| Hospitals in Montreal |
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04/23/2007 03:32
Pierrenot registered
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04/23/2007 03:32
Pierrenot registered
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Hospitals in Montreal
This is an update about a question that I originally asked in October 2006 on the topic of radiation therapy in Canada. Two Montreal hospital addresses were subsequently added to the website as a result. I contacted the two hospitals, I received the following answers:
Hospital Rosemont: to start with, the contact given in the website is not the right one. I eventually talked to the right person who told me that they would get back to me as the doctor was in vacation. I called back later and was told that if they had done radiation therapy in the past, which no one seems to know for sure, they certainly were not doing any at this time. They suggested that I should try the other hospital (Hospital Notre-Dame).
Hospital Notre-Dame: They would not answer my requests, so I got a referral with an orthopedic surgeon and explained my case. Thjis guy was quite knowledgeable about Dupuytren but had never heard of radiation treatment for the disease. So he wrote a letter on my behalf to the Hospital Notre-Dame Department of Oncology. Here is the answer that he forwarded to me: "I am writing you in behalf of Dr Francis Methot who is leaving Notre-Dame Hospital soon. I am in charge of skin diseases in cancer and benign diseases in our department. This is to inform you and the above patient that, whatever recent says, I and we don't give radiation treatment for Dupuytren's disease in our department. We feel that the benefits are too small."
I also made some inquiries with a German Hospital and they were great! They quickly send me some information. The cost of treatment for one hand is of 580 Euros. I will copy the document that they sent me in a follow up e-mail, in the mean time, here is the results of my "investigations".
-Most people know very little about Dupuytren. Physicians know about the disease but not its treatment. Most of them believe that surgery (or do nothing) is the only option.
-I believe that it is a good idea before pursuing radiation therapy to wait and see if the disease progresses slowly or rapidly (in my case, I am still at stage 0 after 3 years).
-I believe that radiation therapy is the best treatment available and I will travel to Germany to obtain it when I am not able to lift my finger off a flat surface, anymore.
-I understand that the risk of cancer is small but it would certainly put my mind at ease if more statistics related to radiation therapy were available ( and no recorded cases of cancer related to radiation therapy is not one of them) i.e. how many patients have taken the treatment, how many years ago, dosages involved, etc.
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04/23/2007 03:35
Pierrenot registered
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04/23/2007 03:35
Pierrenot registered
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Re: Hospitals in Montreal Part 2
This is the first document that I received from the German hospitals:
MANAGEMENT OF EARLY STAGE MORBUS DUPUYTREN
Thank you for your request regarding the management and therapy of Dupuytren’s disease, as it is indicated and worked out in our department. From the scientific article which we would like to send to you (please provide your postal address) you can derive the most interesting facts about this disease with regard to the use of radiotherapy.
If there are only small nodules without any progression within the last 6 – 12 months, it will be possible to wait and watch the further development. However, if there is any progression within the last 6 - 12 months (growth, pain, develpment of new nodules or cords), you will be a candidate for radiotherapy to prevent a worse development, especially functional disorders or symptoms described above.
In our department we offer radiotherapy in the „early and active stage“ of the disease. If you have already developed contractures of the palm and fingers (< 30°) radiotherapy is too late to be effective.
Radiotherapy will be given as an outpatient treatment. Our secretary will prepare a treatment cost estimate (attached form). If you agree, we will arrange an appointment with one of our doctors for an initial consultation and examination, which will be decisive whether there is an indication for radiotherapy. We have 2 radiotherapy options: 7 times during a 2-week period or 10 times (5 times within a week) separated by a 12-week break: Each treatment will take about 5 – 10 minutes. Mechanical, physical and chemical stress to the irradiated hand should be avoided during the phase of the radiotherapy series, and about 3 – 4 weeks thereafter.
Individual lead shieldings and bolus material will be constructed for your specific disease situation in order to protect the regions of your palm which shouldn’t be irradiated. Mild acute skin toxicity could occur like redness and/or dryness in the irradiation field, rarely some local pain and/or swelling.
The reason why radiation therapy for Duputren’s oder Ledderhose disease is not offered in some countries is the very rare possibility of developing cell-nucleus-damage with the theoretical chance to develope cancer within 10 – 30 years after treatment (but only in the treated area). This risk is far below 1 percent. It is impossible to define the level exactly because of statistical problems. We have to draw your attention to this fact because of legal obligations for informed consent (in Germany), but we cannot estimate your individual risk more precisely.
If you are interested in our treatment, please send us digital photos or photocopies of your affected palm(s) with marked nodules and cords (by felt-tip) from which we can conclude the preliminary stage of your disease. If you wish to make futher arrangements concerning your treatment in our hospital, please contact our secretary, Mrs. Christiane Kerstan (phone: +49 201 434 2559 or fax
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04/23/2007 03:38
Pierrenot registered
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04/23/2007 03:38
Pierrenot registered
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Re: Hospitals in Montreal Part3
If you are interested in our treatment, please send us digital photos or photocopies of your affected palm(s) with marked nodules and cords (by felt-tip) from which we can conclude the preliminary stage of your disease. If you wish to make futher arrangements concerning your treatment in our hospital, please contact our secretary, Mrs. Christiane Kerstan (phone: +49 201 434 2559 or fax: +49 201 434 2559 or e-mail christiane.kerstan@krupp-krankenhaus.de).
PS: The same approach is used for Morbus Ledderhose (= Morbus Dupuytren of foot sole).
TREATMENT COST ESTIMATE For 1 HAND
MS/MR.:
(Name):____________________________________________________
(Address):__________________________________________________
1.)
After initial consultation and physical examination there is an indication for radiotherapy in early stage Dupuytren. Radiotheapy is offered as an out patient treatment.
Planned number of fractions:________________________
Planned number of target volume(s) :_______________________
MS/Mr. _____________________ was extensively informed about the different therapeutic options including external beam radiotherapy.
Medical charges of radiotherapy treatment are according to GOÄ (German official scale of medical charges):
Billing Code of GOÄ Explanation Single price Euro Coefficient gem. §5 Abs. 4 GOÄ Final Price Euro
1 3 First Consultation (special case) 8.75 3.5 30.63
1 5 Examination of one hand (special exam. 4.66 3.5 16.31
1 5810 Radiotherapy plan 11.66 2.3 26.82
10 5812 Radiotherapy treatment of benign disease 11.07 2.5 276.75
1 78 After Care (Follow-up exam.) 10.49 3.5 36.72
2 75 Medical certificate/Letter (plan final note) 7.58 3.5 26.53
1 3.5 Information / medical advice 4.66 3.5 16.31
1 stamp 0.55 0.55
Material costs (lead cover, bolus material) 150.00
€ 580.61
Essen,_________________________
______________________________ ___________________________________
Signature patient Signature physician
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