate in the world, which causes us to have lower life expectancy. Along with drug abuse. My nephew is Canadian. He called us and asked us if we could get him in to see a gastroenterologist in the US. He had lost 12 lobs, had bloody diarrhea, both symptoms of bowel cancer. He was told that they didn't know when a gastroenterologist would see him. Specialists in BC don't have a public number. Your name is sent to them by a referring doctor, and they call you when they can schedule. It coudl be 3-4 months before they call. you to schedule. If the article you referred to was talking about prompt healthcare delivered, the results would be different. We did get him in to see the doc the following week, he had his colonoscopy and all is well. Imagine waiting 4 months just to get an appointment.
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We digress
Before I go any further, I just want to warn everyone that I was once a competive debater and just love the back-and-forth of these kind of discussions. I really don't want anyone to think I'm personally attacking their opinions because I believe opposing viewpoints are equally informative and helpful for others to form their own conclusions.
I had to go back and re-read the article to make sure I wasn't going off on a tangent. The article specifically states its discussing "systemic safety lapses" that are concerning "given all the advancements in technology and safety protocols over the past three decades, how can such errors still happen at even the most prestigious hospitals?"
"Sometimes we forget that perfection is not a human quality. There will always be things that go wrong." While it's true that perfection is not a human quality, it is not true that we all expect that from each other. We can be pretty forgiving when we know that we couldn't live up to that standard ourselves. The article itself states " Humans are inevitably going to make errors, but there should be systems in place to prevent those mistakes from leading to harm". Those systems are policies and procedures with adequate and the right kind of staffing to carry them out. That doesn't happen...a lot.
The issue in the article was discussing blood transfusions to make a point in the role hospital policies and practices play in patient safety. While it is true "that millions of transfusions are given safely", what many don't know is that transfusion reactions are more common than you think and thus the need for careful patient monitoring while receiving one. Fatal reactions these days are rarities, but there are other kinds of reactions of varying degrees. No one ever hears about them in the news anymore than you hear about chemo patients needing their infusions adjusted because they have a non-fatal reaction. It's the sensational stuff that gets attention.
Some may find this article from February 2019 interesting about transfusion reactions:
https://www.ncbi.nlm.nih.gov/books/NBK482202/
Getting into private pay vs. socialized medicine is a whole different debate with pros and cons of it's own. All that I'm convinced of at this point is that what we have isn't working very well and it's not currently as safe to recieve care in a hospital as you would expect it to be at even the most reputable places. My thinking is that when you do go in and are vulnerable, you really need someone there at your bedside to watch what's going on (is everyone washing their hands like they should, etc.) and to be a witness to and an advocate for how you are or are not being cared for. It shouldn't come to that, but that's the way things are. I refuse to blame front line staff for all that goes wrong because it's articles like this one that show that there's plenty of blame to go around when things like Bobbi and I experienced happens. I'm sure there are plenty of other's with tales they could share of things that happened to them that shouldn't have.
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Another good article
I think I've read similar advice before or maybe even this article since it's from 2015. I think that's why I brought up about having an advocate whenever you need to go into a hospital.
Even with such a person, things can still go wrong, but at least you might have better odds of getting out with fewer problems. The sticking point is that when you are sick or injured you are not always able to follow all of that advice and even an advocate might not feel comfortable being as assertive as is sometimes needed. Not everybody is a knowledgeable as this doctor is.
It's just not right that patients are being burdened with expectations of monitoring the care they receive or in some cases administering it to themselves because of staffing or procedural inadequacies. Moekay's advice to bring problems to administrator's attention is important because these guys aren't in the trenches to experience the issues with some of the policies and procedures they enact. For some reason I had an administrator checking in and surveying me when I was in the hospital, so she got an earful about was happening to me. I appreciated that, but never got any feedback as to whether or not any of that made a difference.
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I havent had the chance to
I havent had the chance to read this thread as well as i could but i think i get the gist of it. Im not sure how many of you know that i went with out external radiation for my stage 2 grade 3 MMMt uterine cancer. It has been over 3 years since my hysrerectomy. I have been clear wirh no reaccurances. I went with out radiation in my reslasoning was because radiation given to me for my first cancer over 20 years ago caused my uterine cancer my doctor said. I didnt see the point doing radiation again. Either way i could get cancer. My radiation doctor wouldnt do it anyways because the trearment was going to be to close to where i was radiated before. Im glad i didnt do external radiation. Thats my opinion.
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Advocates are a great ideaMoeKay said:Forherself, glad to hear all is well with your nephew
Yes, there are certainly plenty of medical treatment issues, the pros and cons of which we could probably debate forever! I'm glad that your nephew was able to get a prompt colonoscopy and found out that his symptoms were nothing serious. I understand that there are differences in how soon patients in Canada can get an appointment, especially with certain specialists, and that the wait is longer in some provinces than in others. No doubt, that is a serious issue, especially for someone with an undiagnosed, potentially serious condition or someone in pain.
My takeaway from BluebirdOne's article was that it is important to recognize that serious, even life-threatening medical issues can develop as a result of care and treatment (or lack thereof) during a stay at even the top-rated cancer hospitals. So with this information, what is one to do if declining hospitalization is not a realistic option? While perfection is not attainable, I thought that this article, "Tips from the Trenches: How to Survive your Hospitalization," makes some good points on how increase the odds that your hospitalization goes as well as possible: https://www.forbes.com/sites/judystone/2015/04/21/a-doctors-top-ten-tips-for-surviving-your-hospitalization/#7cd47536477f.
On a personal note, I remember one hospitalization in which the nurse brought me my blood pressure medicine. It looked a little different than usual, but I just wrote it off to possibly being a different generic brand. What I found out after I was discharged and obtained a copy of my hospital record was that I was given the wrong (lower) dose of the medication. While in my case, the error did not become life-threatening, in other situations it could have. That incident taught me an important lesson: Trust But Verify.
Also, I think it's important to recognize that a hospital is a business. If you've had a bad experience, after you've had a chance to reflect on the experience, think about writing a letter to the CEO of the hospital and voicing your concerns. I listen to Doctor Radio and there is a talk show on health care insurance coverage and billing issues. The Vice President for Medical Center Clinical Affairs and Affiliates who does the show often advises callers to write to the CEO of hospitals and institutions with whom they have had issues. The VP said that he is tasked with resolving billing issues that come across the desk of the CEO. He said that hospitals really do listen; they do not want to lose business. If what the VP says is true about billing issues, I believe it would be equally true about quality of care issues.
Health care has become so complicated that its hard for patients to take in everything and remember it. An advocate is awesome if you can find someone to do this. I am not sure an advocate would have saved this patients life. We just don't know because we don't know the detaiils. That is my point. And I will wait for the details before I pass a judgement on the hospital, that otherwise saves lives every day with caring hard working personnel. BUT, patients need to give written complaints when receiving poor care so the admistration is aware of it.
Hospitals are not business like every other business. They are highly regulated. They are forced to give care to any person who enters the ER whether they will be paid or not. Most business do not operate like that.
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Forherself, glad to hear all is well with your nephew
Yes, there are certainly plenty of medical treatment issues, the pros and cons of which we could probably debate forever! I'm glad that your nephew was able to get a prompt colonoscopy and found out that his symptoms were nothing serious. I understand that there are differences in how soon patients in Canada can get an appointment, especially with certain specialists, and that the wait is longer in some provinces than in others. No doubt, that is a serious issue, especially for someone with an undiagnosed, potentially serious condition or someone in pain.
My takeaway from BluebirdOne's article was that it is important to recognize that serious, even life-threatening medical issues can develop as a result of care and treatment (or lack thereof) during a stay at even the top-rated cancer hospitals. So with this information, what is one to do if declining hospitalization is not a realistic option? While perfection is not attainable, I thought that this article, "Tips from the Trenches: How to Survive your Hospitalization," makes some good points on how increase the odds that your hospitalization goes as well as possible: https://www.forbes.com/sites/judystone/2015/04/21/a-doctors-top-ten-tips-for-surviving-your-hospitalization/#7cd47536477f.
On a personal note, I remember one hospitalization in which the nurse brought me my blood pressure medicine. It looked a little different than usual, but I just wrote it off to possibly being a different generic brand. What I found out after I was discharged and obtained a copy of my hospital record was that I was given the wrong (lower) dose of the medication. While in my case, the error did not become life-threatening, in other situations it could have. That incident taught me an important lesson: Trust But Verify.
Also, I think it's important to recognize that a hospital is a business. If you've had a bad experience, after you've had a chance to reflect on the experience, think about writing a letter to the CEO of the hospital and voicing your concerns. I listen to Doctor Radio and there is a talk show on health care insurance coverage and billing issues. The Vice President for Medical Center Clinical Affairs and Affiliates who does the show often advises callers to write to the CEO of hospitals and institutions with whom they have had issues. The VP said that he is tasked with resolving billing issues that come across the desk of the CEO. He said that hospitals really do listen; they do not want to lose business. If what the VP says is true about billing issues, I believe it would be equally true about quality of care issues.
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Thanks for keeping me on my toes!Forherself said:Advocates are a great idea
Health care has become so complicated that its hard for patients to take in everything and remember it. An advocate is awesome if you can find someone to do this. I am not sure an advocate would have saved this patients life. We just don't know because we don't know the detaiils. That is my point. And I will wait for the details before I pass a judgement on the hospital, that otherwise saves lives every day with caring hard working personnel. BUT, patients need to give written complaints when receiving poor care so the admistration is aware of it.
Hospitals are not business like every other business. They are highly regulated. They are forced to give care to any person who enters the ER whether they will be paid or not. Most business do not operate like that.
Hi, Forherself! After rereading my post, I deleted the words "like any other business," as I realize now that that the deleted language wasn't the most clear and was subject to different interpretations. My point was that, in general, hospital executives do not want to lose patients, at least paying ones, to other hospitals, so that a patient's legitimate complaints to the CEO would in all likelihood be taken seriously and investigated. To make sure this is the case, if a response addressing my concerns was not received in a reasonable amount of time, I would send a follow-up letter inquiring about the status of the matter.
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No pelvic radiation
my radiation oncologist advised against pelvic radiation for me even though my gyne oncologist wanted it. He indi that they did not know the long term effects of radiation but given how much I scar that getting pelvic radiation Wouk did be detrimental to my health. So they agreed only on brachytherap. Which did eventually cause issues with my ureter.
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