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.

Farewell for Now

Today's the last day of this visit to the PraxisKlinik. I try the fevertherapy this morning, and there's some lower back pain (strange…), but otherwise it's very light.

I get an injection of Newcastle Disease Virus in the prostate this morning, which is always exciting and fun. ;-)

I work out the bill with Christine, and happily hand her a check for 10,000 Euros -- nearly $15,000. Thanks to all the gifts and generous help from everyone, we were able to make this visit happen. If we're able to come again in January for the next visit, it will cost a bit more, nearly 15,000 Euros.

Around noon, Dr. Thaller comes upstairs to say goodbye to all of us, as he is leaving early in the day to go to a wedding. He shakes everyone's hands, says a few words, and starts to head off for downstairs. At the last moment he turns around and heads back toward my bed at the back of the room. He folds his hands at his heart and bows slightly to me, very reverently -- and I do the same in return. I feel honored by his salutation, and almost instantly I have the strong sense that this may be the last time I see him.

So a grand thank you to Herr Dr. Thaller and Christine and Michael and Tanya -- you have all been so very wonderful!

Nurse Liz Comes Through!

Only half of my treatment takes place at the clinic in Germany; the other half takes place at home here in Austin. Each time we leave the clinic, they pack up a month's supply of Newcastle Disease Virus into a dry ice container. Every other morning, Liz injects a small vial of the virus into me, in a 5-step procedure.

First, some background. The Newcastle Disease Virus selectively attacks cancer cells, and leaves normal cells alone. The problem is that the immune system starts clearing out the virus the moment it's injected -- so it's a race against time to have the virus in me for long enough to zap a good amount of cancer cells. To maximize the impact of the virus, Dr. Thaller has had two ports installed into my chest so that these injections can be aimed at particular parts of my body. One port aims toward my upper half, the other toward my lower; this way the virus injections aren't diluted by the entire bloodstream, and can therefore affect the bone metastases in different parts of my body.

So, the injection procedure: I prepare three different syringes -- one with saline solution, one with saline solution plus the virus, and one with taurolock and heparin (to keep the ports and the catheters clean). Liz then pokes a needle into my port, and attaches all of the syringes in a particular sequence until everything is inside me. It's all painless except for a tiny stick at the outset, and it takes about a half hour.

I am constantly amazed and grateful for Liz's steady hand in accomplishing this -- the whole procedure is *not* something that comes naturally to her, and she has really been a godsend with her perseverance and calmness.

Dr. Thaller says I need to keep injecting the virus for a year to have it be truly effective. Fortunately, there are absolutely no symptoms while the virus is active in my system -- only once did I feel a few cold-like symptoms (and that was on a day when I had run myself ragged and had only four hours of sleep).

Comparing Clinics in Germany

Here's a brief update on our adventures here in Germany. Everything is going well, my treatment has begun in earnest, and everyone here has been incredible!

That's the short version -- here's a little bit more detail. Liz and I arrived in Frankfurt and were met by one of our old friends Andreas at the airport -- he and his wife Madeleine and their two kids were vacationing in Germany when we came over, so they diverted their trip to help us out! Andreas drove us through heavy rain to the Hufeland Clinic in Bad Mergentheim on Thursday, where we had a good interview with Dr. Demuth. It was great having Liz and Andreas there with me -- we made a great team, and asked all the right questions! (and Andreas also provided some key translation help). The clinic itself was very professional-looking, and was surrounded by other clinics in an upscale spa town. Dr. Demuth was very professional, and his first recommendation was a conventional palliative treatment for bone strengthening (an IV drip of Zometa), which I can get in the US under my insurance. His clinic's treatments sounding interesting, and were a good integration of body and mind (psychological counseling as well as good alternative therapies), but all of us thought that the clinic was kind of "cancer lite" -- there was nothing specific in what Dr. Demuth said that would apply to my bone metastases, which is the most critical part of the cancer currently, and the most important to do something for.

We spent a great evening that night with Andreas and Madeleine and their kids Ava and Otto, at Andreas' brother's house in Heilbronn. (The brother is on vacation elsewhere, so we had the entire house to ourselves -- very nice!) The next morning we started the second round of interviewing, with Andreas driving us through the rain (again!) to visit the PraxisKlinik Arno Thaller in Markt Berolzheim. This is a tiny Bavarian farm town (the clinic is right next to a cow barn!) and the whole experience was much different than the previous day in Bad Mergentheim. Dr. Thaller operates the clinic out of his large house, and the whole place is filled with wood carvings, publications, a big piano and has a very homey feel. Dr. Thaller himself was large and gregarious, and we had a good conversation with him. He described his particular ideas for my treatment regimen, and it was specifically oriented toward attacking my bone metastases. He showed us pictures and diagrams of a very similar patient with advanced prostate cancer whom he had helped immensely -- the difference between the "before" and "after" bone scans of this patient was dramatic.

Dr. Thaller's treatment is a 4-step process that's focused on helping the body's immune system to attack the cancer. (I'm abridging here from his paper on the process, which you can read here)

• fever therapy (using Coley's Toxins) -- this injection induces a fever, which harms cancer cells much more than normal cells

• local hyperthermia -- this is a heat-generating machine that focuses heat on the tumor -- it's used at the peak of the fever induced from step 1 so that there's an additive effect on the cancer

• virus therapy (using Newcastle Disease Virus) -- this is a virus that's specifically bred on prostate cancer cells, and preferentially targets those cancer cells for destruction. The idea is that the virus gets in and destroys as many cancer cells as possible before the virus itself is destroyed by the immune system (the virus is completely harmless to normal cells). The virus also performs a secondary function of "marking" with an antigen many more cancer cells than it kills -- this primes them for the final step:

• cancer vaccine (or dendritic cell therapy) -- this step makes a vaccine from my own dendritic cells, and injects it back into my body to "wake up" my T-cells to start attacking and killing the cancer cells. American drug companies are doing final Phase III trials on some similar vaccines that are based on a generic prostate cancer cell; the results so far have been fair-to-middling. The advantages of Dr. Thaller's approach are that 1) the vaccine is made from my own dendritic cells, so it is individualized; and 2) the cancer cells have been previously "marked" by the Newcastle Disease Virus, so that they will be more readily attacked by the T-cells once the vaccine is injected.

During our interview, Dr. Thaller explained these four steps to us, as well as other anecdotes -- such as the time that he smuggled some of his special version of Newcastle Disease Virus into a clinic in Jerusalem, evading the airport authorities -- it was a very engaging interview! Andreas asked him at the end of the interview what he expected the result to be, and he stated emphatically: "it is my intention to cure him!" Of course he gave us the caveat that he could guarantee no such thing, but we all liked his positive and experimental attitude toward the case -- it sounded much more proactive than what we had heard from Dr. Demuth at the Hufeland Clinic.

That night we returned to Heilbronn and had a wonderful meal with Madeleine and Andreas and the whole family at Volksgarten, a restaurant serving local dishes -- it was delicious! (Spatzle, yum!) The next day was Ava's 8th birthday so we had a birthday party for her, went grocery shopping, and had a nice hike up into the vineyards that are on all of the hills at the top of the town -- they were only a few blocks uphill from the house where we were staying. Saturday was finally a beautiful sunny day!