I requested a second opinion after reviewing the Heartland Carcinoid Support group website pages and reviewing other patients' therapies and prognoses.

Dr. Botha stood out with his two stage liver resection. I requested consultation and received approval from my primary care physician. At the consult I found out that I was not a candidate for this two stage surgery. Other options were presented. Liver transplant, multi-organ transplant, and PRRT, if we had the means to support it.

Dr. Botha's referral was for my mid-gut primary tumor to be removed followed by PRRT or a liver transplant. However after another CT scan he decided PRRT should be done first.

I presented this referral to my primary physician and he was supportive. The Brigadier General was supportive of the therapy as well, as there are sections in the Tri-Care manual that cover rare diseases and treatments in other countries. Experimental medicine was mentioned, but Dr. Baum's track record with PRRT for the last ten years sufficed for proving it was a safe treatment. Dr. Baum reviewed all my history and scans. In his opinion I was a good candidate for PRRT.

The WTU at Ft. Leonard Wood arranged for my travel to Germany. The WTU in Schweinfurt, Germany arranged for my lodging and transportation to the Zentralklink in Bad Berka, Germany.

I received my first treatment in June 2010 from Dr. Baum with no issues.

I returned for my second treatment in September 2010 and reviewed the results from the first treatment which showed a 30 to 50% reduction in tumors. I received my second treatment with no issues.

I returned for my third treatment in December 2010. The results from my second treatment showed stabilized disease and more reductions. I received my third treatment with no issues.

My fourth treatment was given in April of 2011. My MEB/PEB board has been started and my treatment plan is not completed. I am facing some issues with the change in status for me and Tri-care coverage since my treatments are in Germany.

If I am active duty with Tri-Care Prime, then I am covered 100%. If I retire and receive Tri-Care for life I have no coverage for this treatment.

If I REFRAD (released from active duty) and go back to the Missouri National Guard I have no coverage for non-FDA approved treatments. This means no coverage for treatments in Germany. And if I go to the Veterans Administration I have no coverage

for my treatments either. These are issues that military personnel should be aware of as they plan their treatment.

I can be contacted by email from the website if you have questions regarding military coverage of my treatment in Bad Berka.

Dan B.