It can be a bit daunting to go to another country for treatment especially when you don't know what to expect. We found there were quite a few things we wished we had known ahead of time on Oliver's first Chemo Embolisation, so here is guide I have put together that might help anyone who is going.
Pre-Treatment:
1. The patient must have no food for 4 hours and nothing to drink for 2 hours before your appointment time. Like with most medical procedures this is a precaution in case of an emergency. In the extremely unlikely event that a patient has a reaction that required intubation, If a patient were sick then fluid and material from the stomach could enter the lungs which would be very dangerous and this the main reason and so as not to obscure scans as well.
2. You need arrive to arrive early at Hause 23c at the Klinikum Goete Universitat. There are many medical buildings so be sure to go to Haus 23c. Then go to the interventional Radiology Unit reception on the lower ground Floor (-1), a glass self contained area which is down the stairs immediately left and ahead of you as you come through the main entrance, it's straight ahead towards the back of the floor, where you must first register. Show your passport to the receptionist to avoid questions in German!
3. Then you must next go to Prof Vogl's "Sekretariat" (his secretary) literally next door to his office, and sort out payment for 4000 Euros for the day patient TACE treatment. This is located behind the main reception. When you come out of reception turn right, take first corridor on the right, walk down to the end and turn right into Prof Vogl Wartelounge (a nice private waiting room with a TV), through the back through a door on your left and turn right again following sign to Prof Vogl Sekretariat which is two doors to your right with the Sekretariat sign above. Also I suggest asking fro your next appointment to be on a Tuesday to get the best Frankfurt hotel rates for Monday and Tuesday nights.
4. The Secretary speaks a little English and can find an English speaking colleague if your having trouble understanding her. Once you have paid you'll be asked to wait back in the private waiting room. There is water for your companion, but the patient may not drink.
5. At some point you will be called to go to a small cubicle, (your companion can go with you if you like but it's cramped for 2) where you must change into a hospital gown removing all your clothing, and I mean all, and bag your clothes. Prof Vogl or one of the team will come and see you very briefly and will get you to sign a consent form having explained the risks to you. Prof Vogl and the other doctors do speak English.
6. You will be taken off for an MRI scan, while your companion waits in your cubical. The MRI scan Isvery quick, much quicker than the uk and requires no contrast. About 20-25 mins. You don't have to hold your breath for long either.
Note: from arrival to procedure can take 40mins to 2hrs.
Procedure:
The companion waits back in the waiting room during the procedure.
1. The patient is called into the room with a Siemens artis zeego live scanner with monitors. You will lie on a surgical dolly for the procedure once you have removed your underwear.
2. They canulate you and lay a sterile sheet with an anesthesia pad over you and they press the pad firmly onto your upper thigh releasing the local anaesthetic with some form of iodine based sterilising antiseptic liquid for the wounded area which is totally painless. You will most likely be given a drip of Dexamethesone (20mg) and some anti-sickness medication.
3. Prof Vogl will perform the procedure which requires a tiny incision into the femoral artery for threading a catheter to the tumour sites. This is only mildly discomforting but not painful just a bit disconcerting and happens very quickly. You may be asked to take a deep breath as the catheter maybe fed around the aorta.
4. Within 10 minutes the procedure is finished and he stitchs the incision made earlier and you will feel some strong pressure to the thigh once bandaged.
Recovery:
1. You will be transferred to a trolley bed where you will be taken to the recovery area next door where you stay for an indeterminate time. They will get your companion to be with you. If there is room they may transport you to the day Station upstairs on the second floor.
2. You must stay in bed for 3 hours with only your head able to be slight raised after the procedure, as your leg has been sedated and you would be unable to walk until it has worn off and the wound has clotted sufficiently. Your companion can stay with you for the full recovery period.
3. After a certain length of time the nurse will normally offer the patient a sandwich/ biscuits and tea/ coffee the patient may or may not get a sand which or tea if the recovery is immediately outside the procedure room. I recommend that you bring your own lunch and something for the patient as there is nothing much good available in the hospital but there is a snacks and drinks vending machine on the LG floor sometimes with basic sandwiches, as it will be a long day. The patient can't drink withou a straw but the nurses can provide this. If the patient needs the loo during these hours, just ask for a "Urine Flasche" if ur a chap, I don't know what the female equivalent is but they will know what you mean either way if you ask for this.
4. After your three hours are up you will be told by the nurse to get up and try to walk. It will not be painful, however you will still be in mild discomfort most likely. Walk slowly as it takes a little while to get your balance.
5. Then back downstairs to the the lower ground floor for a very short low dose CT scan. You wait outside CT2 which is the corridor to Prof Vogl's waiting room. (Wartelounge)
6. You will then wait back in the private waiting room to see Prof Vogl. Check in with Prof Vogls secretary first to make sure they know you are there. The meeting will be brief and you will be given anti sickness and painkillers in liquid form. You take 30 drops of each in water as needed. You will also get your next appointment time, a short report and a cd of your scans. You are then free to go. He should give you his card with his number I case of emergency.
Note: we were at the hospital for 7hrs in total.
Aftercare:
1. A taxi may be called for you at the desk near the rearmost doors where ambulances enter or leave the building on the lower ground floor (the floor you will already be on). It's to your right as you leave the interventional radiology unit.
2. You may not fly that day or evening, you can stay anywhere of your choice and do not need to be close to the hospital. I recommend you book a procedure on a Tuesday as the hotels are cheapest Monday and Tuesday nights, so arrive a day early to get your bearings and not be rushed. Some patients get an MRI the day before the procedure depending on dates of your last scans and what prof Vogl decides.
3. You should expect to be in some mild discomfort in your thigh from the incision and maybe some from the area that is embolised. You may feel sick and tired for a few days afterwards, so take the medication given to you as needed. I took the pain medicine called Novaminsulfon once only during the first night but needed the anti-sickness for three days afterwards.
4. It is normal to feel a bit nauseous and some discomfort but you shouldn't be bleeding or in server stomach pain or fever. In the unlikely event that you think something is wrong or know that you need help we were told to call Prof Vogl's number on his card. Prof Vogl would then tell you what to do over the phone or which hospital to go to. We were also told if there was any bleeding, for the patient to lie down and press hard on the incision site. If you are really worried or can't get through to Prof Vogl call ...... For the emergency services.
This picture is a bit like the setup in the room where you have the procedure.
Prof Vogl does the procedure himself and his staff will prep you and do the MRI before and CT after recovery.
