Passive euthanasia: How a living will can be made and executed in India

CHEMOTHERAPY

Most doctors never undergo some treatments. They may “sell” these treatments to their patients or administer them if requested, but they don’t take most such treatments when their own time comes.

The trade-off in the end is “life of quality, not just quantity”. We don’t talk enough about these things and that means we end up with chaotic situations and huge disagreements.

The best advice during the last 4.5 months came from Dr Col Ranga Rao of Paras advised living at home and maximising the quality of life – and if there are strong symptoms, looking for a remedy (generally radiotherapy).

How doctors die. It’s not like the rest of us, but it should be

CGHS claim form

https://cghs.gov.in/index1.php?lang=1&level=1&sublinkid=5797&lid=3725

CGHS empanelled hospitals in NCR 

PDF | Google spreadsheet

Book appointment with CGHS doctor online

Instructions: here.

Go to this.

Medicine reimbursement rules

https://cghs.gov.in/index1.php?page=1&ipp=100&lang=1&level=2&sublinkid=5821&lid=3751

CIRCULARS REGARDING MEDICINES FROM LOCAL CHEMIST TILL 31 OCTOBER 2021

Circular dated 15 April 2021

Circular dated 10 August 2021

CGHS Gurgaon

https://cghs.gov.in/showfile.php?lid=3997

CGHS officials

Manoj Jain: https://cghs.gov.in/WriteReadData/l892s/CGHS%20Directorate%20Contact%20Details5.pdf

Astra Zeneca (Covidshield)
Europe stopped the Astra Zeneca vaccine (which comes here as Covishield) for people under the age of 55 years because maximum harm was seen in this younger group. Gap between two doses of the vaccine is three months for Covishield.

Johnson and Johnson vaccine has also been related with the clotting side effect, although the incidence is said to be low in both cases. This one dose vaccine is coming in November.

Bharat Biotechs Covaxin. With that clotting is not much reported. That can be considered. Gap between two doses of the vaccine is 4 weeks for Covaxin 

The Russian vaccine Sputnik is another alternative. Gap between two doses of the vaccine is 3 weeks for Sputnik.

For persons with DVT
The vaccine is given Intramuscular and in a person taking blood thinners there is a small risk of formation of local hematoma or blood leakage and collection. To prevent that perhaps same precaution of missing the prior day evening dose can be applied.

https://www.seniority.in/blog/hearing-aids/

SPECIALISED WEBSITES

INCA: International Neuroendocrine Cancer Alliance

Living with NET

NET society of India

Facebook page

This is a good summary: https://www.cancercenter.com/cancer-types/neuroendocrine-tumors/treatments

ICMR’s  CONSENSUS TREATMENT

Click to access Consensus_2.pdf

WHY INSUFFICIENT RESEARCH

“this orphan group of tumors which does not hold much interest to the pharmaceutical companies.” [Source]

BROAD TREATMENTS 

Depending on the type of NET, medications that may be used include:

• Somatostatin analogs
• Chemotherapy
• Targeted therapy
• Immunotherapy
• Peptide receptor radionuclide therapy (PRRT)  [Source]

Octreotide LAR

This is a form of somatostatin treatment: From somatostatin to octreotide LAR: evolution of a somatostatin analogue

“Octreotide is a potent synthetic somatostatin analogue that has become the mainstay of medical therapy for tumor control in neuroendocrine disorders. The multiple effects of octreotide throughout the body, combined with its established safety profile, make it an appealing and reliable option for clinicians. ”

“the antiproliferative effect of octreotide LAR in patients with well-differentiated metastatic GEP-NETs of the midgut” – but this is POORLY differentiated.

“Octreotide was among the first biotherapeutic agents used in the management of GEP-NETs and continues to be a mainstay of therapy today, although it is rarely curative”

“In response to results from the PROMID study, guidelines from the National Comprehensive Cancer Network (NCCN) have been updated to recommend octreotide LAR 20–30 mg as a management option in patients with recurrent or unresectable metastatic carcinoid tumors originating from any primary site of disease (small bowel, colon, rectum, appendix, lung, thymus, stomach) irrespective of functional status, symptomatology and progression status” [While there might be an origin in the colon/rectum, there is also a possible link with the prostate]

SIDE EFFECTS OF CHEMOTHERAPY