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UK vs American treatment

silent
Posts: 5
Joined: Feb 2015

Hi everyone, I am a 63 year old male from the UK and have just been given the good news that I am in remission from NHL after 8 R-CHOP cycles.

I am a bit curious about any differences between treatment in the United States and the UK.

I notice that in the US it seems standard to use a port for chemo infusions, is this correct? Here in the UK we have a needle into the back of the hand for every cycle. A chest port is only used if there is persistant difficulty in finding a vein.

We also do not have to worry about Health Insurance, as we have the National Health Service, which provides all treatment free of charge. It amazed me what the cost of chemo drugs is...are you guys automatically covered for chemo drug treatment? It would seem very harsh if you weren't.

I would like to wish a successful outcome to all those undergoing frontline treatment, I am still very euphoric from my own good news, and all the side effects, hair loss, peripheral neuropathy etc have been worth it. Smile

Valvalsdad
Posts: 4
Joined: Feb 2015

Hello, my wifes doctor's here in the US are from France and Russia. She has a pickline beacuse of a mass and blood clots.

Anonymous user (not verified)

Administration of the CHOP regimen here in the USA generally involves a port unless the patient objects to it. Rituxan therapy only does not normally involve a port. The port is for protection against necrosis, blood vessel damage, bruising and/or blood clots in the patient. Most people with FNHl are in their late 50s or 60s and bruising/clots are a major threat. Also once the port is installed it can stay in case new therapy is required. I had a female relative who refused a port and she died of a stroke from blood clots during her second session of CHOP therapy. Downside is that they cost money to be installed and they also require flushing periodically.

silent
Posts: 5
Joined: Feb 2015

Thanks GKH for your information regarding the use of ports in the US. When I asked my chemo nurse why they don't use a port as standard practice in the UK, she said it was due to the elevated risk of infection. After your comments, I am inclined to believe it is down to cost! (Aren't most things). They did always have difficulty in locating a vein in my case, sometimes it took 3 attempts on each hand. Lots of muttering about 'valves'. Mind you, we all become human pin cushions through the various stages of cancer diagnosis and treatment. Once again, thanks for your input.

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3473
Joined: May 2012

Silent,

Many chemo drugs (Vinblastine, Vincristine, Mustargen, and many more) are VESICANTS, or "blister agents."  My cancer clinic, and many others in the US REQUIRE a port for the administration of vesicant drugs, but not all do.  Leakage of many chemo drugs can cause rapid tissue death, and some even require cutting out  of the contaminated area if spilled, so putting these drugs into a tiny vein in the hand is far from ideal.  A port is much better for the veins involved.

I wore a port for seven months, and it never bothered me at all, but some people seem to view them as a great ordeal. 

The first-ever chemo drug was Mustargen, the WW II chemical warfare agent, better known as Mustard Gas.  And the first-ever form of cancer it was used against was Hdogkin's Lymphoma, beginning in secret trials in 1942.  Mustargen is still in common use today for those diseases, although in its weaponized form it is severely controlled by International conventions.   I don't want it inserted into a flimsy needle in my hand, however.

History of Mustargen in WW II:

http://en.wikipedia.org/wiki/Chlormethine

On Mustargen specifically, which is in the MOPP combination therapy, and others:

http://chemocare.com/chemotherapy/drug-info/Mustargen.aspx#.VOzp1l05C70

I like your screen name.

I did a career in the submarine service, which is nicknamed "The Silent Service."  I did mostly under ice missions, and the picture is of a boat surfaced under the polar ice cap. The photo is from astern, and the broken ice just in front of the photographer is where the rudder broke through the ice. If you look carefully, there is a guy off to the far right of the picture standing on the ice also. As they say, "Long and black, and never come back."  The day I arrived on my first boat, a fellow welcomed me aboard, and said, "We were at sea 274 days last year. Of the 100 days we had in port, every third day is 24 hour duty on board, so the average guy had 30 days of free time to see his family all year."

We used to go to Scotland frequently (Sub Base at Faslane, and to Holy Loch also, in Dunoon). The girls in Dunoon so loved the American sailors.  I enjoyed the stops at the English Base at Portsmouth very much also, on the English Channel. I recall going and seeing Charles Dickins' home there.  

The Bristish subs are very similiar to the boats in the US fleet, most technology is shared, of course.  The Brit officers used to ride "Up North" with us on occasion.... Never could get used to the British Ale, being a fan of German lagers instead.  Who can drink beer warm ?

max

 

 

 

 

silent
Posts: 5
Joined: Feb 2015

Max,

I believe the CHOP regime does include a vesicant drug - Vincristine (Oncovin), and yes, they were always careful to avoid tissue damage, and constantly checking that I kept my hand/arm perfectly still with a pillow for support, and several 'backflow' checks on the cannula. I am beginning to wish now that I had insisted on a port!

I did ask once why they use the back of the hand instead of higher up the arm, as for my bloods they always found a vein first time in the crook of my elbow. I was told it is standard practice to start at the hand, as if they hit a valve they cannot go below the point of the first insertion, and have from the wrist to the elbow for further attempts.

So you were a submariner...hats off to you, it's an environment I don't think I could endure. I was in the Military (Airborne), and remember doing a jump in Scotland at Gaelochhead near Helensburgh. We visited a Naval base in that area - I'm certain it was a sub base but I can't remember the name. You are not alone in finding British Ales not to your taste...in fact, most people drink Lager here (including me).

I have had a few trips to the States myself and have always found the people to be very friendly..in fact, as a celebration of my remission, I went to the Mardi Gras in New Orleans - just got back a couple of days ago. My nephew also trained as a Navy fighter pilot with the US Navy in Pensacola Florida and Meridian Mississippi. I went to his 'winging' in Meridian and had a great time there also.

By the way, reading some of your other posts, it seems as if you have really been through the cancer grinder. Makes me feel fortunate that I had it easy - relatively speaking.

 

 

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3473
Joined: May 2012

 Silent,

I found everyone in both England and Scotland to be delightful, no bad experiences. 

I do not know why the hand is the site for infusion, but a friend whom I took for prostate cancer infusions for about a year before his passing always got it in the hand, except for a brief time in ICU, when they put in a PIC Line (under the arm).  And, when I went into the hospital a month ago to have my prostate removed they insisted on the hand also, so there must be sound medical reasons for it.  I was run over by a car decades ago, and during my 25 days in ICU (most of the time on a ventilator), they were always taking arterial blood gasses, which was the most god-aweful, painful thing I ever experienced.  Blood draws from the large artery in the arms (both arms). Even with shunts installed in the arteries, it was terrible.

I do not know the town of Helensburgh, but Faslane is the main UK Sub Base in Scotland (perhaps the only one), and is on the west coast, well above Dunoon.  I have English heritage, since my mother's line was Cooper, and they lived in coastal South Carolina near Georgetown and Charleston from colonial times. Both towns were coastal rice exporting centers. But my father was of Czech descent.

I guess Airborne is about as nutty as sub duty.  I used to hear a line all the time from surface sailors:

"Never jump out of a perfectly good airplane, and never sink a perfectly good ship."

Cool website of HM Base, Faslane, Scotland:  http://www.royalnavy.mod.uk/our-organisation/where-we-are/naval-base/clyde

max

Anonymous user (not verified)

Max and Silent

max is so knowledgeable that he is the main reeason I visit this board. One thing for certain is that all of us and our battles with cancer are different. I am certain that the port is not appropriate for everyone and some just don't want it which i also understand.

I have fond memories of the UK and some very dear friends there whom I communicate with almost daily. I have been all over the country many times on business and was assigned to the Brawdy Wales Naval station for several months. I was on a little known English rock called Ascension Island for 13 months. As for Scotland, my daughter's HS graduation present from me was a trip to Scotland to trace her hero William Wallace with a stay with our friends in Warminster thrown in. We had a great time. I took her to all the London sites and rode the Eye and visited Buckingham and Windsor castles. Her favorite town in England was Wells in the southwest. She said "Dad, lets move here".

UK rocks (especially southwestern England

silent
Posts: 5
Joined: Feb 2015

GKH

Glad to hear you have had positive experiences in our little country. I know Wells very well, it is the smallest cathedral 'city' in the UK. Not far away from Glastonbury, where I used to do a lot of work. I bet the Somerset local accent took some getting used to! But the local Cider takes even more getting used to without falling over backwards after 2 pints. I also know Warminster very well, being ex-military...the School of Infantry was situated nearby. 

In reciprocation, I must say that my experiences in the USA have also been excellent Smile

 

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