Friday, June 23, 2017
Fighting Prostate Cancer At -90 C: My Cryo-therapy Experience At UC Health
3D image shows tumor which was subjected to three freezing cycles, with temperatures as low as 90 degrees below zero, centigrade.
Almost five years to the day after being diagnosed with stage 1 prostate cancer I found myself Tuesday at the University Of Colorado Anschutz Medical Campus - Inpatient Bldg. to check in for focal cryotherapy surgery under Dr. E. David Crawford. After the requisite initial processing of insurance cards, ID and answering prelim questions (Would you like to see a pastor?, Do you have an advanced directive?) I was checked in to the Urology pre-op station, and met by a perky RN I will call 'Greta'. She took my vitals, then had me change into the standard issue gown and yellow happy socks, after which my belongings were bagged (taken away by Janice). I was then connected by Greta to an IV after some initial difficulty finding a vein.
As with my earlier experience with the 3D staging biopsy in January, I was first met by rounds of specialists, to answer further questions, i.e. What is the name of the procedure you're having?, When did you last eat and drink? Do you have an advanced directive or living will? Will you accept a blood transfusion if one is needed? Do you have any allergies? Do you suffer from sleep apnea? Have you had general anesthesia before?
The sole remaining formality was to sign an acknowledgement of risks form, always being told these risks (e.g. fistula) are "relatively low". But, of course, they have to disclose every possible permutation or possible outcome - much like the horrific (possible) side effects of Pharma drugs. Oh, there is also an acknowledgement that no guarantee is made that the treatment will eliminate the cancer. Well, that one's fairly straightforward and no sensible person would expect some magic cure! At least for prostate cancer.
By 7.25 a.m. Dr. Crawford and a urological resident appeared and asked if I had any last minute questions (I had a few, e.g. 'How long does the catheter stay in?') and then I was wheeled into the OR by an anesthesiology resident. Once there I had to move myself to an adjacent table where an oxygen mask was affixed to my face and the anesthesiologist (Dr. Erin Tracy) instructed me to breathe deeply. Within about a minute the slight stinging sensation of fentanyl was noted and then.....lights out.
When I came to it was nearly 10.30 a.m. in the recovery room, and the attending nurse - Shannon - asked how I was feeling. As in January, I noted the burning sensation in the urethra - now the pain arising not only from the insertion of the indwelling (Foley) catheter. - but also a cystoscope to locate the bladder position as the freezing needles (cryoprobes) were inserted into the prostate.
Each cryoprobe from 1-3mm in diameter inserted through the perineum, used Argon for super cooling to sub-zero temperatures. The effect was to freeze the cells of the tumor creating an "iceball" with colder temperature at the center and warmer at the periphery. However, this difference is eliminated by repeated freezing and thawing cycles. To protect the urethra a warming catheter remains in place during all the cycles.
To relieve the post -op urethral pain, Shannon gave me two hydrocodone pills (which UCH calls "narco)' and the pain subsided but the feeling of grogginess increased. This was somewhat different from the 3D biopsy when I came rather quickly out of general anesthesia with little or no hangover. By contrast, this time I had to ask for a barf bag whereupon I did one or two dry heaves.
By 11.30 when Janice arrived, I was able to eat: a couple of saltines with some ginger ale. Janice told me that Dr. Crawford met with her in the main conference room and informed her the procedure went "very well" and a total of three freezing cycles (at different temperatures) were done, including one at -90 Celsius or - 130 F. (Cell death occurs at -40 C which is also - 40 F). This sequence of freezing was why the procedure took longer, and hence the need for more anesthesia.
Only later, once I was dressed, did I realize another source of discomfort was a "scrotal support" that had been appended to me after the procedure. I asked the RN why this had been put on and she explained it was to prevent or inhibit "scrotal edema" - a swelling of the testicles to potential football size that sometimes accompanies insertion of the cryo-probes. I asked how long I needed to have it on and she replied: "Maybe two to three days". Well, after 2 days I cut if off with a jack knife I brought with me to the hotel.
This morning, barely two hours ago, Janice used a saline syringe given to us by the UC staff to change the pressure inside the catheter to release the bulb and the connection. "Liberation" arrived with immense relief but also lots of blood and clots, much of which was probably associated with the dead cancer tissue that had morphed into the "ice ball". After drinking quarts of water the urine has gradually begun to return to the usual (straw) color. The pain has also subsided enough to sit down and write this post - to bring interested readers up to date- also indicate why no posts appeared the past three days.
Anyway, the takeaway is that now I will have to get PSA tests done at 6 month intervals, and then hopefully, see it dive down to negligible levels in about 12-18 months. Otherwise, another biopsy may be needed. But in any case, I've made it clear no further treatments after this.
The prognosis, however, is very good and by all accounts from Dr. Crawford the tumor ought to be literally terminated as an ice ball that subsequently turns to dead cell slush.
Fortunately, I've not had to pay for any of the treatments, tests, biopsies I've had over the past five years. Ok, I take that back, I had to cough up about $1200 for the HDR Brachytherapy treatment I had at UCSF in 2012. But the total I would have had to pay for all cancer treatments, had I not had Medicare, is estimated to be around $115,000 when the cryo-ablation is factored in. In fact, without Medicare, we'd likely have had to declare bankruptcy.
That brings up the question as to what millions of Americans will now do that this misnamed Senate health care bill ("Better Care Reconciliation Act Of 2017") is ready to pass. And by the way, let's also cut the crap this is a health care bill. It is not. It is a revival of the zombie tax cut paradigm that the GOP has turned into an abiding fetish. This despite the fact that NO evidence exists that cutting taxes for the rich or corporations increases economic growth.. That canard was last exposed during the Gee Dumbya Bush reign, but now has been revived by Paul Ryan and Co. Never mind, the Repukes are salivating to cut the critical medical access for tens of millions to give the richest more gold-lined tubs, yachts, 20,000 sq. ft. vacay homes and blood diamonds that they don't need.
So this vile tax cut bill - in the words of one commentator - "takes a meat axe to their health care.". That is, to Medicaid, through which $800b would be cut, lowering the bottom on 75 million Americans. What if the males in that population get a cancer like I have, what can they do? Well, the Repuke bill will ramp up their deductibles, increase co-pays (by an average of 20%) and limit access, while offering only measly tax credits - if they pass an income test. End result? Most would either have to go bankrupt accessing the treatments needed, or allow the cancer to progress.
For people with disabilities, Medicaid is the primary benefit that allows them to stay in their own homes. Without it they will be homeless on the streets, hence the reason for their plaintive cries yesterday (in front of Bitch McConnell's office) to "Save our liberties!"
For lower income folks, the bill amounts to the most massive transfer of resources in history from them to the wealthy for $600b in tax cuts. The low income people will be left with virtually nothing by 2025, or be at the mercy of private insurers. Here in Colorado, Medicaid access will revert back to what it was before the ACA arrived, with draconian qualification measures applied - given the extirpation of Medicaid expansion will leave us with a $750 m. plus deficit. That means a low income mother of 2 kids in 2025 will have to earn no more than $300/ month to qualify to receive Medicaid benefits after this god -awful plan allows only limited block grants to the states. The worst hit will be the underclass disabled and seniors barely making ends meet living in high premium states. Seniors alone will have to cough up 5 times more in premiums thanks to this misbegotten atrocity.
And for a take on the for profit health insurance industry we have these words from William Rivers Pitt - who wrote in a recent Blog post (on 'smirkingchimp.com')- on how they compare to a Mob protection racket:
"The health insurance industry, for the most part, is the Mob painted over with a veneer of legitimacy. They're a protection racket. The Mob got people to pay by offering "protection" for your restaurant or store, and would burn it down if you didn't pay up. With the insurance industry, your body is the store, and as all flesh is inevitably weak, your store will eventually burn down, taking your financial stability with it unless you pay the insurance middleman in full. Nice health you got there, be a shame if something happened to it. That's only if they don't turn down your claim because of a typo on your claim form, which is hardly rare. I had ICU nurses telling me insurance horror stories that made one wistful for the ringing sound of guillotines in the town square.
The problem is the fact that health care in the United States is a for-profit industry, like petroleum speculation or automobile manufacture. It's a few people making a lot of money off of sick people, and after so many years of this being the status quo, they have the political system wired to keep it that way."
Question: If the health insurance lot are analogous to the Mob in a protection racket, what does that make Bitch McConnell, Paul Ryan and the GOP?
Answers? Inquiring minds want to know.