I was talking to one of my best friends yesterday who is an ER MD and has practised on both sides of the border, US and Canada. He cracked the following joke summarizing the two systems which I thought I'd share with everybody.
In the american system the philosophy is "don't just stand there - do something".
In the canadian system the philosophy is "don't just do something - stand there".
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Now this is not necessarily disparaging to the Canadian system because what he is saying is: Americans are tilted towards immediate action and figuring things out as they go, whereas Canadians are tilted towards watching and figuring things out before acting.
Both strategies are valid, the art is knowing when to apply each one.
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If you've been following my saga this is exactly my dilema:
My MO switched treatments on me with bad outcome, he wants to act like a Canadian and wait and see what happens. I on the other hand want to act like an American, I'm like f*** that, I want to switch back to my previous regime now.
I've spent about 1/2 my career working with canadian firms on the C. side of the border and 1/2 my career working with american firms on the A. side of the border, I don't have any problem acting like an american.
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skiingfiend
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I'm on Eligard and have not suffered what you described. When you were on Firmagon, that's a monthly injection as I understand., did you need to make an appt for that injection? The reason I asking is I wonder the driving rationale is reducing office visits? Whether with your MO or another person just to get the injection.
Everybody reacts different. We weren't expecting reactions but obviously eligard didn't work for me. It's gone on long enough and gotten so bad that remediation is needed.
Eligard would have been more convenient, once every four months instead of monthly. Additionally on eligard I don't have any hot flashes and my testicles have grown back larger than they were on firmagon. But that's small consolation if you're in constant pain and popping hydromorphone like candy.
Understand, I wonder what causes the pain? You're not the only one who reacts negatively to Eligard. It would be interesting to see how you reacted to Lupron. Since you're in pain, relief is what you're after so I hope switching back provides that relief.
The clinic doesn't handle injections so they don't care. They outsource injection management to the drug supplier who contracts with nursing service to deliver the injection.
So in my case the drugs are mailed to my house from the speciality pharmacy on a schedule. The nurse contacts me to schedule a time and comes to my house to deliver the injection.
It's actually a very good system and very convenient for the patient. It's designed to operate at Provincial scale and handle a large volume of patients.
When I say clinic that's a misnomer, it's a Province wide cancer management organization with over 3,000 employees, six cancer care centers (ranging from clinic to hospital scale) and a $1B (CAD) annual operating budget.
I would say the only downside for my care team is bureaucratic overhead to get a patient setup or to change them from one drug to another.
That's interesting. The cancer center where I get treatment is where I get my injection....they have "injection chairs" which are just chairs with large arm rests. Anyway, I see my MO and then walk over to the treatment area and get my Eligard injection. I find it very convenient for me at least. If I had to do what you do, I'd probably say that's convenient also. Does the injection nurse arrive on time?
I've never had a problem but I'm sure there's a risk of traffic and weather related delays.
The downside of the BC system is that it doesn't handle rapid changes in direction. In your case, you can decide to change drugs and execute near instaneous. In my case, a change in drug takes 1-2 weeks to execute.
It's a system design issue, their mandate is to deliver cancer care to the entire population of BC many who will not live near one of the six regional centers and would find it onerous to travel (multi-hour road trip or flight) for an injection. BC is 1.5 times the size of texas with about 20% of the population.
Your problem is not Eligard vs Firmagon. It should be an easy switch going back to Firmagon (degarelix). A few years ago my Radiation Oncologist switched me from Zoladex to Firmagon. A year later he switched me back again. Your problem is finding a medical oncologist who is willing to work with you collaboratively. You don't have that right now.
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