One of My Toughest Cases
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Searching for a miracle cure
Oliver Sartor | Medical Oncology and Hematology | Tulane Medical Center
Dr. Oliver Sartor knows first-hand that the practice of oncology is one fraught with emotion. It is a common belief that most doctors are distant and aloof, but Sartor feels the pain of a cancer diagnosis as keenly as his patients.
Toward the beginning of his career, while working in Washington D.C., Sartor took on a patient with advanced prostate cancer. The two men bonded over their shared homeland – Louisiana – and became close friends. Though the man has long since passed, Sartor becomes visibly upset when speaking about his close friend and patient.
“He had horrible prostate cancer. He had failed surgery, radiation, hormones and had been sent to us from Houston because we were doing some crazy experimental work.”
The man’s cancer was extremely aggressive and difficult to treat, which was why he was sent to Sartor in the first place. Even from the beginning of his career, Sartor has treated patients who’ve been passed from doctor to doctor without much progress. “Most of the time people come to me because, to be blunt, they’ve got something kind of tough going on.” That was the case with this patient, whose treatment was remarkable even before he had been sent to D.C.
With the patient in his care, Sartor tried everything he knew to treat the aggressive cancer, with little success. “He went on one protocol and failed; he went on a second protocol and failed; he went on a third protocol and failed; he wasn’t doing well.” Protocols are tested and approved treatments for certain cancers. Depending on the stage and scope of the cancer, doctors determine which protocol is appropriate for each individual patient. “Prostate cancer is an unusual disease because it’s often over-treated as well as under-treated. The key is matching the right therapy with the right patient. Patients who have progressive cancers that fight all the usual stuff you’re throwing at them, they’ve got trouble.”
With each failed protocol the cancer kept progressing, and the case was getting dire when Sartor heard about a similar case where the patient had undergone a slightly unconventional treatment. It was precisely the unconventionality of the treatment that attracted Sartor; after all, the accepted treatments had failed to produce a positive result. “A patient from Florida had done something unusual about stopping and starting a medication, and that was interesting enough to me that I thought I might try to recapitulate that in my patient.”
The results of the somewhat experimental treatment were astounding. “It was literally a miraculous response. His prostate specific antigens were 1,000; he had failed all conventional therapy and multiple external protocols. His prostate specific antigens went to undetectable and stayed there for 12 years.”
Both patient and doctor were equally surprised by the turn-around. “He said, ‘Oliver, if I was Catholic, we could get a saint out of this one,’ and it was true. It probably is the most miraculous case that I’ve ever been a part of.”
Sartor eventually moved to New Orleans, where his then-healthy patient was living. “He was a New Orleanian born and raised here, very connected. He introduced me to a million people in town at dinner parties, and I used to have lunch with him all the time.”
Unfortunately their relationship reverted back to one of doctor-and-patient when the man eventually developed a tumor on one of his kidneys. “He developed a kidney cancer, and lost a kidney because we did a nephrectomy, which is appropriate. Then he developed a kidney cancer on the other side and we did a partial nephrectomy, so he had half-of-a-half of a kidney.
Sadly, Sartor couldn’t keep his friend from death forever, and he passed away years later as a result of complications from a broken hip.
Sartor remembers the case, and the man, fondly though with a touch of sadness in his voice. “We became so close, and to eventually watch him die was just very, very painful.” Sartor continues to handle the difficult cases day in and day out, making decisions and trying new protocols just as he did years ago for his friend.
21 years in practice
MD from Tulane – 1982
Residency at Tulane – 1986
Native of Shreveport
The electromagnetic spine
Joseph T. Crapanzano | Anesthesiology | Parish Pain Specialists
Pain care is one of the most enigmatic and sometimes controversial specialties. Dr. Joseph Crapanzano knows all too well how patients can become dependent on their pain medication and how pain can change someone’s entire personality.
Crapanzano recently treated a woman who was experiencing pain in her left leg, which had resulted from a spinal surgery. “She had had several injections and developed an infection in her spine that ultimately grew into an abscess. So, she was transported to East Jefferson Hospital in an ambulance one night when she had become extremely ill, and the wound was drained.”
Though the abscess was gone, the woman’s pain persisted and she was referred to Crapanzano by a neurologist. “She arrived in my office with her husband some months after her surgery. They were a delightful couple but extremely distraught due to her severe residual left leg pain that didn’t respond to conservative therapy.”
The husband and wife were both at the end of hard-working careers and were both eager for the pain to finally be relieved, as it was making it hard for them to enjoy their retirement. “Mostly they wanted to spend time with their children and grandchildren, and spend time together. They’re not infirm and they wanted to remain active.”
Crapanzano consulted with the patient and her husband about numerous options, none of which appealed to the woman. “She didn’t like having to take pain medications and felt that they were poorly effective in relieving her pain; she didn’t like how they made her feel – the drowsiness, the grogginess. She was reluctant to get another injection because, quite frankly, she had had an injection initially that was thought to be a culprit.”
Every time a spinal injection is performed, the risk of infection is a real possibility. Crapanzano appreciated the woman’s fear of another infection and shared in her desire not to repeat it. “That can happen anytime, anywhere, to anybody. She was well cared for, but she had a complication, and it’s a complication that we fear.”
Being that the common treatments all seemed too risky or just didn’t work, Crapanzano only had one really viable option. “Ultimately it was elected to surgically place a neurostimulation device which treats the pain by creating an electromagnetic field in the epidural space within the spinal canal along the back of the spinal cord.” Specialists still aren’t clear an exactly how electromagnetism alleviates pain, but they do know that it is effective. “There are several proposed mechanisms. One is that the electromagnetic field just interrupts the pain pathways. Another is that it may stimulate certain substances in the spinal cord and central nervous system that inhibit pain transmission.
It’s probably a combination of those factors. A simple analogy would be: if you hit your funny bone, you automatically, instinctively rub it. Why do we do that? We do it because the brain picks up the pressure sensation of the rubbing and it tends to ease the pain. It distracts us from the pain.”
The device is like a small catheter, similar to ones used for epidural injections in relieving labor pains, that’s inserted into the appropriate spot on the spine. If a patient has arm pain, the device is placed in the neck area; for leg pain, it goes toward the bottom of the spine. The procedure, performed in an operating room, takes about two hours. “The most challenging part is usually to get the device and the wires placed in an area where they’re stimulating the correct portion of the body.”
Shortly after the procedure the patient made a full recovery. Her recovery was so full, in fact, that she completely stopped taking her pain medicine. “It’s a little bit amusing because most patients cling to their medications but she just dumped them. The spinal cord stimulator made her feel so good because her pain was gone, but she felt a little crummy because she stopped her medication suddenly.”
Stories like this one are what remind Crapanzano why he’s a doctor. “We are able to help our fellow human beings along life’s journey. On a recent visit to my office, as this couple was getting ready to leave, the woman stopped, looked me in the face and said ‘You saved my life by taking away this pain.’”
25 years in practice
MD from LSU – 1982
Native of New Orleans