[Rolepaul]

So Nina gets the Topotecan (0.4 mg in 5 ml of sterile water) after they pull 18 mls from the Ommaya. She then has a three ml of the withdrawn fluid to flush the tubing, followed by 100 mg of Herceptin in 5 mls of sterile saline. This is flushed with 3 mls of the withdrawn fluid and then 2 mls of sterile saline. It takes about five minutes in total time to do this part, but 15 minutes of prep and 5 minutes of follow up. It does not hurt as they use a 28 gauge needle (think the smallest needle bore made) to go through the skin and pierce the valve on the Ommaya. They dress the area and gown as for a local surgery area. I watch them and give them advice on how to keep the working area sterile (ie do not pass hands over the top of the field, no cardboard or paper within six inches of the edge of the field, they double glove with sterile technique, etc.) The nurses think I am more picky than the training nurse! But I have a dog in this fight. There is good evidence that the Topotecan is not completely necessary, but that was the initial approved protocol that the doctor piggybacked the Herceptin on to. I repeat, this was not easy to get acceptance, but it is now getting more readily approved for patients. The doctor is willing to give Nina's treatment information to other physicians and is treating more patients.