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scientific and evidence based treatments

December 4, 2020 by Kristin Eckland

Greetings from Colombia

December 2020

What a difference a year makes!

In December 2019, we were in the midst of one of our group medical trips.  It was hectic, but fun.  All of our clients had a good time – and the trip was a success.

Then, came Covid-19, and all of us were forever changed.  Our documentary was put on hold, along with all of our upcoming scheduled group trips – and American Physicians Network, like so many other small businesses, struggled to survive.

We worried about our clients, and future clients – and what they were going thru, as the bottom fell out.  We worried about our doctors, scattered across six countries.  We didn’t know that our hometown of Memphis, Tennessee would end up being more dangerous than most of our destinations.

As international flight restrictions eased, I took one of the first flights to our regional office here in Colombia.  I stepped off the plane to feel safer than I had in months.   Covid still exists in Colombia, but it isn’t raging out of control.  Masking policies are universally followed, (nary a bare face to be seen) and all restaurants, shops and other businesses have moved to social distancing policies, mandatory temperature checks and sanitation stations.

Life isn’t back to normal, there are no coffee dates or in person meetings – but because Colombians here in the capital city have embraced these health safeguards after one of the longest lockdown in the world, the virus is not raging out of control.

I return to the USA in a few weeks – and honestly, I’m concerned.  I stocked up on masks, and a durable faceshield here (because there aren’t any shortages here – supplies are cheap and readily available).  Now I have to prepare to jump thru the necessary hoops to come back home.  Delta is still enforcing the empty middle seat policy (which is why I chose them), as well as contact tracing for all International flights entering the United States.  I’ll quarantine when I arrive, and take another covid test before getting back to work. But I’m not as afraid of bringing home Covid – my risks are so much lower here – but I am worried I’ll contract it once I arrive.

That being said – the vaccine brings hope.  With this hope, American Physicians Network (APN) is tentatively planning to offer our next medical trip to Colombia in late May.  Given the current discussions among airlines and nations, we anticipate that travelers will need to have proof of vaccination before being allowed entry to Colombia (or any of our international sites.)  Since it’s our first trip in a year, spots will be limited.  We will continue to offer our 50% discount on our services as we re-ignite our business.

We will continue to monitor Covid-19  activity at our sites in other parts of the world, and will plan to initiate trips to these areas when safe, and feasible.

As always, we will also recommend that all travelers purchase travel insurance.

Of course, as we have all learned, a lot can happen in a few months, so we will check in here again over the upcoming months as the mass vaccination programs are implemented globally.

For the many people out there, who have difficulty accessing health care, who are unable to afford care and for those who who have lost their safety net due to pandemic related issues, we are here for you.

Sincerely,

Kristin Eckland

Filed Under: Blog Tagged With: affordable dental surgery and dental implants, affordable lung surgery, american physicians network, best lung surgeons in the world, Covid 19 and Colombia, Excellent quality at an affordable price, HITHOC, medical tourism, Medical travel and the coronavirus, Medical travel group trip May 2021, orthopedic surgery, plastic surgery, scientific and evidence based treatments, Surgery overseas 2021, Surgical care for the uninsured and the underinsured

January 22, 2020 by Kristin Eckland

Rehab services

We are excited to announce the addition of Rehabilitation services to our roster of accredited and American Physicians Network -credentialed providers.  This facility specializes in the treatment of serious neurological illnesses, injuries and conditions for clients recovering from traumatic brain injuries, brain tumors, strokes and congenital conditions.

They use a holistic patient centered approach utilizing a multi-disciplinary team of rehabilitation professionals to address the emotional, mental and physical care of their patients.  The outpatient rehabilitation center is packed with state-of-art diagnostic and treatment equipment including robotics that help to target, train and evaluate specific areas of the body to treat a wide range of conditions (upper and lower limbs, ambulation mechanics,  fine motor control etc.)

robotic equipment for physical therapy

We are so pleased to be able to offer this service to our clients.  We know, that with serious illnesses and injuries, a comprehensive rehabilitation program is a crucial component to enable our clients to reach their full potential, and enhance wellness and recovery.

Filed Under: News Tagged With: CARF, Comprehensive multidisciplinary holistic rehabilitation at affordable prices, comprehensive rehabilitation services, holistic and patient centered care, hope for recovery, occupational therapy, Physical therapy, scientific and evidence based treatments, traumatic brain injury

July 17, 2019 by Kristin Eckland

Is there five year survival for patients with malignant pleural mesothelioma (MPM)?

Dr. Isik

Is there five year survival for patients with malignant pleural mesothelioma (MPM)?  This is just one of the many questions we asked during an interview with one of the surgeons in the APN network as part of a series discussing HITHOC (hyperthermic intra-thoracic chemotherapy) for malignant pleural mesothelioma and other cancers.

Today, Dr. Isik, a thoracic surgeon, with extensive experience with mesothelioma and HITHOC talks with APN.  We are discussing malignant pleural mesothelioma, the HITHOC procedure and the latest research findings in a Questions and Answers session.

WARNING:  This video contains graphic surgical images.

Full Transcript from video is below.

Q.  Would you please talk about your academic career briefly?

Dr. Isik:  I graduated from University of Ankara, Medical School in 1991 and attended to residency in thoracic surgery of same institute.  After getting to be Thoracic Surgeon in 1996, for 23 years I studied mostly on oncology especially lung, pleura and esophageal carcinoma. I have been working as consultant professor since 2013 in University of Gaziantep, Medical school, Thoracic Surgery Department. I am the chief in this department.

For pleural cancers, I have been studying on radical surgery plus hyperthermic intrapleural perfusion chemotherapy (HITHOC) since 2009. Especially in malignant pleural mesothelioma, pleurectomy/decortication and HITHOC intervention has been observed as feasible and improving survival for those patients. Also in stage 4 M1a lung cancer cases, oncological surgery including lung resection and pleurectomy plus HITHOC has improved life comfort and survival.

I established the Advanced Respiratory Biology Department in Medical Sciences Institute of University of Gaziantep in 2018 after took over the Basic Respiratory Biology program and cell culture laboratory in September 2016. Postgraduate program about cancers of respiratory organs has begun at September 2018. Since 2015, I have been proceeding the accreditation program of Medical School of University of Gaziantep as coordinator in self-evaluation committee.

I have been working on artificial respiratory center for patients with respiratory insufficiency and have patent on this subject named “Telemetric Diaphragm pacing with feedback”. I completed 7 projects about different subjects including experimental studies on animals and cell culture and infrastructure of medical school and its hospital. I have been member of Toraks, TUSAD, Turkish Thoracic Surgery Association, European Society of Thoracic Surgeons, European Respiratory Society.

HITHOC

Now that we know a little more about Dr. Isik, let’s talk more about HITHOC.  After all, that’s why most of our readers are here.

Q. Would you please describe us what HITHOC treatment is?

Dr. Isik:   Hyperthermic intrapleural chemotherapy (HITHOC) is an adjuvant intervention just after the radical surgery of pleura and lung if needed. [ During surgery, warmed up chemotherapy medications are applied directly to the tissue of the chest.  This is believed to kill any cancerous cells that are too small to be seen directly, so that no cancer is left behind].

In scientific investigations, it was found that hyperthermia leads apoptosis of cells. Apoptosis is one of the pathway of cell death. Cancer cells are immortal if they find suitable habitat in human body. Because of this, microscopic pleural seeding should be eradicated by another procedure after surgery. Heated intrapleural chemotherapy is an applicable and effective treatment used for this purpose. It is administrated just after surgery through pleural drainage catheters under general anaesthesia.

In the operating room

Q. What are the advantages of HITHOC treatment?

Dr. Isik:  Chemotherapeutic agents are toxic for human body and cells. For this reason, they cannot be given in high dosages in systemic applications. Hyperthermic intrapleural chemotherapy is a local intervention just after the surgery. So it possible to apply higher dosages of chemotherapeutic agents than systemic therapy, [directly to the affected tissue]. This is the advantage of the treatment. Despite these higher dosages than systemic therapy, we see lesser renal and cardiac complications.

Q.What are the major complications of HITHOC treatment?

Dr. Isik:  The major complication of HITHOC treatment is renal dysfunction and insufficiency. However, incidence of these entities is not high. Generally, we observe temporary renal dysfunction. It improves by hydration easily. Severe renal insufficiency is so rare, but it can be healed by renal dialysis. The incidences are 7% and 1% respectively for renal dysfunction and insufficiency in our series.

Q. What is the success rate of this treatment?

Dr. Isik:  In literature, the success rate is qualified according to survival rates. It has been observed that patients with pleural carcinoma have better survival with radical surgery plus HITHOC than the others significantly (Mean survival 27-35 months with HITHOC and 6-9 months without, respectively).  These patients have the chance of 5 year survival and cure.

Q. Are there any scientific research or evidence for HITHOC? What are the results of those studies?

Both malignant mesothelioma and other secondary pleural cancers have been studied for better survival. As a primary cancer of pleura Malignant Mesothelioma is the most studied subject. Recently, approximately for 15 years most of thoracic surgeons gave up extra pleural pneumonectomy (EPP) because of its morbidity and mortality despite poor prognosis. Radical pleurectomy and decortication with hyperthermic perfusion chemotherapy have been performed instead of EPP. We observed that better comfort and better survival were obtained such as 32-55 months mean survival and 20-25 % five year survival.

Hyperthermic perfusion chemotherapy of pleural space give us a chance for radical solutions of other pleural cancers. Lung cancer is the most seen cancer metastasis pleura. Pleural seeding or metastasis gets the stage to 4 with M1a disease. If patient has no other distant metastasis, we can perform radical surgery for lung cancer plus pleurectomy/decortication and hyperthermic perfusion chemotherapy.

There are many scientific researches about hyperthermic intracavitary chemotherapy for both mesothelioma and other secondary pleural cancers such as lung cancer, breast and over cancers etc.. [Ed. Note. For ease of reading, these references have been placed at the end of the interview].

Dr. Elbeyli and Dr. Isik (right) with APN staff (middle)

 

Q. What are the expected survival rates for patients who undergo HITHOC treatment?

Dr. Isik:   According to literature, radical pleurectomy and adjuvant HITHOC have 28-57 months mean survival. And also have more comfort after surgery and during the treatment period because of lacking pleural effusion recurrence. Five year survival rates are 20-35% for malignant pleural mesothelioma. However we perform radical surgery in patients with M1a lung cancer (Pleural metastatic lung cancer) and other secondary pleural cancers due to such as breast cancer, colon cancer over carcinoma etc. also. In M1a lung cancer cases, we obtain 20-25% 5 year survival where as 6-9 months in patients non-surgery groups. This is significant difference.

Q. Who is eligible for HITHOC treatment?

Dr. Isik:  HITHOC after radical surgery for pleural cancers can be performed in patients that have suitable baseline health and limited disease in the hemithorax.  Patients need to be strong enough for surgery and have the types of cancers that respond to this treatment.

HITHOC has been used to treat: Pleural cancers including malignant pleural mesothelioma, M1a Lung cancer with pleural seeding or metastases,  and other metastatic pleural cancers like breast, colon over  etc carcinomas.

Q. How do you know if patient’s are well enough for surgery?

Dr. Isik:  We evaluate their medical condition/ baseline health with detailed cardiac and respiratory examinations.  Patients need respiratory function tests includes spirometry, to be able to walk 600 meters and climbing 4 flights of stairs. Electrocardiogram and echocardiography if needed are performed by cardiology specialists to understand if patients have any cardiac problem.

For more on HITHOC

Scientific literature and research related to HITHOC:

  1. Giovanella BC, Morgan AC, Stehlin JS, Williams LJ. Selective lethal effect of supranormal temperatures on mouse sarcoma cells. Cancer Res 1973;33: 2568-2578.
  2. Giovanella BC, Stehlin JS, Shepard RC, Williams LJ. Hyperthermic treatment of human tumors heterotransplanted in nude mice. Cancer Res 1979;39: 2236-2241.
  3. Işık AF, Sanlı M, Yılmaz M, Meteroğlu F, Dikensoy O, Sevinç A, Camcı C, Tunçözgür B, Elbeyli L. Intrapleural hyperthermic perfusion chemotherapy in subjects with metastatic pleural malignancies. Respir Med 2013;107: 762-767.
  4. LangLazdunski L, Bille A, Papa S, Marshall S, Lal R, Galeone C, Landau D, Steele J, Spicer J. Pleurectomy/decortication, hyperthermic pleural lavage with povidoneiodine, prophylactic radiotherapy, and systemic chemotherapy in patients with malignant pleural mesothelioma: a 10 year experience. J Thorac Cardiovasc Surg 2015;149: 558-565; discussion 565-556.
  5. Li Q, Sun W, Yuan D, Lv T, Yin J, Cao E, Xiao X, Song Y. Efficacy and safety of recombinant human tumor necrosis factor application for the treatment of malignant pleural effusion caused by lung cancer. Thorac Cancer 2016;7: 136-139.
  6. Lombardi G, Nicoletto MO, Gusella M, Fiduccia P, Dalla Palma M, Zuin A, Fiore D, Donach M, Zagonel V. Intrapleural paclitaxel for malignant pleural effusion from ovarian and breast cancer: a phase II study with pharmacokinetic analysis. Cancer Chemother Pharmacol 2012;69: 781-787.
  7. Migliore M, Calvo D, Criscione A, Viola C, Privitera G, Spatola C, Parra HS, Palmucci S, Ciancio N, Caltabiano R, Di Maria G. Cytoreductive surgery and hyperthermic intrapleural chemotherapy for malignant pleural diseases: preliminary experience. Future Oncol 2015;11: 47-52.
  8. Mujoomdar AA, Sugarbaker DJ. Hyperthermic chemoperfusion for the treatment of malignant pleural mesothelioma. Semin Thorac Cardiovasc Surg 2008;20: 298- 304.
  9. Richards WG, Zellos L, Bueno R, Jaklitsch MT, Jänne PA, Chirieac LR, Yeap BY, Dekkers RJ, Hartigan PM, Capalbo L, Sugarbaker DJ. Phase I to II study of pleurectomy/decortication and intraoperative intracavitary hyperthermic cisplatin lavage for mesothelioma. J Clin Oncol 2006;24: 1561-1567.
  10. Işık AF, Şanlı M, Dikensoy Ö, Aytekin İ, Benli Y, Sevinç A, Camcı C, Tunçözgür B, Elbeyli L. Can hyperthermic intrathoracic perfusion chemotherapy added to lung sparing surgery be the solution for malignant pleural mesothelioma? Turk Gogus Kalp Dama 2016;24:325-332
  11. Ried M, Potzger T, Braune N, Neu R, Zausig Y, Schalke B, Diez C, Hofmann HS. Cytoreductive surgery and hyperthermic intrathoracic chemotherapy perfusion for malignant pleural tumours: perioperative management and clinical experience. Eur J Cardiothorac Surg 2013;43: 801-807.
  12. Sugarbaker DJ, Gill RR, Yeap BY, Wolf AS, DaSilva MC, Baldini EH, Bueno R, Richards WG. Hyperthermic intraoperative pleural cisplatin chemotherapy extends interval to recurrence and survival among low risk patients with malignant pleural mesothelioma undergoing surgical macroscopic complete resection. J Thorac Cardiovasc Surg 2013;145: 955-963.
  13. Tilleman TR, Richards WG, Zellos L, Johnson BE, Jaklitsch MT, Mueller J, Yeap BY, Mujoomdar AA, Ducko CT, Bueno R, Sugarbaker DJ. Extrapleural pneumonectomy followed by intracavitary intraoperative hyperthermic cisplatin with pharmacologic cytoprotection for treatment of malignant pleural mesothelioma: a phase II prospective study. J Thorac Cardiovasc Surg 2009;138: 405-411.
  14. Zellos L, Richards WG, Capalbo L, Jaklitsch MT, Chirieac LR, Johnson BE, Bueno R, Sugarbaker DJ. A phase I study of extrapleural pneumonectomy and intracavitary intraoperative hyperthermic cisplatin with amifostine cytoprotection for malignant pleural mesothelioma. J Thorac Cardiovasc Surg 2009;137: 453-458.
  15. Zhou H, Wu W, Tang X, Zhou J, Shen H. Effect of hyperthermic intrathoracic chemotherapy (HITHOC) on the malignant pleural effusion. Medicine 2017; 96: 1

All photos were taken during a site visit.

Filed Under: Blog Tagged With: Advanced treatment for mesothelioma, HITHOC, how can I afford treatment for advanced cancer?, hyperthermic intrathoracic chemotherapy, Malignant mesothelioma, scientific and evidence based treatments, surviving mesothelioma, treatment for advanced cancer, video explaining hithoc

July 12, 2019 by Kristin Eckland

Cancer knows no language

Treatment of malignant pleural mesothelioma (MPM) with HITHOC

One of our exclusive network surgeons, Dr. Isik has produced a new video explaining HITHOC treatment in detail for our clients.  While many people may be frightened or worried to seek treatment in another country, particularly with a surgeon who speaks another language, Dr. Isik specializes in offering hope against these aggressive forms of cancer including Malignant pleural mesothelioma.

Malignant Mesothelioma & HITHOC

Malignant mesothelioma, which is devastating diagnosis carries a dismal prognosis without aggressive, multi-modal treatment.  The majority of malignant mesothelioma affects the pleura (or the lining around the lung).  This cancer is often associated with exposure to asbestos.

There is another form of mesothelioma which affects the abdomen.  This is best treated with a related procedure called HIPEC.  Click here to learn more about HIPEC treatment with the affiliated providers of American Physicians Network.

In the video below, Dr. Isik explains, in detail, about hyperthermic intra-thoracic chemotherapy, better known as HITHOC, and it’s use in treatment of malignant pleural mesothelioma.

Warning:  The enclosed video has graphic content.

Not just for mesothlioma

HITHOC is also used for the treatment of advanced thymomas, treatment of malignant pleural effusions (from some advanced lung and other cancers).  Dr. Isik is one of our network surgeons that performs this procedure.  He is fluent in English as well, and is currently completing a new video in English for our clients.  (Each program has it’s own inclusion criteria, please contact APN for more information).

Filed Under: Blog Tagged With: american physicians network, high quality surgical care at affordable prices, HITHOC, hyperthermic intrathoracic chemotherapy, meothelioma, scientific and evidence based treatments, surgery for advanced thoracic cancers, surgery for advanced thymomas

June 30, 2019 by Kristin Eckland

APN adds the “masters of thoracic surgery” to our roster

After completing another trip around the world, interviewing, inspecting and observing surgeons, the American Physicians Network  is excited to announce the addition of several new network surgeons in the specialty of thoracic surgery.  We are particularly pleased to announce that we have added several of the ‘modern masters of thoracic surgery’ – who are among the acknowledged top thoracic surgeons in the world.  While these surgeons are new to APN, we have worked with all of these physicians in the past, and they were actively recruited for their surgical skills and advanced training in the area of thoracic surgery.

These surgeons are the very best, and most current in their field.  Each of these surgeons was hand-picked and recruited due to their extensive experience in their respective areas; whether it is expertise in minimally invasive techniques such as uniportal VATS, subxifoid approaches to reduce pain, disability and recovery time or other specialty surgical treatments for various diseases of the lungs, pleural, mediastinum or thorax.  One of our surgeons was recruited to provide patients with an additional facility for HITHOC.  (This is the second HITHOC surgeon in our current roster).

This group of immensely talented and skilled thoracic surgeons is a roll-call of the best and brightest, and includes the inventor of uniportal thoracic surgery, Dr. Diego Gonzalez Rivas, Hong Kong legend, Dr. Alan Sihoe, HITHOC researcher, Dr. Hans – Stefan Hofmann and the founder of International VATS, Dr. Marco Scarci.  APN will bring you more information about these and many of our other network providers in the future.

with Dr. Hofmann outside the operating room after another successful case

All of these surgeons are able to provide world-class care at a fraction of the cost of US-based treatment.  Each of these surgeons has undergone an extensive vetting process which includes direct observation in the operating room.

Filed Under: Blog Tagged With: affordable lung surgery, high quality surgical care at affordable prices, HITHOC, hyperthermic intrathoracic chemotherapy, lung cancers, mesothelioma, minimally invasive surgery, modern masters of thoracic surgery, rapid recovery from surgery, robotic surgery, scientific and evidence based treatments, surgery for advanced thoracic cancers, thoracic surgery, thymomas, uniportal VATS

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