Outside the clinic, snow lay thickly on the ground. Inside, I lay under hot lamps, my core temperature raised to 39 degrees. The doctor wiped my forehead with washcloths dipped into the snow from the balcony. How cool was that?
This was my introduction to whole-body hyperthermia, two days after the trans-arterial chemoembolisation (TACE) treatment.
Hyperthermia is the raising of the core temperature of the body to a high heat, of up to 45 degrees celsius (or 113 fahrenheit) for several hours. Research has shown that such high heat can damage cancer cells (which are more vulnerable to heat), lower the resistance of cancer cells to chemotherapy and also stimulate the immune system. Hyperthermia is usually administered in conjunction with other treatments such as chemotherapy.
The purpose of my hyperthermia session was therefore to potentiate the effects of the TACE procedure and the chemotherapeutic agents administered. By weakening the cancer cells, the chemotherapy would work more effectively.
There are various forms of hyperthermia (e.g. localised hyperthermia and extreme hyperthermia), but the sort I was having was whole-body hyperthermia.
I thought hyperthermia would be like going to a sauna, and I love hot sauna. I hadn’t done much research into this treatment until the night before when someone told me to look it up on Google. Some of the articles made me pale – some clinics (e.g. Klinik St. George and Herzog) anaesthetise their patients in order to achieve temperatures of 45 degrees! I began to wonder if it was like a “sauna” after all.
I’d previously had a form of hyperthermia in a clinic in Brighton. This was done in a sit-down sauna cube, with the head exposed outside. It was hot, and I sweated, but I could have sat in that cube all day. Little did I realise how different proper hyperthermia is.
Whole-body hyperthermia, done properly, is serious business. It is done under strict medical supervision and monitoring throughout the process.
In Germany and at Hallwang, the treatment is usually done using a Heckl tent and far-infrared lamps. Sabine is the hyperthermia technician at Hallwang and she was apparently very good; however, on the day I had my hyperthermia, Sabine wasn’t available, so I had a doctor and nurse take charge instead.
First, ECG, pulse and blood-pressure readings were taken to establish a baseline.
Next, I was put into a hot bath of water (with Badedas bubble bath!), and the temperature was raised slowly. The aim of this bath was to get my core temperature to about 39 degrees celsius. Because I’m used to taking hot baths, I was able to tolerate very hot water, and the nurse and doctor were surprised at how quickly my body temperature soared to the required 39 degrees.
By raising the temperature to 39 degrees, this meant less time had to be spent elevating it even further in the hyperthermia tent.
Once I got to 39 degrees celsius, I was led to a bed which was enclosed in a box-like tent – the Heckel tent. Only my head was positioned outside the tent. This would help to keep the head cool.
Monitors were attached to my body – ECG electrodes, oxygen saturation monitor, and a (yes!) rectal probe to measure the core body temperature. I also had an oxygen feed to help with breathing. At that point, I realised how serious all this was if I would need help with my breathing!At the top of the tent were four water-filtered far-infrared lamps. These were switched on one-by-one, and the heat cranked up in the tent. After about 30 minutes, my core temperature went up to 41.9 degrees celsius – the doctor was impressed by my tolerance for heat.(my secret? I grew up in a tropical country with 100% humidity and without airconditioning, so I had been, in effect, in training for hyperthermia all my life!)
The parameters of the monitors had been set for lower tolerances, my pulse was already on the fast side, so the alarms kept going off, and had to be manually-overidden so that I could continue. Every one has different constitutions and sometimes sedation (e.g. Valium) has to be used to enable the patient to tolerate hyperthermia.
I didn’t require sedation; in fact, I wanted to stay at even longer under the lamps, but because it was my first time, the doctor said I shouldn’t over do it. So the lamps were gradually turned off. I was then wrapped in an insulating blanket for the rest of the session.
What was it like to be at 41 degrees celsius?
I used breath control techniques, very long breaths to keep going. I listened to music. I looked at the snow outside. It was very boring. There was no let up in the heat. It was like burning up from inside. Only the thought of all the cancer cells being weakened kept me going. The doctor helped by soaking a washcloth in snow and then wiping my forehead with it – but the relief was momentary! It was so hot I joked about bringing Rudy the Hallwang Rooster in with me next time so that I could cook roast chicken for dinner!
I lost a lot of fluid through sweating. The sheets and the bed were soaking by the end of the session. My right foot started developing cramps part-way through the session and I had to have two injections of magnesium to correct the electrolyte imbalance that was causing this.To compensate for the fluid loss, I was given two litres of infusions. I also drank about a litre of water even though I didn’t want to as I’d been warned by other patients that this would lower the core body temperature. For the first time in years I indulged in a jug of sugary-sweet orange juice, freshly-squeezed by the kitchen – “But there’s Vitamin C in the infusions!” The doctor said. Yes, but something about being under those lamps made me crave the tangy taste of fresh orange juice. All that fluid had to go somewhere and that meant peeing which meant unfortunately, using a bed pan. Yep, just when I thought it couldn’t get any more embarrassing, I had to have a stranger help me with bodily functions.
To use the bed pan, the insulating blanket had to be lifted which meant that heat escaped, and resulted in my core body temperature started falling. In the last hour it was probably around 38.7 degrees celsius. I was disappointed and wanted to start all over again. [At Herzog’s, because the patient is sedated, an external catheter is inserted]
By the end of the three hours I was wrung out, metaphorically and physically. I felt shaky and light-headed. I wanted to crawl into bed and lie down. Instead I was told to take a shower, and then rest.Surprisingly, after a short rest, I was fit to go downstairs for dinner, looking like a broiled lobster.
I was told I’d reached the second highest temperature in the clinic for hyperthermia. Not bad for a first-timer! So of course I boasted about it. One of the patients who was a hyperthermia veteran, but had never reached such a high temperature accused me of cheating because my normal baseline temperature was higher than his, anyway!
(Us cancer patients are a competitive lot!)
To find out if hyperthermia is right for you:
Hyperthermia costs vary in Germany. Hallwang’s was one of the most expensive – over Euro 1000 for a single session. However, I did get the undivided attention of a doctor and a nurse throughout the three hours. Hallwang does not practise extreme high-heat hyperthermia – something to do with the breakdown of red blood cells at high heat.
Oncothermia, as it is practised in Germany, does not to the best of my knowledge, exist in UK – that’s partly because private clinics in the UK are not licensed for chemotherapy, and most hospitals in the UK do not have hyperthermia units. The closest to the German model I’ve managed to find so far is at the Breakspear Clinic which uses an Iratherm 1000 Hyperthermia bed, which has been imported from Germany. And CancerActive reports that the Raphael Centre has a Heckel tent. I haven’t had a chance to try either centre though, so can’t vouch for how stringent their hyperthermia is.
Lucky you! The Gore Street Medical Clinic in Hobart, Tasmania has a Heckel Tent. Even better, one of the consultants at the clinic also practices at Hallwang clinic – Dr Greg Schwarz. And www.eusano.healthcare supplies hyperthermia machines to Australian clinics, so please contact them for further information.