CHRIS PEDOTA / THE RECORD
Dr. Robert Manzi watching anxiously in his hospital bed as stem cells in the syringe are pumped into his body through a catheter near his heart.Posted on 06/23/2005 7:57:02 PM PDT by Coleus
A desperately ill doctor bets on a miracle
| Sunday, September 26, 2004 |
First of four parts
One patient was on the table and another was in the next exam room when the phone rang for Dr. Robert Manzi, a Ridgefield internist. He took it in the hallway and said, "Hi, Joe, what's up?"
It was his kidney specialist, a colleague at Holy Name Hospital in Teaneck, calling with results from Manzi's biopsy. Manzi hoped to find out why he'd been losing weight, feeling tired, and seeing suds in his urine.
"Bob,'' the specialist said, "you have primary systemic amyloidosis.''
Manzi had read a brief entry about it in a medical textbook more than two decades earlier. But he'd never seen a patient with it, not while training at a busy Newark hospital nor in 20 years of office practice. "What does this mean?" he asked.
The kidney doctor told him to call a blood and bone-marrow disease expert for the answer. With his own patients still waiting, Manzi immediately dialed the number and got him on the line. "I want to know exactly what this means for my future," he said.
"Don't make me say that,'' said the hematologist, another doctor friend.
"It's that bad?" asked Manzi.
His nurse watched and listened, tears gathering. Manzi noticed the patient he'd left on the table looked stricken. Down the hall, the other patient stuck her head out of the exam room.
"I don't want no bullshit,'' Manzi told the doctor. "I want to know exactly what this means."
The hematologist could speak only of outdated studies with little relevance to Manzi's prognosis. "I can tell you that now we have two big drugs in the pipeline,'' he said, trying to sound optimistic. "Now we have stem cells."
"Give me a number," pressed Manzi.
"Sixty months,'' the hematologist answered.
Five years.
It was Manzi's 52nd birthday. He had a wife, three sons, a busy solo practice, a big house in River Edge, and no time for a cold, much less a catastrophic illness.
"The nurse is crying. The people in the rooms are crying," Manzi recalls. "And I said, 'OK, thanks,' and went back and saw patients."
This is the story of what happened after that phone call: How Bob Manzi came to put his hope in a stem-cell transplant and how a doctor suddenly became a patient fighting for his own life.
While the fierce debate about embryonic stem-cell research continues, lives already are being saved with adult stem cells.
Stem cells are the body's basic building blocks. In embryos, they develop into more than 260 specialized types of cells that compose a human being. After a person is born, they remain in various organs, ready to repair and replace cells that have been lost through injury, disease, and normal wear and tear.
The adult stem cells currently used to treat patients are harvested from blood and bone marrow. These cells, when transplanted into the sick, replenish and rejuvenate the essential, life-giving ingredients of blood. They are routinely used to treat leukemia, multiple myeloma, and other blood-borne diseases. Ten thousand patients across the nation will receive transplants this year. North Jersey is home to one of the world's 10 busiest centers for such transplantation, at Hackensack University Medical Center.
In their own way, these treatments with adult stem cells are as miraculous as the wonders predicted from embryonic stem cells - a controversial field of study where research may one day enable doctors to repair spinal cords, regenerate diseased brains, and cure diabetes.
Yet for all its success so far, stem-cell therapy is harrowing. It may be the path of medicine's future, but it is a route to recovery that veers frighteningly close to the precipice. Manzi's journey began that day in February. From his unusual perspective, his case offers a look at some of the perils and potential of this medical frontier.
Amyloidosis.
Manzi and his nurse, Ann Salamanca, could barely spell the disease that promised to kill him in five years. After finishing with the afternoon's patients, they hunkered in a back office to pore through medical encyclopedias.
The illness had come knocking the previous fall. Manzi had been walking door-to-door in River Edge, campaigning for a seat on the Borough Council. When he got home, he collapsed.
The emergency-room doctors at Holy Name told him he was dehydrated. But one of the many tests they ran showed alarmingly high levels of protein in his urine.
That was the calling card of amyloidosis, though it would take a few months to reach a diagnosis.
Hidden within his bone marrow, malfunctioning cells were sending out massive quantities of abnormal proteins. These long, thin protein strands were sticky. They bunched together in microscopic bundles and sheets that lodged in the organs, creating deposits of a substance called amyloid.
The suds in Manzi's urine were protein, a result of the amyloid deposits in his kidneys. The deposits would cause more and more damage, eventually clogging his filtration system and destroying his kidneys.
They could also spread to his heart, causing heart failure; to his lungs, leading to shortness of breath; and to his tongue, thickening it and slurring his speech. Liver, brain, joints - each in turn could become a target. The body can break down some excess protein, but the bone marrow's wild overproduction would quickly overwhelm it.
Even though Manzi was a doctor, the disease is so rare he hadn't come close to figuring the diagnosis out for himself. The man who prided himself on practicing medicine the old-fashioned way - by asking careful questions, taking a thorough history, and relying upon years of experience rather than a computer printout of test results - had been stumped.
His legs were swollen, his blood pressure low, and the fatigue overwhelming. When he left the room, patients would ask the nurse, "What's wrong with Dr. Manzi?"
Until that phone call, he just didn't know.
Manzi had faced a serious health crisis once before, 21 years earlier. That time, he'd gotten his diagnosis right. A pounding headache, darkening vision, a fading pulse - what else could it be? "I'm having a cerebral hemorrhage," he'd told his hospital's emergency-room staff when he'd called to tell them to get ready. "I'll be unconscious by the time the ambulance gets here.''
Manzi was in a coma for four weeks. The accuracy of his self-diagnosis - and the speed of proper treatment - had saved his life. He recovered, resumed his practice, had two more kids.
It was a story he loved to tell. He only hoped this one would end as happily.
A week after that phone call, Manzi turned his medical practice over to a pair of doctors he could trust, made use of his disability coverage, and started his quest for treatment.
The substitute doctors Manzi brought into the Ridgefield practice promised to keep things going just as he would have. Patients would still walk through the doors at the rear of a Ridgefield office building to find the dated photo of Manzi's family, the poster he scrawled to tell people to make an appointment and not drop in, and Sheryl Farrington, the bookkeeper, greeting them. They would still get the same hands-on, personal care.
Ever since he was a sixth-grade pupil at St. Matthew's grammar school in town, the only thing Robert Manzi had ever wanted was to be a doctor, and the only place he'd ever wanted to do it was Ridgefield. After college in Jersey City, and medical school in Guadalajara, he'd spent just a couple of years with other doctors before opening his practice on Ridgefield's Bergen Boulevard.
"My mother still lives there," he says. "I get to see the kids I grew up with, their children, and even their parents. They come in and I say, 'Hey, I know you! You're the blind umpire from when I was in Little League!'Ÿ''
The nurse who worked with him for 17 years says each time she left a patient in a room with him, she'd hear laughter through the door.
There was no laughter now.
Now, Manzi was the patient.
He consulted with the hematologist at Holy Name. He quickly secured appointments with experts in blood-borne diseases at Cornell Medical Center and Memorial Sloan Kettering Cancer Center in New York.
Each offered a terrible prognosis: an inexorable progression from kidneys to heart, brain, tongue, lungs, and so on. The doctors could use chemotherapy to attack the misfiring bone-marrow, steroids to try to control the damage. Both would have heavy side effects. And they'd keep him alive for only a few years.
There was another possibility, though, according to one of the New York doctors: a stem-cell transplant. He recommended that Manzi consult with other experts. He even had one in mind.
"Do you know where Hackensack Medical Center is?" he asked.
The stem-cell transplant program at Hackensack University Medical Center began 14 years ago with a single bone-marrow transplant by Dr. Andrew L. Pecora. This year, the center's doctors will transplant stem cells - from healthy donors as well as patients themselves - into more than 250 adults and 20 children.
The stem cells used in those treatments - adult stem cells - are found in many organs of the body, as well as the blood and bone marrow. Muscle, skin, liver, and other organs have their own stem cells. In the bone marrow, they make new white-blood cells, red-blood cells, and platelets - blood components that fight disease, carry oxygen, and promote clotting.
Embryonic stem cells, which are not yet used in medical treatment, are much more flexible. Found in embryos that are only a few days old, they are the blank templates that develop into more than 200 types of specialized cells, including those that cause the heart to beat, the pancreas to produce insulin, and the brain to secrete chemicals. While their potential is great, much research remains before they can be used.
Manzi not only knew where Hackensack Medical Center was, he had a pass to the doctors' parking garage. He made an appointment with David Siegel, a specialist in stem-cell transplants as treatment for myeloma and lymphoma, two blood-borne cancers. Before they even met, the two physicians talked on the phone for 45 minutes - one perk, perhaps, of being a doctor/patient.
"He told me this disease ain't going to kill me," Manzi said of the conversation. "Now I got a whole different take on this. ... He made me feel like I'm going to do pretty damn well.
"Of course,'' said Manzi, "when you're 52 and you've got your practice, and your family, and this, that, and the other thing, trying to get through this managed-care era, you say, 'Jesus, what's going to happen to me?'Ÿ"
What was going to happen, Siegel and the kidney specialist suggested, was a potential cure. The march of the disease through his body, the transplant doctor said, was not necessarily inevitable.
The treatment would begin with harvesting millions of stem cells from Manzi's blood. He would then be given such high doses of chemotherapy that, in normal circumstances, a patient would die. But in Manzi's case, after his bone marrow was killed, after the defective cells producing the amyloids had died, he would receive an injection of his own stem cells. Those stem cells would find their way to the bone marrow and - here's the magic - regenerate it.
Without the stem cells, he'd be dead. With them, his body could reconstitute his blood: its oxygen-carrying red cells, disease-fighting white cells, and clot-forming platelets.
Afterward, his body would rid itself of the tiny fibers the disease had deposited in his kidneys.
If he were lucky, he'd be cured. He'd be among the 40 percent of amyloidosis patients found in a recent study to go into remission after high-dose chemotherapy followed by stem-cell transplantation.
This doctor gave him hope. In the weeks since the February telephone call, he'd talked with many specialists. He'd tried the standard treatment, and the protein was still leaking from his kidneys. The steroid he was taking was warping his personality so much his friends would ask, upon hearing some nastiness from the doctor's lips, "Is it a Decadron [the steroid] day today?''
He'd go for the stem-cell transplant.
Collecting the stem cells - "harvesting" them, in medical jargon - was the first step.
Normally, the bone marrow produces stem cells in small quantities. The goal for transplant patients is to stimulate the marrow to produce many, many more stem cells - so many that they would spill into the blood stream. There, they can be painlessly siphoned off, without scraping marrow from bone. The key to such overproduction is a drug called Neupogen.
Neupogen was a miracle drug when it was brought to market in 1991 by Amgen. It's still a blockbuster for the California biotech company - "life in a bottle,'' according to one doctor. It is a hormone protein that promotes cell production by the bone marrow.
Manzi injected himself with Neupogen three times a morning during the harvesting period. Each day, he went to the hospital to have the stem cells sifted out of his blood.
As he lay on a stretcher, the blood flowed from a catheter that had been implanted in his chest into tubes leading to a big machine. This leukopheresis machine worked like a giant sieve, collecting the heavier cells - the stem cells - and letting the others through. The remaining blood was then returned to his body through another tube in the catheter.
Morning after morning, bag after bag was filled with the precious fluid. The bags were infused with a solvent to prevent damage during freezing.
Over eight days, 15 million stem cells were collected from his body.
His body produced so many stem cells, "my bones were hurting,'' Manzi said.
Memorial Day arrived at the Manzi home in River Edge with brilliant sun. But Manzi stayed indoors in the coolness. Sometimes now when he got too hot, he passed out.
Over breakfast, he told Shelley, his wife, about his worries.
"I'm going to start tomorrow, and in 48 hours I'm not going to have any white blood cells,'' he said, thinking about the effect of the upcoming mega-dose of chemotherapy. He would be extremely vulnerable until the stem-cell transfusion took hold, probably in nine or 10 days.
"I am very, very nervous about infection," he said.
Many other people do this and survive, she countered.
"They do, but they do get infected, and they have a very rough time,'' he said.
He's a doctor. He knew his disease, now. He knew the physician who would care for him. He knew the treatment.
And he knew the risks.
Sometimes, he thought, he knew too much.
He answered the door in jeans, wearing support hose to keep his legs from swelling. His face was pale beneath his thinning hair, but his wit was razor-sharp. Friends arrived late in the afternoon. They'd put together a huge barbecue.
Manzi loves food - he's always thinking about meals to come, the meal in front of him, or meals past. On this night, though, he couldn't eat the hot dogs or burgers because of his salt restrictions. He sneaked a hot dog, guiltily, to go with his baked chicken. He guzzled more than half a watermelon and a few peaches. Fresh fruit would soon be off-limits.
"It's like the last supper,'' he said.
A priest offered prayers and communion in the living room. As the afternoon waned, his friends kissed him and said goodbye.
Tomorrow he'd head up to the hospital's eighth floor, to the Benito & Carmen Lopez Stem Cell Transplant Unit, a super-clean sanctuary within the sprawling hospital. There are 19 rooms there. He'd be in No. 8907.
"I'll be up in the clouds there,'' Manzi said. "Closer to the angels."
Hope, anxiety mingle as doctor faces transplant
| Monday, September 27, 2004 |
|
CHRIS PEDOTA / THE RECORD Dr. Robert Manzi watching anxiously in his hospital bed as stem cells in the syringe are pumped into his body through a catheter near his heart. |
Second of four parts
Near the last row of cars in the basement of a Hackensack hospital parking garage are doors that have been bolted shut and painted with biohazard warnings. Locked inside are eight vats of liquid nitrogen - freezers that store enough stem cells to save a thousand lives.
The frozen cells have been culled from bone marrow, blood, and umbilical cords, diluted with solvent, and shipped from places as far away as Japan and as near as the fourth floor of the office building overhead.
On the morning of June 2, a technician dons long, thick gloves and reaches into the mist of a waist-high, minus-200-degree freezer. He removes three plastic packages, each protected by a metal jacket. Each contains the strawberry-red juice of life. Each bears the name of Robert A. Manzi. The technician places them in an insulated packing box, amid swirling vapors of dry ice.
A few hours later, on the eighth floor of Hackensack University Medical Center, Joanne Growney slips her hands into two pairs of latex gloves to protect against the cold. A basin of water on a rolling cart outside Room 8907 is heated to exactly 37 degrees Celsius, the temperature of the human body.
Growney, the nurse in charge of stem-cell transplant procedures, lifts a metal package from the box and unlatches the cover. She reads the name and patient identification number aloud to a second nurse, who checks it against the patient's orders. Then Growney slips the package into the warm-water bath to thaw.
The liquid in the bag gradually warms to a rich merlot hue. Growney squeezes it gently, feeling to make sure no icy lumps remain.
Inside Room 8907, Robert Manzi digs through an accordion file of documents with his oldest son, Rob, searching for some insurance papers.
The day before, he'd been given high doses of a chemotherapy drug, Melphalan, which was attacking his bone marrow. Preventive doses of medication to quell today's potential vomiting, fever, swelling, or allergic reaction now flowed through his blood, having been dumped into his intravenous line an hour earlier.
At 3 p.m., all the actors in this medical drama gather in Manzi's hospital room: Dr. David Siegel, transplant specialist in multiple myeloma and leukemia; Dr. Jack Hsu, his partner; Dorianne Stellato, a nurse assigned to care for Manzi on this day; two other nurses; and Rob, his son.
Bone-marrow transplants once were done under bubble-like sterility. No more. Manzi's 23-year-old son, wearing sandals, shorts, and a baseball cap, sits next to his father's bed, straightening some papers he'd brought from home. Others in the room chat about Siegel's recent weight loss, weekend plans, the weather outside.
Then the banter stops.
The first two bags of stem cells, warm now, are brought to the bedside in a basin.
Manzi's face grows taut, his eyes wider and harder. His lips tighten.
What Manzi fears most is not pain or needles, it's a toxic reaction to the solvent in the stored blood cells. It could cause sudden heart failure. As a doctor, he knows what can happen.
Siegel urges Manzi to relax.
"If you have your eyes closed, you won't know it's being done," he says.
For all the miracles it accomplishes, the procedure is remarkably low-tech.
Manzi has a catheter - a direct pipeline into a vein near his heart - implanted in his chest. His stem cells had been removed through it before his body was treated with chemotherapy. His medication has been delivered through it. Now, it will be the route for the stem cells to return to his body.
The nurse, Dori Stellato, leads some tubing from the catheter to a fat syringe in Hsu's hands. More tubing runs from the syringe to the sack of stem cells she is holding. Once she opens the clamp, the cells will flow freely.
"Unlock, please," Hsu says.
Stellato unclamps the tubing. 3:16 p.m.
The red liquid travels in an S-curve to the syringe.
Hsu presses the plunger. The flow pushes on into Manzi's body.
"There it goes," Hsu says.
Instantly, Manzi says, "I can taste it."
No one can quite describe it - garlic? creamed corn? rotten eggs? like jalapeño peppers burning your throat? - but the taste is instantaneous and distinctive.
It's the taste of DMSO, dimethyl sulfoxide, the marvelous solvent that allows stem cells to be frozen and stored, neither disintegrating nor forming ice crystals. It spreads immediately throughout the body, seeps through skin in a millisecond. Siegel can smell it the moment he steps out of the elevator on the transplant unit's floor. In the early days of transplants, when more of the solvent was used, doctors placed lemon wedges around the room to counter the odor.
A nurse hands Manzi ice cubes to chew.
He gnaws on the ice as he watches the red fluid glide through the tubing and into his chest. He stays focused. Doesn't gag.
One by one, the team works its way through the three bags of stem cells. Stellato tips and squeezes each one to get out the last drop.
A nurse checks Manzi's blood pressure.
"How you feeling?" Stellato asks.
"A little nausea."
"Anything in your chest?"
"No, just in my stomach."
"Do you feel hot at all?"
"No, just a funny feeling. I'm starting to get tingling."
Rob looks over. "Feeling weird, Dad?"
"Yup."
Manzi's brown eyes sag a bit. He sucks on the ice chips. A device on his finger measures the oxygen in his blood. An automatic cuff reads his blood pressure: 122 over 90, not too bad. It's quiet in the room.
By 3:31 p.m., it is over. 8.5 million stem cells injected into his body in just 15 minutes.
Manzi's son looks from his dad to the people in a circle around the bed.
"Should everybody clap now?" he asks.
From the moment Manzi's stem cells were extracted until they were returned to him a month later, they were in the control of a private company called Progenitor Cell Therapy. Progenitor owns the freezers in the hospital's basement and a lab on the fourth floor of the adjacent doctors' office building, where the security codes and air locks rival a diamond merchant's.
This is a laboratory for cell engineering, an area of science inconceivable a generation ago.
The laboratory grows human cells. Using small amounts of tissue gleaned from individuals, lab workers cultivate large amounts of disease-fighting T-cells and reinfuse them to fight diseases such as multiple myeloma.
They also manipulate the contents of cells. In one study, scientists are tagging cancer cells with genes to trigger the body's destructive immune reaction. In another, they produce individualized cancer vaccines by modifying the blood cells taken from cancer patients.
The lab has perfected ways to sort and purify cells, separating various types of stem cells to use in different ways. They've developed shipping techniques to transport these cells around the world with the delicacy due a newborn. And, of course, the lab freezes and stores cells.
Handling cells is an exacting science, and this lab has set standards where none existed. Stem cells like those harvested from Manzi, for example, must cool to sub-zero temperatures at the rate of 1 degree per minute to prevent them from fragmenting or collapsing.
Hackensack University Medical Center spun the lab off to a group of investors five years ago. Among the investors was the lab's founder and the hospital's chief oncologist, Dr. Andrew L. Pecora. The hospital retains a seat on the board and a sizable investment. Back then, it looked as if a million patients would be receiving cell transplants by now, and the company would serve as a repository for all those hospitals that couldn't afford their own lab. Progress has been much slower.
But the niche the lab occupies is unique in New Jersey, and it has more than 40 employees. There's another branch in California. It's part of a biotechnology boomlet that has generated 8,000 jobs in New Jersey and is beginning to draw the attention - and investment - of state government, venture capital, and pharmaceutical companies.
Back in Room 8907, the chemotherapy is laying waste to Manzi's bone marrow, destroying the enemy cells that make the sticky fibers characteristic of his disease, amyloidosis. But it's also destroying the factories that produce red blood cells, white blood cells, and platelets - the cells that deliver oxygen, attack germs, and form clots to stop blood loss.
Actually, it's even more indiscriminate: It attacks any cells that divide rapidly. That includes hair and nails as well as the mucous lining of the digestive tract. Sore throat, mouth sores, and diarrhea are common side effects. The chemotherapy causes the DNA, the instructions within the nucleus for replication, to break and stop working.
But now, rescue cells - the stem cells - are in his bloodstream.
"A stem cell," Manzi explained before the procedure, "is sort of like an adolescent. It's something that says, 'I don't really know what I'm supposed to be, but if you give me the right direction, I could be anything.'"
The stem cells will circulate in Manzi's blood for a week or so. This is his body's most vulnerable period, because the chemotherapy has destroyed his immune system. Then, the stem cells will take up residence in the long bones of the femur, the sternum, and the iliac sacrum, big bones where most of the bone marrow is found.
Once settled in the bone marrow, the stem cells will begin producing the factories that make white and red blood cells and platelets so crucial to human survival.
The process is called engraftment. If the cells don't engraft, the patient dies - there is no protection against the environmental assaults of bacteria and viruses, no ability to clot after an injury, no energy for the business of living.
It will be obvious what's happening from the numbers on the daily blood tests. First, the counts of red and white blood cells and platelets will drop to almost nothing because of the chemotherapy. Then they will gradually start to climb.
As a physician, Manzi will be able to read it himself.
A decade ago, "we had people in the hospital for 30 to 40 days, and 25 percent of them died" after a bone-marrow transplant, Pecora says.
But by using Neupogen, a drug that stimulates the bone marrow, and transplanting many thousands more stem cells, the recovery time and the threat of infection are smaller. Patients stay in the hospital eight to 10 days, and "the rate of death is now under 1 percent," Pecora says.
The procedure is very expensive: more than $200,000 in Manzi's case, a cost covered by his wife's health insurance.
The door to Room 8907 swings open shortly after the transplant.
Shelley Manzi and the couple's other two sons, Justin, 19, and Anthony, 14, come in, wringing their hands with the waterless soap dispensed just outside the door. Everyone entering is required to wash their hands, to reduce the risk of infection.
"How's he doing?" she asks Siegel.
Good, Siegel nods.
"It was just like he said," Manzi tells his family. "The minute it went in, it smelled like garlic."
Manzi has gained 19 pounds in water weight over the last 24 hours because of the fluid used to flush the chemotherapy through his system. Now he's taking strong diuretics.
But Manzi is completely upbeat. Yesterday he ate a chicken salad sandwich, breast of chicken, London broil, two vanilla milkshakes, an omelet, and a raisin bagel - even though he had chemotherapy. "I slept like a log," he says.
All his fear about the chemotherapy, the transplant - it wasn't warranted, he says. "I can't believe it," he says. "It's totally unexpected. You know - I was scared as chickenshit."
Anthony reports he's made the town's all-star baseball team as a center fielder. "Swing that bat hard when you step in there," his father tells him.
Siegel lets them talk, then hints at what lies ahead.
"Ask him in seven days," he tells the family.
"You mean it's going to get worse?" asks Manzi.
"Um-hmm."
And it will. It will get so much worse that Manzi will regret ever having begun this journey.
A cure that seems worse than the disease
| Tuesday, September 28, 2004 |
Third of four parts
Robert Manzi shivered. He hugged his arms to his chest, struggling to get warm.
This was it, he was sure. Infection, sepsis. The beginning of the end. As a doctor, he had seen simple infections lay waste to patients with immune systems as weak as his.
Eight days earlier, he'd received a dose of chemotherapy that could kill a person. Since then, his body had jettisoned its most basic defenses, cell by cell.
The cells that engulf and destroy foreign bacteria - almost completely destroyed. The cells that transport oxygen to limbs, organs, brain - almost completely destroyed. The cells that knit together wounds and repair damaged blood vessels - almost completely destroyed.
It was good riddance to some of what he'd lost: mutated marrow cells that put out way too much protein, causing the disease called amyloidosis that was likely to kill him in five years.
But he'd also lost the sense of control he'd developed over 23 years as a practicing physician.
Lying with a fever in Room 8907 at Hackensack University Medical Center, he was just one of 19 patients fighting for life in the stem-cell transplantation unit. He was waiting for the stem cells transfused into his body to take hold. Waiting for them to rebuild his bone marrow, to give him back his life.
His white blood-cell count was 100: 100 cells per milliliter of blood. A healthy person would have 100 times as many of these protective cells.
He was on the precipice, he knew, the narrow zone between survival and overwhelming infection.
He pulled the sheets closer and called for a nurse. She gave him an antibiotic.
When a visitor stopped by, his door was closed, the curtain drawn round the bed. Only Manzi's feet could be seen, tenting the white covers. He lay still.
"Maybe better to let him rest,'' the nurse said.
The floor was quiet. A young patient in a bathrobe walked in the hallway, an older woman's arm around her waist. She said not a word. One foot in front of the other, that was all she could manage.
Inside Room 8907, Manzi slept.
When Bob Manzi decided to gamble on a stem-cell transplant, he hadn't dwelt on the "potential risks" enumerated in the three-ring handbook for patients. It led off with infection, bleeding, and anemia, and concluded with the nearly hopeless "relapse."
The book didn't say it, but this was a journey through some of the worst treatment a human can be subjected to in the name of healing.
His body bore the stigmata of that treatment.
Five purple bruises on his upper arm marked the handprint of someone who'd helped him out of bed. His forearm was traced with purple tracks - "like a junkie" - from the needle sticks for his blood tests. The platelets that aid clotting had been destroyed by the chemo and the marks were little hemorrhages. "I know people who've spontaneously hemorrhaged in their heads, when their platelets get this low,'' he said. "This is scary shit."
And, now, he had the chills.
The transplant specialist had given standing orders for a strong dose of antibiotics at the slightest sign of a fever. Such bumps on the road to recovery are commonplace, the specialist said.
In 36 hours, the fever receded like the tide.
But it left Manzi fearful and weak. What if it was the first of many fevers? What if his white-cell count did not stop its slide?
"If I had my way," he told his wife, "I wouldn't have done this." He would have gone for the standard treatment, accepted the fact that he'd be dead in five years.
"I've been exhausted from working before, but this is like I'm poisoned," he said. "Got a metal taste in my mouth. Poisoned. Oh my God, this is bad. I never felt this shitty in my life.''He'd gained 30 pounds as his diseased kidneys labored to process the endless stream of intravenous fluid. He didn't walk so much as waddle now. The ID band on his wrist was so tight "you can't slip a hair under it."
The usually voracious eater had to force himself to down an Ensure protein drink. Even a chicken-salad sandwich held no appeal.
"I just don't want to eat," he said. "I feel miserable."
His doctor, Rosy Joseph, a kidney specialist, got an earful. "I said to her, 'You know, Rose, I shouldn't have done this.'Ÿ''
"She said, 'Stop that! Your kidney is going to go back to normal, Bob. This is from the poison they gave you.'Ÿ"
"Rosy, it's a horrible feeling.''
''You watch,'' was her reply.
The risk of infection altered almost every aspect of what now passed for his lifestyle.
He couldn't brush his teeth - he had to use a special sponge. "When the white blood count falls," he explained, "if you crack the mucosa [the mucous lining], the bacteria in your mouth get in there and infect you.''
He couldn't eat fresh fruit because it is loaded with bacteria.
"When you go to the bathroom, you can't clean yourself the regular way,'' he added, "because if you tear the mucosa, bacteria gets into your blood. Besides walking around with this," he gestured at the IV pole, "you're trying to get in there and not fall off the toilet.''
There were rules for everything: No nail clippers, only an emery board. No razor blades, only an electric shaver. No flowers or potted plants because bacteria lurked in the soil and on the leaves. No food from home, unless cleared by the nurse. No visitors who'd traveled outside the country within the past six months. No one, obviously, with a skin rash or cold.
He couldn't even blow his nose hard for fear his eyes might bleed because of the low platelets.
This hospital unit overlooked nothing in the effort to prevent infection. Air flowed into the patient rooms through a HEPA filter. A constant positive pressure kept outside air from getting in. The tile in the floor had no grout, because grouting would collect mold. The ceiling tiles were smooth, because sound-absorbing pores would gather mold and dust. Soap dispensers hung beside every door. The cleaning crew disinfected doorknobs and switches every time it saw a smudge.
Every day he had to weigh himself and shower with an antibacterial soap, scrubbing from the neck down. And he had to exercise: walk the halls, pull on the stretchy band as the physical therapist had instructed.
If the truth be told, though, his physical regimen - rigorous as it was - was the easy part. It was the emotional stress that wore Manzi down.
He was needed at home. He was worried about things going on with one of his sons, yet he could do nothing.
"I got to do this,'' he said, gesturing at his IVs and hospital room, "got to think about getting well, got to think about the future, got to think about my family's financial future - but still it would be wrong to think about this before my son."
His wife, Shelley, was now barred from visiting. Infectious-disease specialists ordered up a special test to see if she'd been infected with a virus known as Fifth's Disease going around the elementary school where she worked. In the meantime, they told her to stay away from her husband - and the ward.
"It's the most empty feeling in the world, being here,'' Manzi said.
When his thoughts turned to his practice - which he'd left in the hands of other doctors - he'd nearly despair.
"I do not think I can do medicine," he said. "I don't think so. I hope the place [his office] is fine - but there's just too much shit. It's nice not to have to worry about paying bills, about who's going to make you do what, about the goddamn malpractice rates going up.''
Outside the eighth-floor window, the sky was overcast and drizzly. A woman walked past his door once, twice, three times, pushing her IV pole, doing her laps. There was nothing but peach fuzz on her gleaming bald head.
His own head was on fire. He kept looking at the mirror to see if he had dandruff. But it was the chemo. "I can feel it,'' he said. "Every hair root is dissolved."
Sometimes, on his laps round the hall, Manzi talked to other patients.
There was the 70-something man who was in for his second treatment with chemotherapy and stem-cell transplant. Manzi couldn't imagine repeating such a horror.
And there were the people in their beds, seen through the window glass, with photos of children aligned just so on their bedside tables. Many were MUDS, transplant jargon for "matched unrelated donors."
Their risks of complication and death were much, much higher than Manzi's. He'd donated his own stem cells for his transplant, but theirs came from other people. Sometimes they battled rejection or graft-versus-host disease for months. Sometimes, they didn't make it.
"God bless them," Manzi said. "Who the hell am I to ever walk around and say I don't feel good? I told you, I'm a wuss."
As Manzi worried over his family, his nurses tried to offer comfort and encouragement. "Every one of them would come in and say, 'You all right?' They'd say, 'I got kids. You want to talk?' It was unbelievable."
They assured him his recovery was on course. All was unfolding as it should.
Other staff members stopped by. They'd worked with him in Newark when he was chief resident at St. Michael's Medical Center, or knew him because he'd cared for their relatives.
Late one afternoon, a longtime patient of Manzi's called. The doctor had helped her mother through a serious stroke. He gave a quick synopsis of how exhausted he felt, how he was waiting for the stem cells to take, and how he hoped to be discharged soon.
She wanted to help. To donate blood perhaps? To pay a visit?
"Nope," said Manzi, concluding the conversation.
"There's nothing to do. Just pray."
The nurses urged Manzi to get out of bed and walk to avoid pneumonia and clots. After the fever, he forced himself up. He was so weak now, he usually sagged back into bed after a short lap.
Late on Day Ten of his hospital stay, he was standing in pajamas and robe outside his room, catching his breath, when he heard a shout.
Nurses and doctors came flying by. They were running to a Code Blue for the patient next door.
In one of medicine's cruel reversals, the stem cells transfused into the woman had created antibodies that were now attacking her. The precious gift had turned on her, like a bomb in Christmas wrapping. All of her immune responses had been destroyed or suppressed. At 30, she had no defenses.
Manzi - a doctor by profession, a patient by necessity - couldn't help.
He was a doctor, identifying with the desperate work of the code team. And he was a patient, identifying with the desperate illness of his young neighbor. The team worked on her for a long time, then rushed her to intensive-care. But nothing could be done.
The woman - whose name he did not know, but whose struggles he shared - was dead.
Promise and pitfalls of the 'magical' stem cell
| Wednesday, September 29, 2004 |
In their white-coat world, medical researchers seldom use such words as "miracle" and "magic." But tongues have been loosened by the possibilities of stem cells, those tiny blank building blocks of life that can morph into all the cells the body needs.
"They are magical cells in every way," says Dr. Darwin Prockop, director of the center for gene therapy at Tulane University. "They are a win-win cell that keeps giving and giving."
Among the blue-sky scenarios scientists envision:
Heart transplants may become obsolete if bone-marrow stem cells injected into the hearts of patients with heart failure are proven to help grow new muscle.
These miracles could be tantalizingly close once the process by which stem cells develop into other kinds of living tissue is understood and controlled. Decoding that process is the Holy Grail for stem-cell scientists.
It's easy to get swept up in the excitement. But stem-cell transplantation - except for its use in cancers of the blood and bone marrow, and in diseases such as Robert Manzi's amyloidosis - is still completely experimental. Embryonic human stem cells, the most versatile - and controversial — of all the cells under study, have not yet been implanted in humans.
The most exciting breakthroughs, so far, have taken place in lab rats.
It can be dangerous when hope outstrips research.
In the 1980s and 1990s, women with advanced breast cancer begged for bone-marrow transplants, sometimes suing their insurance companies to cover the expense. Thousands of women received such treatments, without waiting for the research to be completed.
Then, in 1999, four studies showed no added benefit for therapy using high-dose chemotherapy with a stem-cell transplant, as compared to conventional chemotherapy. And it turned out that a fifth study, which did show value to the treatment, had been faked. Far from being the "gold standard" of care for women with late-stage breast cancer, the difficult ordeal may have inflicted unnecessary suffering.
"The history of how that came to happen should be a cautionary tale," says Barbara Brenner of Breast Cancer Action, a national advocacy group.
"We need desperately to tone it down a notch and not promise things we can't deliver," she said. "We need to do the same with stem-cell research. We have to do research with much less hype."
In the laboratory, embryonic stem cells from mice have been coaxed into becoming at least 20 different types of tissues. In lab dishes, the cells not only develop into the various components of, say, a blood vessel, but they line themselves up and become a blood vessel. But the work has been fraught with technical problems. An undifferentiated embryonic stem cell injected into a mouse may form a monstrous tumor of hair and teeth.
Adult stem cells are already used to treat leukemia, lymphoma, and myeloma. These cells, it's believed, are capable of developing into only a narrow range of cells. But some research suggests that there may be adult stem cells with broader potential. Ongoing studies aim to address whether bone-marrow stem cells injected in the human heart, for example, will cause it to grow additional muscle tissue.
Stem cells also can be derived from umbilical-cord blood, placental tissue, and even aborted fetuses. Commercial cord-blood banks, including one in New Jersey, now store the cord blood of newborns for possible future uses.
Cells from all these different sources vary in their quantity and flexibility to become different specialized cells. Some replicate more quickly than others. Some are more compatible with unrelated recipients, because their immune identity is not fully formed.
But which cells are better? How can they be grown best? What induces them to become different specialized cells? How can that process be controlled?
Dr. Ira Black, a neuroscientist and pioneer in the field of stem-cell research at the University of Medicine and Dentistry of New Jersey, achieved a breakthrough earlier this year when his experiments with rats showed that stem cells taken from adult bone marrow and implanted in the brains of embryos would become a different type of cell, a neuron.
It was an important finding in a key area of stem-cell science: the question of whether adult stem cells from one type of tissue can become another type. But it is a long way from any clinical application.
"We have to answer some basic questions,'' Black says.
Nervous countdown, joyous turnaround
| Wednesday, September 29, 2004 |
Fourth of four parts
Robert Manzi watched his blood counts with a doctor's eyes - he was one, after all - looking for a sign that the stem-cell transplant he'd received was taking hold.
Daily tests tallied the numbers of white blood cells, red blood cells, and platelets in a tiny drop of blood. These cells were the blood's essential components: They fought infection, carried oxygen, and helped clots form. They made life possible.
He followed their totals like a gambler who'd staked his last dime on a horse.
They'd started to plummet after he was hit with a high dose of chemotherapy on his first day in the hospital. At his feverish worst, on the ninth day, Manzi was more susceptible to infection than at any point in his life. He had just 100 white blood cells per milliliter of blood. A healthy person would have 7,000 to 10,000 in the same droplet.
Then, on Day 11 of his stay at Hackensack University Medical Center, an infinitesimal upturn on the graph of his blood counts prompted his nurse to burst through the door with a joyous announcement:
"It's going up!"
The stem cells had circulated in his body for a week before they found their way to the bone marrow. Then they started making the cells that would churn out the blood cells he so desperately needed.
Like carrier pigeons, they homed in on the production centers for blood and got to work. This miraculous process held the potential for a complete recovery, free of the disease that threatened to kill him.
The power of stem cells to regenerate parts of the body that are diseased, injured, or malfunctioning explains science's fascination with their use. It represents a fundamental shift in medicine.
"It's regenerative medicine - that's what it's called,'' says Dr. Andrew J. Pecora, who founded Hackensack's stem-cell transplant program 12 years ago. "Current modalities of medicine treat diseases. Cellular medicine, including transplants, restores health. You don't have a disease anymore.''
In Manzi's case, chemotherapy - it was hoped - had killed the cells producing the excess protein of amyloidosis, a rare disease that would lead to organ failure. Now the stem cells were repairing what had been lost, re-creating normal bone marrow. White blood cells, red blood cells, and platelets were beginning to multiply.
The blood cells were so new that Manzi would need to receive all the childhood vaccines - for measles, mumps, rubella, diphtheria, tetanus, pertussis. They were so fresh that his lifelong allergy to penicillin might even disappear.
When the nurse made her announcement, Manzi's "count" had inched from 100 to 200 white blood cells. The climb sped up after an injection of Neupogen, a drug that boosts cell reproduction in the marrow.
By Day 12, it reached 600.
Doctors said Manzi needed to reach a minimum of 1,000 white blood cells per milliliter of blood. When "the count" crossed that mark, he would no longer be as vulnerable to infection. He could go home.
Or rather, he could be discharged.
Manzi couldn't go home because his wife had been exposed to a measles-like virus at work, and been advised to stay away from her husband for two weeks. He could leave the hospital, but he needed someplace else to stay.
On Sunday morning, June 13, the nurse drew his blood early. Overnight, the count had shot up to 2,200.
This was what they'd been waiting for. At 10:30 a.m., his doctor signed the discharge order.
Thirteen days after he'd been admitted, it was time to leave the hospital.
Manzi pushed the big square button that opens the transplant unit's entry. His 19-year-old middle son, Justin, was by his side. The huge hospital doors swung slowly open. Justin picked up his father's suitcase, and they walked through.
The nurses waved goodbye.
"We're off to see the wizard,'' Manzi said.
Actually, they were off to see Manzi's mother, Stella. He'd be staying at her Ridgefield home until his doctor decided it was safe to go to his own.
Through the hospital's long hallways, he walked - all the way to the garage. "I might feel like an invalid,'' he said, "but I don't want anybody to see me like an invalid."
His strength was returning. One symptom of his disease - suds in the urine from leaking protein - was disappearing. The extra water weight — all 30 pounds of it - was almost gone.
What remained was the long, slow recovery, as the gummy fibers of amyloid in his kidneys dissolved, and his immunities were rebuilt.
"The period following your transplant is a time of cell recovery and growth,'' says the patient handbook. "This growth requires calories and energy and may explain why you feel much more tired than you anticipated."
For the next year, his new immune system would be more susceptible to bacterial, fungal, and viral infections. The book recommended precautions: He was to wear a surgical mask in crowds, keep his towel and washcloth separate from others, avoid restaurants, swimming pools, and air travel. Manzi laughed at a checklist of symptoms that required urgent consultation - as if he would ignore a stiff neck and a high fever.
In Ridgefield, Stella Manzi couldn't do enough for her only son.
"It's like paradise,'' her boy exulted. "My mom's an Italian mother. Are you kidding me?"
Justin took him on a drive-by past his house in River Edge, where Manzi's wife, Shelley, stood on the front steps and waved. They bantered across the lawn. She kept her distance.
A drug-company rep stopped by Stella's with two thick porterhouse steaks and two rib-eyes from Kocher's butcher, along with zeppole from Rispoli Pastry. The doctor was delighted. His appetite had most definitely returned.
He even spoke about returning to his medical office one day - a step which during his hospital stay he didn't believe would be possible. Limited hours, to be sure, but back in practice again.
Sitting at his mother's kitchen table, he said, "I'm the kind of guy who could go out on the back porch right now and have a cup of coffee and a cigarette and say, 'You know, it wasn't so bad.
But he wouldn't. He was done with smoking.
Does he believe he's been cured?
"I certainly hope so. I'm basically too chicken to do this again.''
Just in case, though, 5.5 million of his stem cells are still in the freezer at the hospital.
The future for Robert Manzi will be marked by frequent blood tests, strenuous efforts to prevent infection, regular medication, and monitoring of his kidneys to make sure the sudsy urine doesn't recur.
It's still too early to say whether his disease is in complete remission, the term doctors prefer to "cure." Only one major study of the same treatment on patients with amyloidosis has been published, in the January edition of the Annals of Internal Medicine. The study found that the treatment was successful in 40 percent of the patients: A year after treatment, no evidence of the damaging amyloid proteins was found in their bodies.
Many of them get the disease back.
Manzi himself had not read that study. When he heard about it, there was silence as he took it in. Then, after a pause, he offered: "That's pretty good. I'll take it."
Dr. Rosy Joseph, Manzi's kidney specialist, noted that he was a great candidate for the procedure, because his heart and other organs had not been damaged. And his response to the treatment so far has been excellent, she said.
The Ridgefield doctor has survived a treatment that galvanizes researchers and tantalizes and challenges physicians. He's earned a front-row seat for the national drama over stem cells.
The adult stem cells with which he's been treated hold none of the controversy of embryonic stem cells. These adult stem cells are an adjunct to high-dose chemotherapy, a way to reconstitute the bone marrow after the take-no-prisoners assault of that medical poison.
Eventually, these stem cells may become tools of other treatments: They may induce the heart to produce new muscle, or the brain to make new neurons, or the body to produce an immune response to cancer. But that work is still in the pipeline. Scientists still don't have conclusive proof that adult stem cells taken from one part of the body can be used to produce other types of specialized cells.
Researchers believe that embryonic stem cells hold more promise because they have the ability to differentiate into all of the more than 200 cell types that compose the human body. They also can be modified to avoid the immune reaction that causes problems when donor and recipient are not matched.
But just six years after the first human embryonic stem cells were isolated, much remains unknown about how their development can be controlled and used in medical treatment.
The study of embryonic stem cells has been limited by President Bush's ban on spending federal funds to use human embryos, left over from fertility treatments, for research. He has been unwavering in this position, even as Nancy Reagan split from the Republican position to urge support for research.
While the national debate intensifies, New Jersey has staked a position solidly in favor of embryonic as well as adult stem-cell research. New Jersey is the second state in the nation to explicitly endorse stem-cell research, and the first to dedicate public funding to a stem-cell research institute, which will be built in New Brunswick.
A researcher at the University of Medicine and Dentistry of New Jersey, Dr. Ira Black, is considered a pioneer in the field for showing that adult stem cells taken from bone marrow, when implanted in a rat embryo's brain, will become brain cells. At Rutgers, another researcher, Dr. Wise Young, is exploring the potential of stem cells to treat spinal-cord injuries.
Besides $9.5 million for the New Jersey Stem Cell Institute, this year's state budget allocated $500,000 for stem-cell research at Hackensack University Medical Center. Experiments are under way at the hospital to expand the use of self-donated adult stem cells for prostate and lung cancer. The hope is that the stem cells will help the body develop an immune response to the diseased cells and destroy them.
Four other hospitals in the state also offer stem-cell transplants: St. Joseph's Regional Medical Center, Morristown Memorial Hospital, Saint Barnabas Medical Center, and The Cancer Institute of New Jersey.
One day, perhaps, thousands more with other diseases may experience a medical miracle similar to Manzi's.
Bob Manzi was back in the bedroom he'd slept in as a boy.
The catheter into the vein above his heart had been removed, improving his quality of life substantially. "I feel like a human being," he said, "I can shower again."
But each time he showered, handfuls of hair fell out. He tried to laugh it off - "there ain't enough up there to worry about" - but it was a reminder of the potency of his chemotherapy.
His mother was indulgent. "He had his breakfast and he had to lay down," she told a caller, explaining why he couldn't come to the phone. "He's wiped out. It's one of those days."
The hours passed in a simple routine. "You get up, you lay down, you go to the hospital and walk around a little bit," he said. "Then it's time to eat." But it was nicer than the hospital, of course. "And the food is better," he said.
Each day, he visited Dr. David Siegel, the transplant specialist. Siegel monitored the blood counts, charting the rise of red and white blood cells and platelets. One day, he said the counts were high enough for Manzi to start eating fruit again. A few days later, he cleared Manzi to drive. To celebrate, the son drove his mom to ShopRite.
"My weight is back to 181, no swelling," he said. And his white blood-cell count? "8,600! That's normal!"
Three weeks had passed since the stem-cell transplant. Now only time would tell how his kidneys fared.
It was time to go home.
When Bob Manzi drove his big blue Audi up the sloping driveway in River Edge - finally - his 14-year-old son Anthony was tossing a football with friends on the front lawn. It was a bright summer afternoon. He could hear the shouts of children in backyard pools. Anthony carried Manzi's overnight bag into the house.
Fresh from his trip to the edge of death, the doctor stood examining the day's mail in the front hall and wondered what they would eat for supper.
Promise and pitfalls of the 'magical' stem cell
| Wednesday, September 29, 2004 |
In their white-coat world, medical researchers seldom use such words as "miracle" and "magic." But tongues have been loosened by the possibilities of stem cells, those tiny blank building blocks of life that can morph into all the cells the body needs.
"They are magical cells in every way," says Dr. Darwin Prockop, director of the center for gene therapy at Tulane University. "They are a win-win cell that keeps giving and giving."
Among the blue-sky scenarios scientists envision:
Heart transplants may become obsolete if bone-marrow stem cells injected into the hearts of patients with heart failure are proven to help grow new muscle.
These miracles could be tantalizingly close once the process by which stem cells develop into other kinds of living tissue is understood and controlled. Decoding that process is the Holy Grail for stem-cell scientists.
It's easy to get swept up in the excitement. But stem-cell transplantation - except for its use in cancers of the blood and bone marrow, and in diseases such as Robert Manzi's amyloidosis - is still completely experimental. Embryonic human stem cells, the most versatile - and controversial — of all the cells under study, have not yet been implanted in humans.
The most exciting breakthroughs, so far, have taken place in lab rats.
It can be dangerous when hope outstrips research.
In the 1980s and 1990s, women with advanced breast cancer begged for bone-marrow transplants, sometimes suing their insurance companies to cover the expense. Thousands of women received such treatments, without waiting for the research to be completed.
Then, in 1999, four studies showed no added benefit for therapy using high-dose chemotherapy with a stem-cell transplant, as compared to conventional chemotherapy. And it turned out that a fifth study, which did show value to the treatment, had been faked. Far from being the "gold standard" of care for women with late-stage breast cancer, the difficult ordeal may have inflicted unnecessary suffering.
"The history of how that came to happen should be a cautionary tale," says Barbara Brenner of Breast Cancer Action, a national advocacy group.
"We need desperately to tone it down a notch and not promise things we can't deliver," she said. "We need to do the same with stem-cell research. We have to do research with much less hype."
In the laboratory, embryonic stem cells from mice have been coaxed into becoming at least 20 different types of tissues. In lab dishes, the cells not only develop into the various components of, say, a blood vessel, but they line themselves up and become a blood vessel. But the work has been fraught with technical problems. An undifferentiated embryonic stem cell injected into a mouse may form a monstrous tumor of hair and teeth.
Adult stem cells are already used to treat leukemia, lymphoma, and myeloma. These cells, it's believed, are capable of developing into only a narrow range of cells. But some research suggests that there may be adult stem cells with broader potential. Ongoing studies aim to address whether bone-marrow stem cells injected in the human heart, for example, will cause it to grow additional muscle tissue.
Stem cells also can be derived from umbilical-cord blood, placental tissue, and even aborted fetuses. Commercial cord-blood banks, including one in New Jersey, now store the cord blood of newborns for possible future uses.
Cells from all these different sources vary in their quantity and flexibility to become different specialized cells. Some replicate more quickly than others. Some are more compatible with unrelated recipients, because their immune identity is not fully formed.
But which cells are better? How can they be grown best? What induces them to become different specialized cells? How can that process be controlled?
Dr. Ira Black, a neuroscientist and pioneer in the field of stem-cell research at the University of Medicine and Dentistry of New Jersey, achieved a breakthrough earlier this year when his experiments with rats showed that stem cells taken from adult bone marrow and implanted in the brains of embryos would become a different type of cell, a neuron.
It was an important finding in a key area of stem-cell science: the question of whether adult stem cells from one type of tissue can become another type. But it is a long way from any clinical application.
"We have to answer some basic questions,'' Black says.
Regarding your series "The promise of stem cells":
Your articles covering the journey of Dr. Robert Manzi of Ridgefield are very inspiring to us all. We always feel that our physicians are different from us. We are the patients looking to them for answers. Now we see how the doctors, too, have the same fears and doubts that we all have when facing a tragic illness.
I applaud his courage and openness in these articles. They show the physicians' human side, which many of us forget exists. Our prayers go out to him and his family for his continued recovery. I know I look forward to seeing him with his stethoscope hanging nonchalantly from his neck as he peers out his office waiting area and says, "Hey, boss, how you doing?"
Therese Leonard
Hackensack, Sept. 28
The Record did a wonderful job in bringing stem-cell treatments to the personal level and allowing us to see exactly what they can mean to a patient.
I wish it had paid as much attention to the nursing care that Dr. Robert Manzi received in the hospital ("The promise of stem cells," Page A-1, Sept. 26-29). He received 24-hour, around-the-clock intensive care from educated, compassionate nurses.
We heard about the physicians that cared for him, sometimes from the distance of their offices. Maybe The Record could follow a nurse for even just a shift on such a case and see the full extent of her contributions, too.
Christine Contillo
Haworth, Sept. 29The new medicine
| Friday, October 1, 2004 |
THE national debate over stem cells is really about embryonic stem cells, microscopic blood particles harvested from fertilized eggs.
But there's another type of stem cells. They come from the blood and bone marrow of adults, and they are free of the controversy surrounding their embryonic cousins.
Adult stem cells are already used to treat leukemia and other blood-borne diseases, as Record Staff Writer Lindy Washburn showed in a series of compelling articles this week.
Ms. Washburn told the story of Robert Manzi, a 52-year-old Ridgefield physician given five years to live after his diagnosis with a rare blood disease. Trying to beat those odds, he underwent a harrowing course of chemotherapy and stem-cell transplantation at Hackensack University Medical Center. So far, so good. Although no one knows the doctor's future, one study showed that 40 percent of people with his disease went into remission after such treatment.
The success in using adult stem cells to cure deadly illnesses points to the even greater potential of embryonic stem cells.
But here's the frustrating part. The Bush administration's limitations on embryonic stem-cell research puts the United States at risk of falling behind other nations in this important new field of medical science.
President Bush's refusal to spend federal research money on any but a small number of already developed cell lines has left states and private groups to pick up the ball.
Californians will vote next month on a ballot measure to spend billions of dollars on such research. New Jersey has also taken a leading role. But it's doubtful that any state can come close to filling the void left by the federal government.
Stem cells, adult and embryonic, are the body's building blocks. Transplanting them to restore body parts that are diseased or injured represents a new type of health care.
Medicine currently focuses on treating disease. This new field is about regenerating the body to restore health so "you don't have a disease anymore," as one physician told Ms. Washburn.
Embryonic stem cells hold the most promise because they are less specialized than adult cells, allowing them to develop into nearly any type of tissue, such as in the lungs, heart, or brain. Scientists hope they could eventually use embryonic stem cells to repair broken spinal cords, cure diabetes, and fix damaged hearts.
So far, there's more hope than hard evidence. But only further research will show whether the imagined potential is real.
Opponents disapprove of the research on human embryos. Believing that life begins at conception, they consider it immoral to destroy fertilized eggs for lab work or medical treatment.
It's important to take seriously the ethical questions arising from scientific advances. But the embryos used in stem-cell research aren't intended to be inserted into a uterus to develop into a human. They are either left over from fertility treatments, donated for laboratory work, or cloned in petri dishes. If they weren't used for research, they would be discarded.
Moreover, governments can set restrictions to guard against violations of ethical standards. The California initiative, for example, would fund the cloning of embryos for research, but not for reproduction.
The potential of embryonic stem cells is so great that even some noted abortion opponents such as Nancy Reagan and U.S. Sen. Orrin Hatch, R-Utah, support it.
But the Bush administration's shortsighted funding restrictions hamper our nation's ability to explore the possibilities of this new kind of medicine.
Judging from the editorial which appeared on the last day of the story we see that the paper couldn't wait to bash president Bush and advocate for embryonic stem cell research. They never mentioned that using embryonic cells are a failure and NEVER worked on one human being and are using junk science, scare tactics and "guessing" by saying that embryonic stem cells hold the most promise. They fail to say that embryonic stem cells are primitive, primordial and act like cancer cells (rapid, uncontrolled growth) in the body and since these cells are made up of real and individual distinct humans, the patients reject these cells just as they do with organ transplants.
Embryos are human beings and are the by-products or throw aways of In-vitro fertilization procedures conducted in the more than 350 fertility clinics in America.
This is a really cool article! I read the wholle story, at least until the reporter began talking about NJ's policy on stem cells. I read the other day (I think on FR), that researchers are discovering serious genetic mutations in embryonic stem cells after a few months. My assumption was that this meant they were basically useless.
If I'm not mistaken, Bob Casey, former governor from PA, had amyloidosis, and ended up getting a heart/liver transplant.
Wonderful, miraculous treatment, if not cure. We've got one in our family: my granddaughter had an umbilical cord transplant at 15 months old because of a genetic problem that kept her from ever making enough white blood cells (her count was never above 1800, despite Nupogen) and then complete bone marrow failure.
We learned today that adult stem cells continue dividing much longer and reliably than previously thought.
http://biz.yahoo.com/prnews/050623/clth053.html?.v=14
(For goodness sake, we learned last year that women make new eggs for their whole lives - negating what used to be Truth: all eggs are created by a girl before birth.
For some reason, far too many with the loudest voices and public forums continue to lack imagination. For some reason, they insist that it will be more useful to create clones of each patient, find or create stem cells - destroying the clone - to treat the disease.
Why on earth would anyone believe that cloning is more feasible than finding and treating and then using adult stem cells???
How's she doing now?
Roni (short for Veronica) is healthier than any other kid I know. She had to have all her shots again - the immunity she did have was wiped out with the chemo and the new born baby boy who donated his umbilical cord blood had never had those shots, of course.
Her blood type went from A negative to O positive. And now, her karyotype from a blood sample is no longer 46, XX (girl) - it's 46, XY. (think she can be a Baptist preacher, now?)
Here's a bump Coleus.
that's wonderful, praise God and thank Him for modern medicine.
In that 'bashing' editorial was the following: "Stem cells, adult and embryonic, are the body's building blocks. Transplanting them to restore body parts that are diseased or injured represents a new type of health care." The writer carefully avoided the full truth, that the embryonic stem cells ARE the body parts of a very young human life, that to 'harvest' those body parts is to kill another human life, that to restore body parts of the older patient, a very young other human must have their body parts ripped from them killing that younger to serve the older. Frankly, that's cannibalism. But it doesn't sound like a bad thing, the cannibalism, when obfuscated in this type of deceitful editorial, does it?
Amyloid plaques are found upon autopsy of Alzheimer's patients, and they are a devastating interference in the brain, but it is not decided yet whether the amyloids cause the Alzheimer syptoms and progression or are a by product of some other cause yet the 'killers in the brain'. [An as yet undetected virus may be causing the plaques that then kill the patient, for example.]
President Discusses Embryo Adoption and Ethical Stem Cell Research (Remarks on Bioethics)
The Truth About Stem Cell Research ON STEM CELL RESEARCH
Adult stem cells vs. Embryonic stem cells.
Congregation Doctrine Faith - Donum Vitae. (Only the Sections that apply to the Sacrament of Marriage and procreation. God's Natural law does not include IVF and test tube babies. Adoption is the Loving option.)
Adult Stem Cells: It's Not Pie-in-the-Sky
From Stem Cell Research Opponents, an Embryo Crusade
Croatia's Catholic Bishops Warn In Vitro Fertilization is “a Serious Crime”
Congregation for the Doctrine of the Faith DONUM VITAE
Instruction on Respect for Human Life in Its Origin and on the Dignity of Procreation
Replies to Certain Questions of the Day, February 22, 1987
Actress Brooke Shields aborted How Many of her own Children by undergoing 7 IVF Treatments
Bishops in Croatia assail fertility method Snowflakes Embryo Adoption Program
Beginning of the End for Embryonic Stem Cell Research?
The Adult Answer: Moving beyond the embryonic-stem-cell debate.
Bump, and marking for reading tomorrow. Looks like a great article.
Thank you for posting this.
Last August my father got this diagnosis. Within three months he was gone. This was my prayer thread:
http://www.freerepublic.com/focus/f-news/1190929/posts
He needed a heart transplant and a stem cell transplant but his diagnosis came too late. I'm so thankful so many others have been saved when it's caught in time.
Happy Father's Day Daddy.
I'm terribly sorry for your loss, please accept my condolences. I hope and pray people no longer will have to suffer from this disease.
Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.