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Re: Hospitals that install HAI pump?

Posted: Sun Dec 30, 2018 2:17 pm
by cartech78
mpbser wrote:P.S. It's good to know how far out these procedures are being booked there. We are expected to meet with Dr. Kingham before making the decision. I'm surprised at how quickly you got yours scheduled.

Thats funny! I just read your message. You wont be one of the first to get the new pump, they have done a bunch of them already. The service of the new pump is where the conundrum is. It requires maintenance every two weeks which sucks but i guess that is what it is. Hopefully they can find you a hospital close to where you live to service you on the off weeks. There are a few Facebook groups im in with members that have the new pump already if you want to ask questions to people that have them. Check out Liver Mets from CRC on Facebook. I cant remember if Hieders has the Codman or the Medtronic.

Re: Hospitals that install HAI pump?

Posted: Sun Dec 30, 2018 8:24 pm
by chadwick1
I saw the name mentioned and just wanted to say I had a liver resection with Dr. Kingham last month and it went really well. Both he and my onc agreed I wasn’t a good candidate for the pump due to a probable lung met, so I don’t have anything to add about that unfortunately. But surgically in general he and his team were great and I think you will be in good hands.

Re: Hospitals that install HAI pump?

Posted: Mon Dec 31, 2018 12:24 am
by heiders33
I have the Medtronic pump. I think I somehow slipped in before that trial started, because I don’t have the old Codman catheter. Not exactly sure how that happened. But anyways, the trial seems to be kind of a formality. It’s perfectly safe (notwithstanding the usual pump risks).

Re: Hospitals that install HAI pump?

Posted: Mon Dec 31, 2018 7:32 am
by mpbser
How do you know it's perfectly safe? It's a brand new adaptation that hasn't been used on/in more than a handful of people yet.

Re: Hospitals that install HAI pump?

Posted: Mon Dec 31, 2018 8:41 am
by heiders33
I guess I’m just going off what Kemeny/Kingham told me. If you are concerned about it, you should definitely ask them and get their reaction firsthand. I can’t really speak from my own experience because I don’t have the Codman catheter. But my impression from Kemeny is that it’s a trial driven by Medtronic and not something that she is particularly concerned about.

Re: Hospitals that install HAI pump?

Posted: Mon Dec 31, 2018 4:14 pm
by mpbser
Someone on a Facebook colon cancer stage IV group just mentioned that the there have been some issues with the trial pump. I wish I had more information. This is very unnerving, when perhaps the best chance for a cure is now a non-FDA approved adapted device under trial. UGH! I wish I could get my hands on a Codman pump!!!!

Re: Hospitals that install HAI pump?

Posted: Mon Dec 31, 2018 4:44 pm
by mpbser
OK, here is what I have been told: "my liver surgeon is from XYZ and he was coordinating a possible HAI pump with a colleague who does them from ABC. He looked everywhere to try get me a Codman pump and of course there are none available. I didn’t get specifics but he said they are having more problems with the Medtronic pump than MSK is admitting to and advised against it at this time. I know some are having problems with the chemo reaching the entire liver."

*SIGH* Great.... I will keep probing.....

Re: Hospitals that install HAI pump?

Posted: Mon Dec 31, 2018 5:44 pm
by juliej
mpbser wrote:How do you know it's perfectly safe? It's a brand new adaptation that hasn't been used on/in more than a handful of people yet.

My MSKCC liver surgeon has implanted the new Medtronic pumps for several months now. I specifically asked him if the surgery was more difficult. He said there's no issue there, the issue is with maintenance because it requires a bit more skill than the Codman. It has a separate external unit that is used to program the pump to adjust the chemo and oncology nurses have to learn to use it. He said the pump is performing well though and he's implanted many of them now.

I agree that the clinical trial is a formality to get the pump approved for liver mets since Medtronic originally designed it as a pain pump. MSK would not use anything they felt was even remotely dangerous for the patient. Codman is the bad guy in this scenario. It is the norm to allow a long period of time before discontinuing a medical device, but Codman literally decided to stop production with a few weeks notice. It wasn't only MSK who was left in the lurch - about a dozen other cancer centers had just started HAI programs shortly before this happened. Everyone was left scrambling. Codman's only response was that it wasn't a money maker for them. My response to that is "charge more money for it then, but don't leave patients high and dry. It's simply unethical."

chadwick1 wrote:I saw the name mentioned and just wanted to say I had a liver resection with Dr. Kingham last month and it went really well. Both he and my onc agreed I wasn’t a good candidate for the pump due to a probable lung met, so I don’t have anything to add about that unfortunately. But surgically in general he and his team were great and I think you will be in good hands.

Chadwick, I'm confused why your liver was resected but they didn't implant the pump at the same time. I had a met in each of my lungs and still got the pump. Hopefully your liver will stay clear in your next scans, but if you have a recurrence, get a consultation with Dr. Kemeny about the pump.

Juliej

Re: Hospitals that install HAI pump?

Posted: Mon Dec 31, 2018 6:07 pm
by mpbser
Thanks, julie! Perhaps the servicing is where the issues with the Medtronic lie. Appreciate the input!!!

Re: Hospitals that install HAI pump?

Posted: Mon Dec 31, 2018 6:33 pm
by heiders33
mpbser wrote:OK, here is what I have been told: "my liver surgeon is from XYZ and he was coordinating a possible HAI pump with a colleague who does them from ABC. He looked everywhere to try get me a Codman pump and of course there are none available. I didn’t get specifics but he said they are having more problems with the Medtronic pump than MSK is admitting to and advised against it at this time. I know some are having problems with the chemo reaching the entire liver."

*SIGH* Great.... I will keep probing.....


A liver surgeon in our Facebook group cleared this up. He said that the issue with chemo not reaching the whole liver is an anatomy issue, not a pump issue. I believe he posted about this in either the Liver Mets group or the HAI pump group, maybe cartech remembers. Or you can search for Paul Wright’s posts.

Thanks Julie for providing more expertise than I can! Sometimes I feel like I’m just repeating what I hear but I don’t always know what’s behind it. All I know is that I’ve had the Medtronic for a few months with zero issues.

Re: Hospitals that install HAI pump?

Posted: Mon Dec 31, 2018 7:02 pm
by juliej
heiders33 wrote:A liver surgeon in our Facebook group cleared this up. He said that the issue with chemo not reaching the whole liver is an anatomy issue, not a pump issue. I believe he posted about this in either the Liver Mets group or the HAI pump group, maybe cartech remembers. Or you can search for Paul Wright’s posts.

Thanks Julie for providing more expertise than I can! Sometimes I feel like I’m just repeating what I hear but I don’t always know what’s behind it. All I know is that I’ve had the Medtronic for a few months with zero issues.

That's why all patients at MSKCC undergo hepatic arteriography using CT angiography to define your particular hepatic arterial anatomy before implanting the pump. Then they can tell if the chemo in the pump will reach all parts of the liver. However, some patients with anatomical variants that would technically make them illegible for the HAI pump can get it anyway if the surgeon determines that small vessels can be tied off to allow for proper perfusion.

People forget how important individual anatomy is to surgery and they also forget that there are many anatomical variations among humans, such as an accessory (extra) spleen or an extra rib (cervical rib), among others. We don't have cookie cutter bodies! :D

Juliej

Re: Hospitals that install HAI pump?

Posted: Mon Dec 31, 2018 11:28 pm
by cartech78
mpbser wrote:Thanks, julie! Perhaps the servicing is where the issues with the Medtronic lie. Appreciate the input!!!

What Heiders wrote is correct! The surgeon from spectrum Health in Grand Rapids Michigan, his name is Paul Wright cleared up a lot of rumors about the pump. 1 the pump is already FDA approved but using whatever catheter they are using is not, hence the trial! Makes since if you think about it because insurance wouldn’t cover it most likely if it wasn’t FDA approved. 2. He is a believer in the pump because it’s effective and knows it can help some. 3. The profusion problems he has seen have all been due to abnormal anatomy. The pump doesn’t help everyone and a few it actually had put into liver failure by csusing damage to the bile ducts. Those were with the codman by the way, the new one can do it to though. Unfortunately it wont get everyone to resection and can even hurt a small percentage of people. For my own situation its a risk im willing to take as im not sure Chemo alone can get me to surgery.

Re: Hospitals that install HAI pump?

Posted: Mon Dec 31, 2018 11:34 pm
by cartech78
chadwick1 wrote:I saw the name mentioned and just wanted to say I had a liver resection with Dr. Kingham last month and it went really well. Both he and my onc agreed I wasn’t a good candidate for the pump due to a probable lung met, so I don’t have anything to add about that unfortunately. But surgically in general he and his team were great and I think you will be in good hands.

Thanks Chadwick! That makes me feel good! I have not heard anything bad about Dr.Kingham yet and it hasn’t been for a lack of asking! It makes you feel better when you know your with one of the best.

Re: Hospitals that install HAI pump?

Posted: Tue Jan 01, 2019 8:02 am
by mpbser
Wow! You guys are so awesome! Thanks so much for this information. Have a wonderful New Year, today and all of 2019!!!

Re: Hospitals that install HAI pump?

Posted: Tue Jan 01, 2019 8:49 pm
by chadwick1
juliej wrote:Chadwick, I'm confused why your liver was resected but they didn't implant the pump at the same time. I had a met in each of my lungs and still got the pump. Hopefully your liver will stay clear in your next scans, but if you have a recurrence, get a consultation with Dr. Kemeny about the pump.

Hi Julie, thanks, that’s really interesting to hear! I’m not sure but looking at your sig I wonder if perhaps the protocol has changed since then? I’m seeing a different onc at MSK and we were a bit skeptical at first when she said I wouldn’t be a good candidate, but we asked Kingham about it too and he said the same thing: the lung met would mean systemic chemo and that would be a contra-indication for the pump. I won’t pretend to fully understand why medically but they both were pretty unequivocal. Certainly if this scan or another shows more liver recurrence I’ll be bringing it back up!