X-Message-Number: 2867
Date: 09 Jul 94 03:02:55 EDT
From: Mike Darwin <>
Subject: CRYONICS Case Report (1/3)

BPI Tech Brief  #9

The following  is case history of an ACS patient cryopreserved 
by Biopreservation.  In accordance with the patient's wishes his 
name has been disclosed in this report.  Wherever XXXX, XXXX 
appears it means that an individual did not wish (or we were 
unable to reach or otherwise get authorization to disclose) 
his/her name and we are respecting that individual's 
wishes and/or erring on the side of caution.

A number of caveats about this report need to be made at the 

1) Graphic data is usually critical to understanding what went 
on and it cannot easily be presented here -- in the case of 
this author it cannot be presented at all.  Individuals who wish 
a copy of this report with the graphic data (charts, diagrams, 
etc.) may obtain one by contacting either BioPreservation or ACS.  
The report in its rough form (i.e., without photographs) will be 
furnished at the cost of duplication and handling (probably 
around $25.00).  Copies of the finished report will be available 
through both ACS  and BPI at a lower cost (larger press run, less 
administrative time) although when this final version will be 
ready it is not now possible to say.

2) This report will be presented in two parts: an initial almost 
exclusively descritive part, and  a second and much shorter part 
which will contain some conclusions, discussion, and suggestions 
as to how this case might have been optimized and how future 
cases might be better handled as a result of what was learned 
here.  Thus, I have deliberately avoided (wherever possible) 
drawing conclusions or making comments in the first part.  
Readers may find this frustrating but I believe it is important, 
in an area as speculative as cryonics, to try and carefully 
delinerate between simple observations and conclusion, opinion, 
and speculation.

3) This is technical case report.  No translation or brief 
summary for the casual reader is provided.  It will be tough 
sledding for anyone who does not have either a lot of patience 
and a couple of good reference books and/or a medical 
background.  I do not apologize for this, merely caution the 
reader.  I believe there is a need for reports such as this 
because they lay down, with some precision, what is being done 
and what results.  I hope to routinely (in the future) begin 
correlating the gross and laboratory results observed in human 
patients with histological and ultrastructural results. To this 
end BPI has spent considerable time and money acquiring 
clinical biopsy equipment which allows for tissue sampling with 
minimum invasiveness.

4) An added frustration in viewing this report will 
probably be the hashing-up and/or omission of symbols such degree, 
micron, and so on.  There may also be the loss of regularity in 
some of the tabular data.  I regret that I do not have either 
the time, or in some cases the expertise, to go into the text and 
correct or otherwise replace characters which will be deleted by 
conversion to ASCII.  I ask the reader to bear with me and/or to 
request a paper copy.

---Mike Darwin

Cryopreservation Case Report:
Jerome Butler White

American Cryonics Society ID #: ACS 9577
Patient Name: Jerome B. White
Date of Birth: 10-31-1938
Social Security #: 525-88-9577
Cryopreservation Date: 02-05-1994

Transport Staff :

Michael G. Darwin, C.T.T., C.R.T., Team Leader, Surgeon
Naomi Reynolds, C.T.T., Transport Technician (Medications)
Shawn Shermer, B.S., C.T.T., Perfusionist
Jim Yount, C.T.T., Transport Technician (Thumper, Logistic 
XXXXX, XXXXX, C.T.T. (Scribe)
Cheryl Heisler, Videographer

Cryoprotective Perfusion Staff:
XXXXX, XXXXXX, Ph.D., Surgeon
Faye Smith, R.N., Scrub Nurse
Michael G. Darwin, C.T.T, C.R.T., Team Leader
Naomi Reynolds, C.T.T., Scribe
Shawn Shermer, B.S., C.T.T., Perfusionist
Sandra Russell, B.S., Assistant Perfusionist, Laboratory 
Analysis, CPA Ramp Technician
Paul Wakfer, B.Sc., CPA Ramp Technician, Logistic Support
Jim Yount, C.T.T., Videographer/Photographer
Allen Lopp, B.S., Logistic Support
Michael Fletcher, R.T, Equipment Technician, Logistic Support
Mark Connaughton, B.S.M.E., -79 C Cool-Down Technician
Candy Wood, Circulator
Larry Wood, M.S., Logistic Support

Biographical Background and Social History

	Mr. White became involved in cryonics shortly after the 
publication of Robert Ettinger's book The Prospect of 
Immortality in 1964.  He was one of the founders of the American 
Cryonics Society (ACS) (then the Bay Area Cryonics Society) in 
1968.  From 1968 through 1982, and from 1990 through 1992, he 
served as an Officer, Governor and committee member for ACS.  
Mr. White was the second President of ACS serving from 1971 
through 1982.  Mr. White was also a frequent spokesman for ACS, 
and for the promotion of cryonics,  appearing on radio and 
television shows and speaking to schools, educational and civic 
groups.  Mr. White was also a one of the founders of Trans Time, 
Inc., a commercial cryonics services organization.

	Mr. White had a varied professional and educational 
background.  He received his B.A. in philosophy from the 
University of New Mexico in 1966 and continued his education at 
the University of California at Berkeley where he studied 
Computer Science and education with special emphasis on the 
psychology of learning, programmed learning, and computer aided 

	From 1983 to 1992 Mr. White was lead designer for software 
for Sterling Federal Systems, Inc. a contractor to NASA Ames.  
While at Sterling Mr. White worked on a variety of NASA projects 
including participating in the development of software to 
analyze the Martian atmosphere.  He also participated in design 
work on a variety of programs to develop tilt-wing aircraft.

	Mr. White was also responsible for the first paper 
describing a detailed and scientifically plausible approach to 
the repair of cryopreservation-induced damage: "Virus-induced 
repair of damaged neurons with preservation of long-term 
information content" which was presented at the First Annual 
Cryonics Conference in Ann Arbor Michigan in 1969.

	Over the course of his nearly three decades of active 
involvement with cryonics Mr. White repeatedly updated and re-
executed legal and financial paperwork to provide for his 
cryopreservation, including a Consent for Cryonic Suspension  
(cryopreservation) executed on 27 August, 1985 and Durable 
Powers of Attorney for both finances an healthcare executed in 
August of 1993.

	Mr. White's academic background, his long years of active 
involvement in cryonics, and his first-hand participation in 
every aspect of a number of human cryopreservations establishes 
his informed consent.

Medical History

     The patient is a 55-year-old Caucasian male homosexual who 
was diagnosed with HIV (Human Immunodeficiency Virus Type I) 
disease in 1989.  The first CD4 cell count noted in the 
patient's medical record was 465 per cmm on 01-24-1992.  The 
patient experienced an atypical precipitous decline in CD4 count 
from 386 per cmm on 01-31-1992 to 114 per cmm on 04-29-1992.  A 
formal diagnosis of AIDS (Acquired Immune Deficiency Syndrome) 
Related Condition (ARC) was made on 08-10-1989.   Prior to that 
time the patient had enjoyed good health with a medical history 
remarkable only for long-standing seasonal allergic rhinitis and 
hepatitis B, the latter of which ran its course without 
complications in 1977.  At the time of his diagnosis with ARC 
the patient was begun on Nizoril for onychomyocosis.  On 08-28-
1989 the patient was started on an antiretroviral treatment 
consisting of 100 mg Zidovudine q. 4 hours.  On 06-11-1991 the 
patient was begun on 300 mg Nebupent (aerosolized pentamadine 
for pneumocystis carinii prophylaxis) q.d. and the 
antiretroviral ddC (2',3'-dideoxycytidine) was added to his 
regimen at a dose of 500 mg t.i.d.

	As of 03-31-1992 the patient was described as doing well 
and all organ systems were negative for pathology with the 
exception of the skin which presented a rash thought to be due 
to ddC (ddC was discontinued for this reason  on 02-28-92).

	Record of an office visit to his primary care physician 
Dennis McShane, M.D. on 05-28-1992 notes the following: ddC 
restarted on 05-14-1992 without complications, the development 
of simple bronchitis on 04-29-1992, complaint of depression on 
04-29-1992, and the presence of hairy leukoplakia on 05-08-1989.  
The patient's Karnofsky score at the time of  the 05-28-1993 
visit was 80%.

	During an office visit on 07-02-1992 the patient noted the 
beginning of intermittent diarrhea, some decrease in energy 
level, and slight numbness in the feet.  By 09-10-1992 the 
patient was experiencing chronic watery diarrhea on a daily 
basis and his Karnofsky score had declined to 70%.  Medications 
were transiently discontinued to evaluate for their possible 
effect on diarrhea.  By 10-15-1992 the patient had experienced 
considerable weight loss as a result of chronic diarrhea (down 
to 65 kg from a normal baseline of 75 kg), consistent daily 
fatigue, and his CD4 count had declined to 45 per cmm.  At that 
time, 1 tbs. of Metamucil b.i.d. and 400 mg Trental t.i.d. (the 
latter as an inhibitor of tumor necrosis factor/treatment for 
AIDS wasting syndrome) were added to his daily medications.

	On 10-29-1992 the patient's condition was noted to be 
continuing to deteriorate with a further decline in his CD4 
count as well continued deterioration in the patient's 
subjective condition.  At that time 200 mg of ddI (2',3-
dideoxyinosine) b.i.d. and 250 mg Azithromycin q.d. (for 
mycoplasm avians intracellularae (MAI)  prophylaxis) were added 
to the patient's regimen with concurrent discontinuation of the 
zidovudine and ddC.  The ddI resulted in exacerbation of the 
diarrhea and was discontinued with a return the zidovudine/ddC 
protocol resulting in lessening of the diarrhea.  On 11-11-1992 
a flexible sigmoidoscopy was performed in an attempt to 
determine the cause of the diarrhea.  The results of 
sigmoidoscopy were unremarkable.

	By 02-25-1993 the patient's weight had declined to 59 kg 
and his Karnofsky score to 60%. Stavudine (2'3'-
didehydrodideoxythymidine) (d4T), 4 ea., b.i.d. was begun 02-05-

	 On 05-05-1993 the patient's weight had declined to 57.7 kg 
with diarrhea, cachexia and marked temporalis muscle wasting 
noted.  On 02-06-1993 a peripherally inserted central venous 
catheter (PICC line) was placed and the patient was started on 
total parenteral nutrition (TPN) at 2000 cc per day with 10% 
lipids at a rate of 167 cc/hr over 12 hours.

	 Due to persistent abdominal pain a CT of the abdomen was 
performed on 05-14-1993 which disclosed fatty infiltration of 
the liver, mild to moderate splenomegaly, and a 2 cm non-
contrast filling mass just below the cecum.  Cefelexin was added 
to the patient's antibiotic regimen to cover for the possibility 
that the abdominal mass was an abcess.  On 05-20-1993, 50 mg 
pyridoxine q.d. and 50 mg thiamine q.d. were added to his 
treatment program.  The patient's weight was stable at 57.7 kg 
and his Karnofsky score was 80% at that time.

	On 06-18-1993 the patient was noted to have markedly 
increased pain secondary to ddC neuropathy with unexplained 
reluctance to take analagesics in the prescribed way (possibly 
indicative of early neurological deficit secondary to his 
illness).  Medications added on 06-03-1993 were as follows:  25 
mg Elavil, h.s., Vicodin, 1 q. 4 hrs., 100 mg Diflucan  
(fluconazole) q.d.  Elavil was increased to 50 mg h.s. on 06-18-

	The patient continued to do fairly well with some weight 
gain on TPN (62 kg) until 08-11-1993 at which time the patient 
was seen with complaints of  falling due to lack of balance.  
Neuro exam disclosed intact cranial nerves, PERRLA, ability to 
rise from seated position without assistance, oriented x 3 (but 
with verbal responses slightly slowed), negative Romberg, 
unsteady gait without ataxia, and inability to stand on tiptoe 
or hop on each foot.

	A CT scan of the head was performed 08-12-1993 at Standford 
Medical Center which revealed a mass in the right thalamus with 
surrounding edema which involved the thalamus, right internal 
capsule, posterior limb and globus pallidus.  Post contrast scan 
disclosed a mass approximately 12 mm in diameter.

	Following the CT scan the patient was admitted to Sequoia 
Hospital in Redwood City, California for stereotactic biopsy to 
discover the etiology of the thalamic mass and  begin 
appropriate medical treatment of the lesion.  At the time of 
this admission, in addition to the acute thalamic mass, the 
patient was noted to be suffering from AIDS wasting syndrome, 
oral thrush, AIDS and/or antiretroviral peripheral neuropathy, 
myopathy due to AIDS and zidovudine, and depression due to his 
underlying poor condition.  At the time of his admission the 
patient's mentation was noted to be intact, but with some 
slowness and thickening of speech.  Thalamic lesion biopsy 
results reported on 08-13-1993 disclosed the presence of 
toxoplasmosis gondii, and initial treatment consisting of 
pyremethamine and sulfadiazine was commenced. On 08-24-1993 the 
patient developed an erythamatous mobiliform rash which was 
believed due to sulfonamide sensitivity.  Sulfonamide was 
discontinued and the patient was begun on I.V. clindamycin.  He 
slowly improved and was discharged on 08-12-1993 on maintenance 
doses of 75 mg pyrimethamine,  600 mg clindamycin q. 6 hrs, and 
10 mg leucovorin b.i.d. all administered p.o. for treatment of 
the toxoplasmosis.

	The patient was readmitted to Sequoia Hospital on 08-16-
1993  following an episode of prolonged confusion, possible 
(unwitnessed) seizure, fever (39.3 C) and rapidly progressive 
debilitation.  A CT scan revealed an increase in the size of the 
right thalamic lesion with involvement of the head of the right 
caudate nucleus.  The patient was begun on broad spectrum 
antibiotics (ceftazidine and vancomycin) for the possibility of 
sepsis.  Because of the presumed progression of his CNS 
toxoplasmosis he was begun on high dose pyrimethamine in 
addition to clindamycin and atovaquone.  

	On 10-16-1993 the patient was again admitted to Sequoia 
Hospital  with recurrent seizures.  At that time it was 
determined that the patient had become noncompliant in taking 
his medications (discontinued taking his medications 2-3 weeks 
prior to this admission) due to depression and deteriorating 
mental state.  The patient was started on Dilantin (phenytonin) which was 
subsequently  discontinued due to skin rash and substituted with 
Phenobarbital (120 mg at bedtime, 60 mg in the a.m., both given 
p.o.).  During this admission the patient also developed Staph 
cellulitis  at the site of his PICC line with culture of the 
catheter tip revealing coagulase negative Staphylococcus.  The 
patient was treated with vancomycin and the catheter was 
removed.   A new PICC line was placed prior to discharge.  The 
patient was discharged on 11-04-1993.

	By 11-08-1993 the patient's mental state had deteriorated 
to the point that the reliability of self-care of his PICC, and 
of his self-medication were questionable (the patient had 
formerly been  meticulous in his self-care).  On a follow-up 
visit by the home healthcare nurse on 11-11-1993 it was 
determined that the patient had become incapable of further 
medical self-care and at this point I.V. medication and TPN 
treatments were administered by his Primary Caretaker and 
medical and financial power of attorney, Margaret Bradshaw (a 
close friend).  At this time the patient's Karnofsky score was 
50% with the patient requiring full-time assistance and 
considerable medical care.

	On 11-22-1993 the patient was seen in his primary care 
physician's office emergently for acute pain and swelling of his 
left arm apparently secondary to infection of his PICC line.  
The PICC line was removed and the patient was continued on 1 g 
vancomycin q. 12 hrs.  At this time the patient was also started 
on 2 mg dilaudid q. 4 hrs for pain.

	Following the discontinuation of TPN the patient lost 5.45 
kg and decided to restart TPN.  A PICC line was again placed and 
TPN was restarted on 12-15-1993.  Medications at this time were 
as follows:

Table I: Medications as of 12-15-1993

Drug		   Dose		Frequency	Start Date

Nebupent    	   300 mg	q.d.		06-11-91

Trental		   400 mg	t.i.d.		10-15-92

Pyridoxine	   50 mg	q.d.			05-20-93

Thiamine	   50 mg	q.d.			05-20-93

Vicodin	   tablet	q. 4hr, p.r.n.			06-03-93

Riopan	  1-2 tab	q.i.d.				07-12-93

Leucovorin	   10 mg	b.i.d.			08-15-93

Haldol     	   2 mg		h.s., p.r.n.	08-31-93

Diflucan	   50 mg	q.d.				08-20-93

Azithromycin	   250 mg	q.d.		09-23-93

Zantac		   150 mg	b.i.d.		08-31-93

Pyramethamine   25 mg	q.d.			11-11-93

Phenobarbital     120 mg	h.s.			11-01-93

Clindamycin       600 mg	q.i.d.			11-11-93

Dilaudid	   4 mg		q. 4hr			01-06-94  (+ 2 mg from11-22)

Testosterone	   100 mg	q.m.o., I.M. 	12-23-93


	By 01-20-1994 the patient was severely disabled with a 
Karnofsky score of 30%.   Ms. Bradshaw noted that the patient 
was increasingly somnolent and bed-bound and there was 
discussion of discontinuing life-supporting treatment in the 
near future (i.e., TPN, antibiotics, etc.).  Diagnoses at this 
time were as follows:

Table II: Diagnoses as of  01-20-1994

	Diagnosis			Start Date
	Hairy Leukoplakia		05-08-89
	Depression			04-29-92
	Diarrhea			07-02-92
	Weight Loss			01-08-93
	AIDS				02-16-93
	AIDS Wasting Syndrome		05-05-93
	Peripheral Neuropathy		05-20-93
	Myopathy			07-29-93
	CNS Toxoplasmosis		08-11-93
	Impotence			10-07-93
	Knowledge Deficit		11-11-93

	On 01-28-1994 the patient experienced an acute febrile 
episode (39.6 C) with pulmonary congestion (rhonchi present 
bilaterally), labored respirations. Pulse oximetery was 
instituted on the afternoon 01-28-1994 using Criticare Model 503 
pulse oximeter. Oxygen saturation at that time was 85% and the 
patient was obtunded with a Glasgow Coma score of  4.  The 
patient was started on  4LPM oxygen and given 1 g vancomycin  
b.i.d. under advice from a consulting physician, Ronit Katz, 
M.D.  Due to the patient's poor quality of life  and the 
advanced stage of his disease (multisystem organ failure) it was 
determined by Ms. Bradshaw  (his medical power of attorney) in 
accordance with the patient's previously expressed wishes 
concerning what constituted an acceptable quality of life to 
him, and in consultation with his primary care physician Dennis 
McShane, M.D.,  that hospitalization was  medically 
inappropriate.  It was the opinion of both of his physician and 
his attending home healthcare R.N. that death was imminent.

	Standby personnel from both Northern and Southern 
California were deployed.  Shortly after the arrival of  Standby 
personnel the patient's condition stabilized and improved 
markedly.  There was considerable improvement in breath sounds, 
return of responsiveness,  and decrease in fever to 38.0 C.   By 
01-13-1993 the patient was able to take fluid by mouth and was 
able to be assisted to a chair for short periods of time.  The 
patient's mental state was one of confusion and apraxia/aphasia 
although he did seem to recognize friends and caretakers, and 
was able to respond to verbal commands/interrogation by nodding 
his head appropriately.  The Standby Team stood down at this 

Agonal Course

  -- To Be Continued --

Rate This Message: http://www.cryonet.org/cgi-bin/rate.cgi?msg=2867