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This text was dumped from the document file which was used to create the hardcopy version of CryoCare Report. The text was reformatted for transmission online. We doubt that any errors were introduced by format conversion, but this possibility does exist. If in doubt, please refer to the hardcopy version of CryoCare Report as the definitive one.
In the previous issue of CryoCare Report I contributed an autobiographical piece to provide some background about myself and my approach to cryonics. Unfortunately in that busy issue we ran out of time and space to include a fuller message describing my vision of CryoCare. I'd like to now take this opportunity to talk about CryoCare - where it has been, and where it is going.
When CryoCare was formed two years ago, it was described by some as the "Alcor schism group," a band of a dozen malcontents who believed that:
Much has happened since then.
CryoCare's cryopreservation service provider, BioPreservation (BPI), has performed ground-breaking research (reported in the previous issue of CryoCare Report) showing, for the first time, the quality of neural preservation that can be achieved with the best cryonics procedures today. While we still have a long way to go to achieve perfect brain preservation, BPI has showed that we are off to a good start, and technology does matter!
CryoCare's most popular long-term care provider, CryoSpan, has now completed its unique underground vault storage system and taken on a large load of patients (reported elsewhere in this issue). The underground vaults provide an unprecedented level of protection against fire, earthquakes, vandalism, and even terrorism. They are truly an engineering first in cryonics, and will be a model for other cryonics facilities for decades to come.
The Independent Patient Care Foundation (IPCF), which was formed to manage the long-term funds of CryoCare Patients, applied jointly with CryoCare earlier this year to obtain 501(c)13 tax-exempt status as a Cemetery Perpetual Care Fund. If granted, this status will make us unique among cryonics organizations. Patient care funds will be able to grow tax free, yet still be accounted individually. Your cryonics life insurance premiums, and other fees payable to CryoCare, will even be tax deductible!
Also earlier this year, an agreement was reached with the Cryonics Institute (CI) in Michigan whereby CryoCare members can choose long-term care with CI instead of with CryoSpan. It was also informally agreed that CI would consider accepting CryoCare patients transferred from other long-term care provider(s) if this ever became necessary. We see this arrangement as a first step toward a new era of competition and redundancy in cryonics.
In April of next year, the first Annual CryoCare Meeting and Board Elections will be held in New York. Votes can be cast by CryoCare members either in person or by mail. Further details of this meeting, open Board positions, and voting procedures will appear in the next issue of CryoCare Report. This process is one of the feedback mechanisms we are establishing to insure that CryoCare always remains responsive to the needs of its members and patients.
Obviously great progress has been made in achieving the goals we set for ourselves. Much of this progress has been made by the companies that serve CryoCare. However, CryoCare itself has made some of the greatest strides. Members are the lifeblood of a cryonics organization, and CryoCare has now grown from those "dozen malcontents" to almost 80 members (a large number of whom are not former Alcor members).
The impressive initial growth of CryoCare is due almost entirely to the dedicated efforts of one person: CryoCare Director and founding President, Brenda Peters. In 1993 Brenda agreed to take on the daunting task of building a new cryonics organization. For almost two years she worked full time without pay as president and signup administrator. I can say without exaggeration that if it were not for Brenda, CryoCare would not exist in its present form today. On behalf of the CryoCare Board, officers, and membership, I want to offer Brenda a heartfelt thank you! Brenda is continuing her oversight of CryoCare as a director, but is now using her personal time to pursue her career as a children's book writer. We wish Brenda the best of luck, and hope that she will still find time in her new schedule for occasional cryonics projects.
CryoCare faces many challenges ahead. The biggest challenge is insuring the smooth operation of a decentralized organization that depends heavily on volunteers. (The work that used to be done by Brenda Peters in one office is now performed part-time by three people in three different cities.) We are also going to have to work hard to continue the momentum of growth started by Brenda. Getting cryonics publicity is easy (talk shows and news media gobble up and disseminate most anything we give them). Getting cryonics members is hard. Currently, we have almost 400 people who have expressed strong interest in signing up with us, but have not yet followed through and completed their documents.
In the long term, I suspect that the Internet may prove to be the ultimate marketing ground for cryonics. Unlike sound and text "bites" of conventional advertising, the Internet (and the World Wide Web in particular) is a place where we can place the entire case for cryonics in easily-digestible pieces for anyone's perusal. The CryoCare Web Page project was started by CryoCare member Micheal O'Neal (the originator of CryoCare Forum) earlier this year, and we anticipate its completion before year end.
We have other exciting projects in the works also, but space does not permit further discussion here. Suffice it to say that CryoCare is now the gateway to the finest cryonics care avialable anywhere. I intend to do my best to get this message out to the world, and to make our next year as successful as our past two.
Long Life,
- Brian Wowk
On Tuesday, September 12th, 1995, high-density concrete was poured to surround numerous reinforcing bars, producing a virtually indestructible collar enclosing the tops of our two new cylindrical, underground dewar vaults. This marked the completion of a project that had consumed more than eighteen months in planning, design, approval, and execution. We believe it is the largest and most costly construction effort in the history of cryonics. Its completion fulfills a promise made by CryoSpan to its two cryonics organization clients two years previously.
Even before the founding of CryoSpan, the originators of the CryoCare structure of independent organizations had realized that if a long-term care company was to be located in Southern California, it must take steps to protect its patients from the major earthquakes which are certain to hit the area before any patients can be revived. The first plan was to secure the dewars against a wall of the building and surround them with a protective cage. However, right from the beginning there were problems both with the total safety of this plan and with the practicalities of servicing the dewars using such a design, especially with a building whose standard roof height was insufficient to allow a standard patient pod to be lifted above a standard dewar for insertion into it. Little by little, the audacious idea of putting the dewars into underground reinforced-concrete vaults began to make more and more practical sense.
After reviewing design ideas for such a project with several engineering and contracting firms (some of which wanted to build a big underground room to house several dewars), firm estimates were produced and the current design of two silo-vaults was begun.
CryoSpan was fortunate to have as designer of the project, working for General Physics Corporation of San Diego, a seasoned design engineer with world-wide experience building solid underground structures using reinforced-concrete pipe. His design ideas matched what Mark Connaughton (an experienced Mechanical Engineering graduate of MIT) and I (an Engineering Physics graduate) had thought should be the best approach, and he expanded those ideas into a final design which is both practical and totally safe from virtually all natural and man-made calamities.
Three months after the engineering and contracting firms were chosen, a test boring was made 20 feet down the center of each proposed vault site and the soil was analyzed for acidity, susceptibility to cave-in during construction, earthquake acceleration transmissivity, and vibration liquidity. The soil testing turned out as expected and verified that the proposed design was able to withstand the strongest acceleration which could come from any fault in the area with a safety factor of at least four. We also verified that the construction should be possible by digging inside the pipes as they were lowered into place.
At this time (November 1994) a down payment of one-half the cost of the reinforced concrete pipe was given to the contractor to allow him to order the pipe, and he was instructed to get the plans accepted by the City of Rancho Cucamonga (by receiving a building permit) and, then, get on with the construction. I had (wrongly as it turned out) assumed that an experienced contractor would quickly get approval from the city if he sought it himself. By May, 1995, after the plans had already been returned twice to the engineers for some minor and unimportant change demanded by the city regulators, I decided to take over the job of obtaining the permit. Because I was the "owner," or knew more about the rationale of the design, or could better describe the properties of what would be put in the silos, or was more determined to "get the job done," or for whatever reason, we soon had a permit to start construction.
On June 20th, 1995 I asked the contractor to proceed with all possible haste. By mid-July, the contractor came back to us saying he could not find anyone to drill the hole and, instead, would have to use a backhoe to dig a very large sloping hole further from the corner of the building than planned. This hole would then have to be back-filled; consequently, the soil would not be as firmly packed and the overall structure would not be as strong. Also, even though we had a signed contract for a fixed sum, the contractor now wanted more because of the extra cost of having to do the job a different way than planned.
So, having had almost a year to find out whether he could do it or not and having signed a fixed price contract to do it our way, the contractor now informed us he couldn't do it after all. At this point, realizing that "you can't get blood from a stone," we gave up on the contractor (his very minimal charge for services already rendered showed that he really did want out of the contract), and we decided that Mark Connaughton being between jobs and having prior building experience in addition to his engineering jack-of-all-trades aptitude, would act as the general contractor for the job. For this Mark would get paid whatever money was left when the job was complete from the total which the original contractor was to have received.
The rest of the job went very quickly, only delayed by the patient transfer from Trans-Time, a cryopreservation cool-down, and the necessary time required to select subcontractors for digging and setting pipe in place, for cutting, bending and tying the rebar, for making the lids and lid rings, and for building a service access channel (extending it to the surface was a practical afterthought not in the original design). Mark himself did the work of buying, building, and placing the safety drain pipe, installing the service access channel (using our crane), installing the rings and tying them to the rebar, and building the forms to extend the cylindrical vaults the necessary ten inches from the top of the concrete pipe to the bottom of the lid rings. I want to thank Mark personally and publicly for a job very well done. While there was a reasonable amount left to pay him for his talents and hard work, I wish that there had been more.
The obvious next step is to lower our bigfoot dewar (full of patients since the Trans-Time transfer) into one of the vaults. However, the bigfoot we own now (a new and properly designed one is on order) was ordered before the vaults were thought of and matches those at Alcor with 5 large casters sticking about 9ý out each side. Since to lower cost, use less floor space, and be stronger the vaults were built with a diameter only 12ý larger than the dewars, our current dewar will not fit unless we cut off the caster brackets. We do plan to do this soon. Both Mark and Mike Darwin think that it will be safe to do so with the patients inside the dewar. In addition, we have the transfer box and the neuro dewar for backup should anything happen. Still, I am more cautious and have decided to wait the extra few weeks until the new dewar arrives and is available for backup. Therefore, in the next issue of CryoCare Report, I fully expect to be able to report to you that we have dewars installed in both vaults, at least one of which is full of patients.
At the end of July, CryoSpan transferred 3 human whole-body patients, 1 human neuro patient, 1 human brain-only patient, 1 whole-body cat and 1 neuro cat from Trans-Time in Oakland, California to CryoSpan's long-term cryonics patient care facility in Rancho Cucamonga, California. All patients are under the guardianship of the American Cryonics Society and will be cared for at CryoSpan under the terms of the CryoSpan/ACS contractual agreement. Jerry White, who was already at CryoSpan, has now been joined by his mother and his cat. Owen and Mary, the parents of a long-time ACS member, together with their cat have joined the family dog "Pumpkin", already at CryoSpan. The other ACS patients had been at Trans Time for a number of years.
The transfer was accomplished on July 27, 1995 using CryoSpan's newly constructed and tested urethane-foam insulated fiber-glass box. The box is large enough to hold four whole-body patients in containers, is supported by six easy rolling casters, and is sturdy enough to be transported by a conventional truck while filled with patients immersed in liquid nitrogen. The measured boil-off rate for the box is about 50-60 liters per day when sitting still, but almost twice as much in a moving truck.
In preparation for the transfer, the box and CryoSpan's whole-body dewar (which is large enough for four patients) were filled with a total of 800 gallons of liquid nitrogen from a bulk-delivery tanker truck. The box, now weighing close to 4,000 lbs, was then loaded onto a rented 24-foot box truck by lifting it with a combination of CryoSpan's newly acquired three-ton crane and the truck's 2,500 lb power lift-gate.
Three CryoSpan personnel - Paul Wakfer, Mark Connaughton, and Louis Ortiz - drove the truck and a "chase" vehicle the 400 miles from Rancho Cucamonga to Oakland. They were joined at the Trans-Time facility by Charles (Chuck) Olson, where they readied the transfer equipment and donned rainsuits, face shields, gloves and insulated shoe covers for protection from possible cryogenic burns caused by liquid nitrogen dripping or running from the patient containers. One by one, the patients - in their metal containers - were hoisted from the Trans-Time dewar and lowered into the waiting arms of CryoSpan personnel by Trans-Time personnel (assisted by a very eager and energetic Chuck Olson). After being slipped into sleeping bags to stop the leakage of liquid nitrogen and prevent them from bumping against the box walls during transport, the containers were carried about twenty-five feet to the truck, where they were quickly immersed in the liquid nitrogen of the transfer box.
No patient container was out of liquid nitrogen more than 15 minutes (the vast majority of which was spent sitting above the Trans-Time dewar draining liquid nitrogen because Trans-Time personnel were not fitted with sufficient protective clothing). Since the patients were also surrounded by much liquid-nitrogen saturated insulation inside the metal containers and were, in addition, insulated and cushioned by the outer sleeping bag wrappers, we believe that they suffered little if any additional damage during this transfer.
The truck with its precious cargo arrived back at the CryoSpan facility in Rancho Cucamonga at 4:00 AM, having set out at 10:00 AM the previous day. After checking that the liquid nitrogen level was still well above the patient containers, we decided to get some sleep. Next morning we unloaded the transfer box and all other equipment from the truck. The liquid level of the box was still good and we knew that it would be above the patient containers for at least a couple of days. Also, we had additional supplies of liquid nitrogen in our big-foot dewar. Therefore, we decided to postpone the transfer from the box to the dewar until Saturday morning, giving us time to get some more rest and make other necessary preparations.
Early on Saturday morning, with all preparations in place, we used an electric hoist to lift each of the three whole-body containers out of the transfer box and into the waiting dewar. During this transfer no patient container was un-immersed for more than five minutes and most of that time was spent fitting the odd-sized (by our standards, at least) containers into the dewar. In fact, we have been able to accommodate only three whole-body containers instead of the usual four. However, each container does hold more than the usual number of neuros, brains and companion animals and still has space for more.
CryoSpan wishes to thank the Cryonics Institute for sharing information with us concerning the glass fiber epoxy resin which they have used successfully in box construction. We also thank Trans-Time for their cooperation in handling the patients during the transfer; ACS for placing their confidence in CryoSpan and its officers; and all personnel who assisted us during this transfer.
CryoSpan now has three human whole-body patients, four human neuro patients, three human brain-only patients, two neuro dogs, two neuro cats, one whole-body dog, and one whole-body cat under its care. Since CryoSpan has been in business for less than two years and now has a total of ten human patients, it has grown faster than any other long-term patient care organization in cryonics history.
The cost of cryonics is always a sensitive subject. On one hand, we are a non-profit organization composed of volunteers who donate their time because we believe that cryonics can save lives. On the other hand, the history of cryonics has taught us that an organization which doesn't charge an adequate amount for its services may not be stable in the long term. If we reduce our margins too much, or accept inadequately funded "charity cases," we jeopardize the security of all our fully-paid-up members who depend on us.
Bearing this in mind, we can't afford to kid ourselves where funding is concerned, and we urge you to be honest, too, about your financial arrangements for cryopreservation. In the very long term we think it is likely that nanotechnology may make vastly complex operations - such as repairing the human brain - relatively cheap by current standards. But in the nearer term there are other expenses to think about: in particular, the cost of cryopreservation procedures before a patient is frozen, and the cost of long-term care after a patient has entered the frozen state.
Our minimum funding levels cover these two major costs, plus a small additional sum (currently, $1,000) to pay for our own administrative expenses associated with supervising a cryopreservation. Unfortunately, many people seem to think that "minimum funding level" is the same thing as "optimum funding level." This is absolutely not the case.
Many CryoCare members are still young and healthy. By the time they require cryo-preservation, it is almost certain that two forces will have increased its cost. Those forces are inflation and innovation.
Inflation is difficult to predict, but a few percent a year seems to be the historical average.
Innovation is likely to be a much larger factor in future price increases (as it has been in medicine in general). With cryonics research now at a higher level of activity than ever before, we look forward to great advances in transport protocols, brain cryopreservation, and eventually perfected suspended animation - in other words, placing a patient in a frozen state that does not, itself, create any damage, and can be reversed without resorting to nanotechnology. These new capabilities will be expensive initially, one reason being that medical professionals will be essential to their implementation.
On the other hand, a factor that will act to decrease the cost of cryonics is improving economies of scale. In particular, the cost of maintaining patients in the frozen state can be reduced to near-negligible levels if large-scale -130 degrees Celsius storage facilities, holding hundreds of patients, become a reality.
Overall, I believe that increases in the front-end cost of quality cryonics service will tend to outpace future reductions in storage cost. The following scenarios illustrate how this may actually affect our members, fifteen or twenty years or more in the future.
Brain cryopreservation is perfected. The procedure requires a professional surgical team, a cryobiologist, and expensive capital equipment. Procedure cost: $100,000 (excluding long-term care).
Should it ever become available, such technology would be offered as a new service option by CryoCare. The option would only be available to members with funding arrangements sufficient to cover the cost - but other members would still retain access to the previous service option they selected when they signed up with CryoCare.
Because of inflation or other cost increases, CryoCare has to raise its funding minimum for the service option that you have selected. Your funding is no longer adequate, and for one reason or another, you are not able to increase it.
We have discussed this situation with our service providers. When necessary, they have agreed to make available less expensive cryonics service options. This may be done by excluding items such as laboratory monitoring, outside medical consulting, and other extras not absolutely essential to the cryonics procedure.
In an extreme case - for example, if one of our members is pronounced legally dead and does not have enough funding to cover the most basic cryopreservation with the most economical service provider - CryoCare reserves the right to convert your whole-body option to the neuro option, or even perform a straight (non-cryoprotected) freeze of your remains if absolutely necessary. In other words, you will not be abandoned by us, but if your funding is hopelessly inadequate, your service level will be reduced.
Note: The fact that CryoCare may be willing to do this for an existing member does not mean we are obligated to do this for new members who want to sign up cheaply. This would be very unwise since they would have no fallback option in the future.
Remote standby runs over ten days for a member with minimum funding. (Remote standby is time spent by a cryopreservation team near a dying member prior to cryopreservation.)
BioPreservation, Inc. bills CryoCare $1,000 a day for remote standby time. Our minimum funding arrangement allows for up to ten days of remote standby (slightly less if air travel expenses are incurred). After this reserve is spent standby will continue, but if the patient does not have any "cushion" of funding above the minimum, we may have to make economies in care along the same lines as described in Scenario 2.
Note that if the standby is less than ten days, any money that is saved is added to funds that are set aside for long-term care in the Independent Patient Care Foundation.
We cannot emphasize too strongly that you should try to fund yourself above the current minimum level if you can. CryoCare itself does not benefit in any way if you increase your funding; our administrative fee for a cryopreservation remains the same. The only person who ultimately benefits is you. The money that you provide will be used initially for your cryopreservation. The excess will go into the Independent Patient Care Foundation, where it will earn interest on your behalf indefinitely. It will serve as insurance for you if storage costs rise, and we hope that it will help to pay for your eventual cell repair and resuscitation.
Note that the cost of life insurance climbs steeply after age forty. If you are in your twenties and thirties, this is the ideal time to buy extra insurance.
Also, note that most insurance companies now offer policies where the face value (the amount that is paid on legal death) escalates each year depending on the rate of inflation. Your premium also rises slightly to cover this escalation, but we consider this an excellent way around the problem that some people face when they find that their insurance becomes insufficient and they are in an age group where additional life insurance is unaffordable. Even if you currently have a policy that is not linked with inflation, you may be able to convert your current policy to that basis.
I hope this brief discussion has shed some light on the important question of cryonics funding levels. It should be clear, now, that when people ask "What is the optimum funding level for cryonics?" the only answer is, As much as you can afford.
As CryoCare's primary service provider for standby and perfusion services, part of my job is to keep not only CryoCare management appraised of progress and/or setbacks, but to keep CryoCare's members informed as well.
Usually it is two steps forward, one step back, under the best of circumstances. This is a hard thing we are trying to do.
However, since the previous issue of CryoCare Report it has been all steps forward with maybe a pause or two along the way at most.
As many of you know, BioPreservation, Inc. (BPI) works in close conjunction with 21st Century Medicine. Over the past three years 21st has focused almost exclusively on research modalaties with near-term clinical application, and further has actively solicited "contract" research from outside companies who are interested in areas where we have expertise.
BPI's role has primarily been confined to doing human cryopreservations and conducting research to document exactly what kind of results we are really achieving with existing human cryopreservation techniques. I'll talk about this work first.
Phase One was documented in the fourth issue of CryoCare Report and on CryoNet. We are now well underway with freeze-substitution studies and have been able (we believe) to correlate injury seen after thawing with injury we can observe in the frozen state.
Freeze-substitution allows us to look at frozen tissue without rewarming it. To accomplish this, we dissolve away all the ice/cryoprotectant at dry-ice temperature (-79 degrees Celsius) and then "fix" the tissue and embed it in plastic. We hope to have results and pictures available within the next three to six months, but we can say now that we have pretty confidently determined that a significant amount of the "strewn rubble" of tissue fine structure we have seen after thawing is, as expected, partly due to "mixing" or "stirring" of the damaged tissue during thawing and processing. In other words, lesions look cleaner and much more inferrable of their former (healthy) state before thawing and while frozen.
We still have a couple more studies to do in this model, but we are now reasonably confident that the approach we are using is at least moderately effective in preserving tissue fine structure and very effective in preserving more rugged structural elements (which may be where our memories and personalities lie) such as synapses.
At their annual meeting earlier this year, the principals of 21st Century Medicine decided that the company would focus heavily on reversible brain cryopreservation with support and interaction from BPI. The secondary and closely allied goal will be to step up the pace of canine total-body washout experiments. We now believe that it is realistic to hope that in the future, we may routinely recover dogs from 8 to 24 hours of deep hypothermia (2 to 4 degrees Celsius) without neurological deficit. Certainly, the brain is not our limiting problem; even after eight hours of cold storage we get good neurological recovery in nonsurvival models.
Perhaps the most exciting news is the advances that are being made in research that we are doing under contract for an outside client. (Why is it you always get lucky when you are playing someone else's hand?) For some time Greg Fahy and I have had some vey innovative and very different ideas about minimizing the damage from brain ischemia (lack of blood flow). Our ideas are different from each other, as well as different from the conventional biomedical approach.
Progress in this area is of obvious great benefit to cryonicists since, under current law, all cases must experience clinical (legal) death which will usually mean exposure to many hours of premortem shock and at least several minutes of complete ischemia due to cardiac arrest, before cryonics procedures can start. Treatment for ischemia also holds enormous commercial potential in conventional medicine.
When our clients began negotiating with us to carry out this research, I was extremely pessimistic. I did everything I could to discourage them, and I told them that their expectations were unrealistic. We had performed a number of experiments in this area over the years, and the results had been so unpromising, 21st had little interest in pursuing the work further. Typically, a dog (anesthetized and not able to feel any pain) could not survive even 10 minutes of ischemia at 37.5 degrees Celsius, even with multiple drugs given and vigorous support on restarting blood circulation with a heart-lung machine.
Perhaps most dismally, the protocol developed at Alcor by Jerry Leaf, myself, and others was found to be actively deleterious even when drugs that would prevent normal resumption of body function were eliminated (such as sodium citrate, potassium chloride, and high doses of barbiturates). Even in healthy dogs the protocol caused serious injury or death. This is always the danger of adding things together which look good on paper or have worked in someone else's lab but have not been emperically tested and proven.
The first experiments we performed in accordance with our client's specifications worked out a little better, and one animal actually returned to more or less normal kennel behavior. (A careful neuro exam would have been needed to find abnormalaties. We suspect heavy cell loss in the hippocampus and other "selectively vulnerable" areas of the brain.) We will document this loss by counting neurons from various brain areas in the near future.
In order to carry out this research we have brought on a lot of new staff and they are working well together. In particular, Sandra Russsell's mother Joan O'Farrell has been an invaluable aid in data acquisition, since she has a strong medical background and runs the cath lab in a hospital not far from us. Further, we've acquired a real go-getter of a head ICU nurse, Carlotta Pengali. We are in the process of hiring a skilled cardiothoracic surgeon and we have a veterinary researcher who should sign on board as our consulting vet and a research team member. He does moonlight practice at a vet clinic near us and his area of expertise is spinal cord injury. He is very anxious to join the staff and we look forward to having him.
We have also hired a professional animal care crew and Vet Tech to supervise day-to-day care and socialization of the animals.
Recently BPI had a transport class to teach, and Greg Fahy was going to be unable to join us that weekend for another brain resuscitation experiment. I was itching to try out some new ideas I had, and I offered the students an option: Would they like to practice cryoprotective perfusion, simulating transport and subsequent perfusion and freezing with an animal model, or would they like to try to recover an animal after 11-12 minutes of cardiac arrest? Since one of the students, Merrill Westfall, is a paramedic with a keen interest in brain resuscitation research, it was an easy sell. Our protocol consisted of 11 minutes and 15 seconds of essentially normothermic (room-temperature) cardiac arrest, followed by 5 more minutes of reperfusion with trickle-flow (to simulate CPR) at a mean arterial pressure (MAP) of 30 mm Hg or less, followed by five more minutes of "reduced" flow at a MAP of 50 mm Hg or less.
My choice of new drugs were given, and the special reperfusion techniques which had shown promise in the previous animals were applied. Cerebral function monitoring allowed us to see in real-time the reperfusion development of excitotoxicity, which occurs due to flooding of the brain with excitatory signaling chemicals during the arrest and when blood flow is restored. This is the last thing injured and energy depleted brain cells need after 11 minutes of oxygen and nutrient starvation. The cerebral function monitor (CFM) allows us to see this happening right before our eyes and to see how good we are at stopping it!
After trying the new protocol and getting our animal subject hemodynamically stable I went home around 3 AM. Carlotta, Sandra, and Merrill were left to mind the store. About 1 PM the following day I got a call from Carlotta informing me that the dog was giving them difficulty and trying to "cough out" his endotracheal tube. Further, his minute and tidal breath volumes were excellent when he was briefly unhooked from the ventilator and they were measured. I chalked all this up to wild overoptimism and gave orders to up the sedation, put the dog on "IMV" (an intermediate "weaning" step to discontinuing ventilator support), do blood gases in 15 minutes, and if they were okay, not to bother me. In other words I tried to ring off so I could go back to sleep. Carlotta was just about to say okay when she said I could forget those orders, the tube was out and the dog was up! I pulled on my pants, threw on a shirt and drove over.
I have considered myself blessed in some ways. Most men live their lives without ever being in the presence of the miraculous. I define miraculous here rather loosely. It is a situation where there is a feeling of awe, coupled with wonderment and joy and supported by the knowledge that what you are experiencing will change forever the world in which you live; or at least has the capacity to do so. We think of such experiences primarliy in the sphere of the religious and the mystical. When we speak of them in science we think of Watson and Crick walking around their completed model of DNA and marveling at what they beheld and had created.
I have been blessed indeed, since I have had this feeling of rapture at least twice before in my life. (One time was watching the first Alcor/Cryovita TBW dog wake up after 4 hours of bloodless perfusion at 4 degrees Celsius.)
When I walked into the operating room that afternoon there are no words to describe what I felt. But I can tell you what I saw. I saw the experimental animal pause from wolfing down a can of dog food and recognize me and begin wagging his tail. I was 20 feet from the toddler playpen where he was sitting up and looking around himself with interest. This dog had not only lived, he had recovered faster than our nonischemic sham operated animals, and he had not had any seizures or other expected evidence of neurological injury that we have seen even in the "best" of the prior survivors. I was awestruck.
Lazarus, as he was called, went on to recover fully and uneventfully. We have repeated the experiment and obtained similar results. The protocol involves multiple drugs, but amazingly is not costly. Our clients are in patent process, as you might imagine.
More to the point, the drugs in BPI's standby kits for CryoCare members have been altered to reflect the insights gained from this work. I can now say with reasonable confidence that we can recover dogs from 11 minutes of normothermic ischemia, followed by a fairly long period of dismal reflow, with no direct or indirect signs of neurological deficit, memory loss, or alteration of learned or routine kennel behavior.
A somewhat unexpected benefit of this work has been spinoff technologies which will be of great value to cryonicists. We measure brain temperature indirectly in both dying and post-arrest (start of transport) cryonics patients by using the tympanic (eardrum) temperature using a hand-held infared device. This has been done in our lab using a clinical tympanic thermometer developed for animals. Trouble is, its not easy to use rapidly. You have to position the sensor and then push a button and wait it for to reset before you can get the next reading.
This kind of "point-click-ship" approach may be great for sending FedEx packages, but it stinks as a continuous monitoring modality. Recently Greg and I flew out to meet the grand old man of brain resuscitation, Dr. Peter Safar at his International Resuscitation Institute at the University of Pittsburgh. We had a great day with Dr. Safar both personally and professionally, and we took many tips back to help us with our model. One of them was to measure tympanic temperature directly by placing a thermocouple probe right on the tympanic membrane of the ear and sealing the ear canal with silicone swimmers' earplug putty.
This approach allows for continuous real-time, fast response measurement, and it can even be used to get accurate brain temperatures if the animal or human's head is immersed in ice water!
This is of great utility in cryonics cases because the initially placed esophageal probe (placement of which is often delayed) quickly becomes inaccurate in measuring true brain temperature. It also does not allow for evaluation of brain temperature in each hemisphere independently. Rectal probes take time to place and are even less meaningful. We now have a way to quickly, accurately, reliably and continuously monitor brain temperature during transport in human patients.
BPI is developing sensors for exactly this use and patents are underway.
Yet another spinoff from the research that 21st and BPI have been engaged in is a development that frees us from the need to use barbiturates at the start of transport. We give barbiturates to reduce brain metabolic demand and prevent any return of consciousness or awareness in the patient as we start transport. As our cardio-pulmonary support (CPR) techniques have radically improved, as well as our pharmacologic management of cerebral ischemia, the return of consciousness during initial post-mortem support becomes more and more of a concern.
The problem with barbiturates is that they are Schedule II controlled substances which are illegal to posess in the absence of a prescription from a physician with a Drug Enforcement Agency (DEA) "triplicate book." In California this not too much of a problem because we have cooperating physicians who can dispense the drug. However, in other states barbiturates cannot be used or even legally possesed without a precription. This has created a real moral and medico-legal conundrum. Fortunately, we have not had to deal with making the decision not to use barbiturates in a patient who might recover some degree of consciousness during the first phase of transport.
The problem is now solved. One of the drugs we use to block excitotoxicity is far superior to barbiturate. It drops cerebral metabolic demand comparably, blocks one major pathway of excitotoxicity, decreases white blood cell activation, partially inhibits the immune/inflammatory cascade, AND is a wonderful general anesthetic! Best of all, it is not an illegal drug or chemical to possess. We see a bright future for this drug clinically and not just in cryonics patients. Additionally, we have obtained a new (and very costly) anesthetic (FDA approved) which is not a scheduled drug. The kits will be updated to contain this compound as well.
One major problem in maintaining remote cryonics capabilities everywhere is perfusate - the fluid that is used to replace the blood and maintain the viability of the patient's tissues during iced transport to the facility where cryoprotectants can be introduced before freezing and long term storage. In the past Alcor, ACS, CryoCare (through BPI) have relied on Viaspan, a commercial organ preservative solution made by DuPont Pharmaceuticals. While Viaspan is certainly better than the older Ringers Solution and even the other organ preservation fluids that made long-term iced storage of kidneys possible (such as Collin's Solution), it is not the optimum cold-storage medium for the brain.
It has two other major disadvantages: first it is extremely expensive at $2,500 for a mere ten liters (20 liters is the optimum washout volume for the average adult). Second, it has a short shelf life due to degradation of the glutathione in it and leaching of the plasticizer from the bags it is packaged in.
For some time BPI and 21st have been looking for a solution to the "solution" problem. Mixing dry components at the scene is too time consuming. Storing premixed perfusate, even on ice, cannot be safely done beyond 24 hours due to bacterial growth which is optimally supported by one of the ingredients (glutathione). So, what we need is a way to package and reliably store perfusate of our own making which is optimized for prolonged deep hypothermic (0 to 2 degrees Celsius) storage of the brain.
BPI has been working toward this goal and has acquired a laminar-flow sterile-air set up for sterile packaging of large volumes of perfusate. We expect to have our first proto- production run in about a month. If all goes well, we should have a perfusate with a shelf life of two to three years on the East Coast and in Southern California. The product will be offered to other local groups for a moderate fee, probably sometime early in 1996.
We expect that lower cost and greatly increased stability of the product will result in far better field washout. BPI plans to deploy the perfusate in 20 liter lots.
On October 6th, four large metal boxes containing a complete standby/transport capability were delivered by air freight from BioPreservation to a location in New York City. This kit is one the most sophisticated we have ever deployed. It not only has heart-lung resuscitator support, but blood washout and and extracorporeal cooling capability. The kit contains the new 21st cerebroprotective medications, a sophisticated surgical tray, blood pump, oxygenator-heat exchanger, and all associated support equipment and disposables.
The kit contains a modified air compressor so that the Thumper can be run on room air in a pinch. We are also urging the New York Group to purchase a collapsible portable ice bath (PIB). This would mean that in a critical emergency anyone with a car could transport drugs, thumper, and PIB rapidly to the scene of the emergency without needing a van or truck and without tediously assembling the old-style PIBs. The new design by Charles Platt can be unfolded and assembled in about five minutes by a relatively inexperienced person. An experienced person can put it together in literally half that time.
The new standby kit has greatly improved our response capability on the Eastern Seaboard, especially since Merrill Westfall and Tim Kornmesser of Pittsburgh, Pennsylvania completed a training course here at BPI (Merrill is an experienced paramedic). Plans call for Merrill to travel to NYC to conduct training and familiarization of the kit with other skilled CSNY members.
A patient transport box is waiting to go East as well, but so far there are no takers willing or able to store this human-sized container. If you are in the New York area and might be willing to accommodate this box, please contact Charles Platt at (212) 929-3983.
This year's theme is "Preventive Medicine, Therapeutic Technology, and the Search for Answers for Age-Related Diseases". The conference will be held at Alexis Park Resort, Las Vegas, Nevada, from Saturday, December 9th through Monday, December 11th.
Just a few of the symposium presentations and speakers:
The Conference promises to deliver exciting interactive dialogues between the speakers and the attendees on lifespan extension.
For Conference Registration contact:
BioConferences International
A4M, 4405 East-West Highway, Suite 501, Bethesda, MD 20814-4536
Fax: (301) 652-4951.
For reservations at the all-suite Alexis Resort please call (800) 453-8000. Identify yourself as an Anti-Aging conference attendee. Rooms are $85 or $95 plus tax.
USA Hosts is the official Anti-Aging travel service. They are offering 10% off excursion or coach tickets on Southwest Airlines. Call (800) 792-9999 to make your flight reservations.
CryoCare will be hosting a Hospitality Suite after hours. This will be an excellent opportunity to join Ben Best (Secretary of CryoCare), Paul Wakfer (director of CryoSpan), Carol La Valley (signup administrator for CryoCare), and others. We can answer your questions about cryonics or help you to complete your CryoCare paperwork and have it witnessed.
We look forward to seeing you there!
Many of our members previously belonged to other cryonics organizations, particularly Alcor. Recently we discovered that one of our members had neglected to inform Alcor that he had switched to CryoCare, and Alcor still believed that he was their responsibility in any emergency. Also, the member was apparently still wearing an Alcor bracelet in addition to his CryoCare bracelet!
This is a potentially dangerous situation. Mobilizing a cryonics transport team in response to someone who is no longer a member costs thousands of dollars and puts other members of that cryonics organization at risk. A cryopreservation can only be done quickly, efficiently, and successfully if there is no doubt which organization has the responsibility and will receive the funding.
We have also heard of members who have paperwork and funding in force for two organizations, perhaps because they believe that one organization can act as backup for the other. Unfortunately, this is not compatible with the contractual arrangements that cryonics organizations make with their members. Only one organization can receive human remains under the Uniform Anatomical Gift Act, and you must decide which organization this will be while you are still alive.
At CryoCare, we like the idea of building redundancy into our own system and have already taken steps in this direction. We have contractual arrangements with two different organizations (CryoSpan and The Cryonics Institute) for long-term care; we can permit patients to be transferred, if necessary, from one provider to another; and in extreme circumstances (outlined in the Patient Advocate Agreement) a patient may be removed from our custody completely.
Unfortunately, however, at this time we only have contractual arrangements with one provider of standby, transport, and perfusion services. In this respect, we are like any other cryonics organization: we rely on one team of people to care for our members. Of course, this team itself does have some redundancy, since there are now several people associated with BioPreservation who possess the skills necessary to do a standby and perfusion.
Getting back to the subject of multiple memberships, we have informed other cryonics organizations in cases where we knew that people joining us had been signed up elsewhere. However it appears that these efforts have been inadequate, and we will have to take more aggressive measures to address the membership overlap problem. If you are now a CryoCare member, and if you have any doubt about your membership status with another cryonics organization, please notify that organization and remind them that you are now signed up with us. Also, if you receive any questionnaires or phone calls from CryoCare regarding past membership in other cryonics organizations, please answer honestly. Like all personal information you provide CryoCare, this information will be strictly private. We are only asking for it now to avoid costly consequences in any future emergency.
CryoCare's signup administration and newsletter mailings are now being handled by Carol La Valley, of Carol La Valley Services in Reseda, California. Former Manager of support services for a major law firm, Carol brings with her a wealth of administrative experience and a large measure of enthusiasm for cryonics. We foresee Carol becoming increasingly involved in many aspects of CryoCare operations as she continues to climb the cryonics "learning curve." Special thanks to CryoCare director and former President, Brenda Peters, for finding Carol for us.
Unfortunately, the transfer of signup processing from the New York offices of Brenda Peters to Carol's office in California has not been perfectly smooth. We apologize to those members who have experienced delays or other problems in the processing of signup paperwork. We are working to develop mechanisms to speed the signup process, yet still ensure all paperwork and insurance arrangements are properly in place.
As part of the transfer of signup administration, we have done a thorough review of the files of CryoCare members who are already signed up. During the initial rush of signups last year, many people did not complete their paperwork fully, or made errors in the witnessing process, or applied for membership without making proper funding arrangements. We have already notified everyone who falls into any of these categories, but if the flaws in your paperwork still haven't been fixed, you may expect Carol to get in touch with you. Remember, it's not "just paperwork": it's your cryonics arrangements, and your life.
If you want information about CryoCare or a signup kit, you can contact Carol at
Carol La Valley Services 8150 Rhea Avenue Reseda, CA 91335 Phone: (818) 727-9486 email: Note: there is a numeral 1, not a lower-case letter l, after the "Y" in this email address.)
Carol operates her business out of her home. Please try not to call her outside of business hours. Also, please bear in mind that she prefers to do as much CryoCare business as possible on Wednesdays. If you are already a CryoCare member, and have questions about your arrangements, you should speak to Charles Platt, our Vice President, at (212) 929-3983. In case of emergency you can still call us anytime at (800) TOP-CARE. Someone is always on call on a 24-hour basis, seven days a week.
PLEASE COPY THIS LIST OF NUMBERS AND PUT IT IN A SAFE, MEMORABLE PLACE!
In a CryoCare emergency, you may call:
Brian Wowk Daytime: (204) 984 6618 Evening: (204) 254 6192 Pager: (204) 933 0324
Charles Platt Day/Eve: (212) 929 3983 Pager: (800) 908 0470
Billy Seidel Daytime: (310) 836 1111 Evening: (310) 836 1231
Brian is the president of CryoCare. Charles and Billy are vice-presidents. Any of these three people can help you in an emergency.
CryoCare Report is published four times a year by CryoCare foundation, a non-profit corporation whose main office is located at 10627 Youngworth Road, Culver City, California 90230.
| Effective 1996 the new address is: |
|---|
| CryoCare Foundation |
| Suite 3410 NorthEast Hercules Plaza |
| 1313 North Market Street |
| Wilmington, Delaware 19801-1151 |
President: Brian Wowk
Directors:
Brenda Peters, Brian Wowk, Peter Crowley.
Vice Presidents: Charles Platt, Billy Seidel.
Treasurer: Kevin Brown.
Secretary: Ben Best.
Members of CryoCare receive the newsletter at no charge.
If you are a non-member and wish to continue receiving CryoCare Report, write a check made payable to CryoCare Foundation for just $9. The next four issues will be sent to you via first class mail.
Provided your name and address are on the check, you don't need to enclose anything with it. Just write "Subscription" on the memo line of the check and send it to Kevin Brown, Ph.D., Treasurer of CryoCare, at 19-353 Dell Place, Stanhope, NJ 07874. We'll do the rest.
Overseas subscriptions: by air mail only, $15 per year. Payment must be made in US funds: cash, a check drawn on a US bank, or an International Money Order.
Back issues: $3 each ($4 overseas).