Researching the Next Step

OK, now that the last visit to the PraxisKlinik is under my belt, I can turn to the question at hand: what's the best way to continue my treatment going forward?

One option is to continue the visits to Dr. Thaller every 6 weeks or so. The three treatments I'll continue with would be the fevertherapy, the Newcastle Disease Virus injections, and the Dendritic Cell injections. (Alongside these there are the additional treatments of vitamin C and ozone infusions, and local hyperthermia).

Liz and I have 20 vials of the virus with us here in the States, so the injections with those will continue through January in any case.

A second option is to work with Dr. Pfeifer at the Aeskulap Klinik in Switzerland. He has a very interesting-sounding protocol for prostate cancer, which consists of high dosages of four different supplements. (I've already started taking one of these -- ProstaSol -- and my PSA went down by over 50% in one month! )

The third option is to go with the enzyme therapy that Dr. Gonzalez is known for. This is an intensive self-care program consisting of supplements (mainly pancreas enzymes), a strict diet, and detoxification procedures. I'm strangely drawn to this path, as it is a way that 1) I can take responsibility for controlling my own health, and 2) is something that I can maintain over the long term, as I manage this cancer as a chronic condition. (I don't imagine that there will be a sudden cure for what I have, and the costs of Thaller's treatment -- around $15,000 a visit -- make it extremely hard to envision continuing to do it over the long term!)

In any case, I'm going to be getting some help in sorting these issues out -- I'll be doing another phone consultation next week with Dr. Ralph Moss, the über-researcher that keeps his finger on the pulse of all the new cancer therapies that are being tried.

All The Gang

Today's a more social day at the Clinic. It helps that I decide that no how no way am I going to take the fevertherapy today! A little break is in order after the wild ride yesterday.

When I arrive at the clinic, both Christine and Dr. Thaller agree -- yesterday was a little extreme! Then I discover the key ingredient that was missing: I hadn't been taking Celebrex (a pain reliever) before the fevertherapy like all the other patients. I'm not sure how I missed this, as I don't remember anyone ever telling me. I suppose it could have been one of those moments when I was being overly-agreeable and pretending to understand something in German when I really didn't. Oh well -- at least now I know the trick to surviving the fevertherapy!

So without the shivering and the fever, it's easier to catch up today with all the other people in the clinic. Sometimes I might give the impression that there's no one else around, but we're all actually quite close together -- the clinic is quite small and can only hold 8 or 9 people per day. So Liz and I are able to have nice chats with the couple from Long Island, the guy from Canada and his daughter, and the nurses, Michael, Tanya and Christine. Even Dr. Thaller comes upstairs for a few minutes.

Not much else happens today. Christine finally clears my port (which has been blocked for extracting blood, but fine for injecting things) -- she hooks me up to a machine which injects 100,000 units of urokinase over an hour's period, which seems to do the trick.

Showdown at the Fevertherapy Corral

Today starts out normally enough. I'm thankful that I'm not having any adverse reaction to the dendritic cell injections from yesterday.

I get my fevertherapy injection, and Christine tells me that it will be a moderate dose. I head upstairs to my feverbed, and settle in for the wait. In about 20 minutes, the shivering starts in earnest: and today, more than ever before, I'm hit by an intense breathlessness. It's really hard to catch my breath -- I have to sit up to make it at all possible.

Michael asks me if this is serious -- I say yes -- and he bolts downstairs to get Dr. Thaller. In seemingly an instant, the whole crew is at my bedside: Dr. Thaller, Michael, Christine and Tanya. It looks like a SWAT team in action: everything is a blur of slapping on electrodes, stethoscopes, checking and re-checking the various monitors around my bed (and setting new ones up). Dr. Thaller zooms in to give me a quick ear acupuncture (like staple guns to the ear), there is a quick injection into my port of aspirin to calm the fever and digitalis to strengthen my heart.

There's probably a lot more going on, but I'm not exactly paying full attention at this moment. I'm really struggling for breath, my heart is beating hard, it all kind of hurts, and, truth be told, I'm a little freaked out. Dr. Thaller implores me to breathe deep, into my diaphragm, in an attempt to calm things down.

The strangest part is that after everyone has done all the interventions that they can think of, there's nothing for them to do but sit around and watch my strange predicament. I'm still heaving, gasping for breath, but nothing is getting any worse, and I have the presence of mind to perceive that I must be a pretty strange phenomenon to everyone right now.

At one point, Dr. Thaller leans over to Liz and stage whispers to her: "His lungs are fine…his heart is fine…I believe that part of the struggle is in his *soul*!"

This turns out, chronologically and psychologically, to be the climax of the day's experience. I eventually calm down and go into a deep fever: 41.0 degrees (105.8 in Fahrenheit). This is very high and will be very effective in killing cancer cells. I'm always pretty delirious until the fever gets below 38.6 or so -- I keep asking Liz every couple of minutes, "What time is it?", but I never remember what she says.

At the end of the day I am completely spent, again.

I'm not sure what to make of Dr. Thaller's comment about the struggle for my soul. It makes me realize that this week is a very transitional point -- like a swing at the top of its arc, or a pendulum just before it heads back in the opposite direction. There's been a quiet here as the previous period of my life ends, and a beat, just a moment, before the next phase begins. The last couple of months has been all about finding out about my diagnosis, searching for the best treatment, fundraising so I can get here (with an extra dose of helping out my Dad during his own health crisis). Now all those events are at least temporarily stable, and I' m headed into a full-time job search and discovering the next chapter of what it is that I'm doing here.

In a strange way I'm grateful that the transition between these two phases was so clear and dramatic.

Welcome to the Big Top -- Step Right Up!

Today is the big day, the dendritic cell injection. It's the main reason I'm here (and it's also the most expensive treatment of the visit!)

The prelude is an acupuncture treatment, to prevent further lower back pain like I had yesterday. Dr. Thaller's acupuncture is unlike any that I've received in the States. There are the normal needles (in great profusion!), but there is also a steel cylinder that sounds (and feels!) almost like a staple gun -- he lines up the cylinder with a particular point, and then BAM! -- a spring-loaded tip slightly punctures my skin and infuses it with a homeopathic solution. It doesn't really hurt, but it does pound me with some force; I have to focus clearly in order to maintain my balance.

Afterwards I have a relatively light fevertherapy -- nothing like the reaction that I had yesterday, thanks to the acupuncture.

At the end of the day comes the main event, the dendritic cell injection. Dendritic cells that have been prepared from my own white blood cells (which were collected on a previous visit) are injected into both of my shoulders. Dr. Thaller has an intense focus while he's doing the injections: he seems completely at one with his needle, and his motions are a completely fluid dance around both of my shoulders. He makes about 10 injections into each shoulder, varying the location and the length of the shot each time he goes in with the needle. It's strangely ritualistic -- and when it's over, we both look at each other as if to acknowledge the completion of the ritual.

There's one additional bit to take care of, though: the injection of a dose of immature dendritic cells directly into my prostate. This dose has been prepared differently from the previous dose, and is keyed on the cells finding cancer cells that have been previously marked by the Newcastle Disease Virus that I have been taking.

I never get used to these direct prostate injections. They are only 10 seconds long, but they are supremely uncomfortable, and in addition there is a roulette effect at work. Depending on whether the needle hits one of the several nerve bundles that go through the prostate (and depending on what angle at which it hits), I can get a severe jolt of pain. Unfortunately, this effect is completely unpredictable. And today I get a small version of this jolt. Fortunately, it's over quickly!

Round 3 at the PraxisKlinik (ground level)

Today I'm back in the thick of the action at the PraxisKlinik. I get a small dose of fevertherapy for my initial visit -- and even so, Christine gives me an aspirin injection halfway through to minimize the effect. She wants to make sure I don't have too strong a reaction, in preparation for tomorrow's injection of dendritic cells (the centerpiece of this week's visit.)

Despite these precautions, I have a really strong reaction to the fevertherapy -- lots of shivering, and a relatively high fever of 102 degrees. When I try to lie down for my hyperthermia treatment, I'm not able to lie straight because of pain in my sacrum and lower back -- Dr. Thaller almost insists that I get a shot of fenadryl, but I insist on letting it calm down on my own, and eventually I'm able to relax the spasm and let the fever wind down on its own course.

For dessert, I get an injection of Natural Killer cells directly into my prostate. As always, this is one of my most fun activities here at the Klinik!

At the end of it all, it's an unexpectedly exhausting day. I can only walk home by focusing on one step at a time. And it's late in the evening before I feel normal again.

Last Day in Markt Berolzheim

I had one last intense fever therapy session today. The shivering was intense (over 30 minutes!), and the fever got up to 104.4°. Also local hyperthermia on my scapula.

Kristina packed up the supplies we'll need to continue injections of the Newcastle Disease Virus until we return to the PraxisKlinik in six weeks. Tanya and Kristina and I had a long "conversation" (them in German, me in English) about my flight times and the time difference with Texas to determine if we had enough dry ice to protect the virus for the whole trip. It doesn't seem like it will be a problem.

Then came "die Rechnung", the bill for the past two weeks. Because of the start of the dendritic cell therapy, this will be our most expensive trip here: the total was $24,887. Yow! Liz wryly noted that this would be a down payment on an apartment in the South Bronx…but then, I'd still have cancer, and I'd be stuck in the South Bronx!

All in all a really great trip. Herr Doktor Thaller gave me the highlights of my laboratory results from this week: my liver functions have *dramatically* improved since the last visit. And my PSA is down to 4.2, less than half of what it was the previous visit. Yippee!!

Something's Happening

Another strong session of fever therapy today -- I was shivering intensely for 30 minutes, and my temperature got up to 105°. I was really wiped out by the end of the day.

The best sign of the day was that my body is working hard to eliminate some toxins -- my urine is a weird orange color and it smells wretched. And I feel sick all afternoon after leaving the clinic -- a snuffly nose and exhaustion, which is unusual. These are both potentially good signs -- maybe the dendritic cells are having an effect already?

Whew, It's HOT in Here!!

Big day at the Klinik today. I didn't respond to the initial dose of the fever therapy, so I received a second dose around 10:30. That *really* set me off -- within 40 minutes I was shivering vigorously, and ended up having a fever of 106.2° -- yow! I think that's probably the highest fever I've had in my life. At that temperature, I am really not present mentally: Liz says I was talking, but I don't remember anything for about an hour and a half. Herr Doktor was really happy -- as I was leaving for the day he pulled off his glasses and emphatically said, "*Very* effective results!" Fry those cancer cells, baby!

I had local hyperthermia today too, focused on the prostate -- I have my legs up in the gynecological position for an hour, which is extremely charming. So far I've been able to persuade Liz *not* to do a drawing of me in that position.

The big surprise of the day was saved for last: my Natural Killer cells had arrived back from the lab. So I got a wad of them injected directly into my prostate. Kids, this is *definitely* something you don't want to try at home! Ow, ow, ow, ow, ow.

Knocked Out at the Klinik

Today is the first day back at the Fever Therapy. The shivering is intense, I throw out my back, the pain gets bad enough that Herr Doctor first gives me ear acupuncture (doesn't work), and then has to give me a dose of fentanyl (opiate pain reliever), which knocks me out *instantly*. The problem is that once I leave the Klinik I'm knocked out for the rest of the day and night -- I can barely put one foot in front of the other to walk home, and immediately fall asleep for 18 hours.

The good news is that my fever got to 104.9, the highest it's ever gotten in these treatments. Higher fever = more cancer cells dead.

Let the Treatment Begin!

Sunday we bid goodbye to Madeleine and Andreas -- they were such a godsend! - and took the train to Nurnberg, where we stayed for a couple of nights in the "Altstadt", the medieval part of the town that was painstakingly rebuilt after being bombed extensively during WWII. Here Liz and I discussed our strategy going forward (we liked Thaller a lot, but his treatment program is much more expensive!), and geared up for returning to Markt Berolzheim. By Tuesday morning we had acquired a cheap rental car (with a TomTom navigating device, a must for going to small towns!) and drove down to begin treatment.

Dr. Thaller gave us a warm welcome again, and gave me a "focus diagnostic" that led him to prescribe various homeopathic remedies for general detoxification. On the 2nd morning, I began the fever therapy -- 1 hour after the injection, I was shivering with chills, then in another 20 minutes I had a 103 - 104 degree fever (up to 38.9 Celsius) -- whew, that put me through the wringer very quickly! I spent all afternoon recovering from that. Fortunately I met two other patients with their helpers here who were all English-speakers -- they had all come over on the recommendation of Ralph Moss from the Moss report; this was really reaffirming that we were not alone in our strange quest to come to this farm town in Bavaria!

Thursday we spent the day driving cross-country to a very nice hospital clinic in the Black Forest . We stopped for lunch at a great café in Nordlingen, and enjoyed the scenery as we approached the "Black Forest" -- we are in a town, Donaueschingen, where the Danube River begins, and it is extremely beautiful. The windows to the hospital room are open all night, there is no TV in the room, and both my hospital room and Liz's family room are 30 Euros a night -- which seems incredibly low! Here a colleague of Dr. Thaller's, Dr Geiger, will insert two ports in my upper chest directly underneath the skin. Each will have a catheter in it that will guide either a virus or cancer vaccine injection directly to the neighborhood of the tumor . The idea is not to have the injection diluted by having to go through the entire bloodstream first; it will instead target the exact area of the tumor. The devices themselves won't be visible from the outside -- they will just be bumps in the skin, but injections can be made directly into their nylon core without any pain. Dr. Geiger seems very adept and intelligent, so I am looking forward to going off to the operation in a few minutes here!

(just back from the operation, everything went great. I came out of the anesthesia in a snap, and the doctor said the operation went very quickly. This afternoon there is a HUGE double rainbow outside the window -- very auspicious!)