Dr. Dominic deKeratry and Dr. Esther Fields around the cryospray machine

Freeze ray guns save lives

Linda Eckert has a condition called tracheal stenosis, a narrowing of the windpipe. It can occur for several reasons, but in Linda’s case, scar tissue had built up, causing increasing shortness of breath. “It was keeping me from doing the things I like to do,” she says.

In 2003, Linda was referred to interventional pulmonologist Dr. Dominic deKeratry, who performed laser therapy to remove the scarring in Linda’s airway. “It worked for a short while,” she says, “but I’d have to have it done again every six to nine months, and after almost five years, I worried I was headed for a tracheotomy.” Fortunately for Linda, Dr. deKeratry kept looking for other options, and in 2008 he offered what she calls “the miracle I’d been praying for.”

Linda’s miracle came in the form of what Dr. deKeratry calls a “very large freeze ray gun.” What sounds like an action movie prop is actually a sophisticated piece of life-saving medical equipment used to perform cryospray ablation (CSA) therapy. Linda had the procedure done at Baylor Scott & White Medical Center in Temple. “It worked wonders,” she says. “After that, I had some surgery with intubation that caused additional scarring, so I had to have the CSA therapy again in 2010.” By that time, Dr. deKeratry and the “freeze ray gun” were located in Georgetown.

In 2008 Dr. deKeratry and his wife, Dr. Esther Fields, two of just a handful of interventional pulmonologists in the nation trained in CSA therapy, were interested in moving their practice from Temple to Georgetown. St. David’s Georgetown Hospital CEO Hugh Brown explains, “I knew that bringing this unique technology to Georgetown was an opportunity for both our patients and the community, so we agreed to purchase the equipment and to have Dr. deKeratry and Dr. Fields train our staff.”

Dr. Dominic deKeratry and Dr. Esther Fields using truFreeze

CSA therapy is a specialized treatment that can destroy cancerous lung tumors and severe airway scars while avoiding much of the re-scarring caused by traditional surgical methods. Although cryotherapy has been used in other areas of the body for decades, using it in the airways is a relatively new application. Drs. deKeratry and Fields were among the first in the U.S. to use this type of therapy. In lay terms, the “freeze ray gun” removes blockages—tumors, scarring, and other obstructions—from the patient’s airway, significantly increasing the ability to breathe.

Dr. deKeratry explains, “CSA involves the direct application of liquid nitrogen (at a temperature of ¯196° C) to the visible tumor bed or area of scarring.” This is accomplished with the truFreeze System, which can be used during a flexible or rigid bronchoscopy for airway problems. It can also be used during a minimally invasive chest surgery or medical thoracoscopy. The procedures, which may require hospitalization, are performed under sedation along with a local anesthetic.

“St. David’s provides a great toolbox, including a variety of therapies,” says Dr. deKeratry, “but we tend to go to CSA more often than others because using it actually rejuvenates the pulmonary tissue, whereas thermal [laser] therapy essentially burns the scar tissue off. The body naturally wants to heal the burn by growing more scar tissue, resulting in the patient having to come back to have the procedure performed again and again.”

Hugh Brown explains that St. David Georgetown’s first CSA patient was a young mother who had an inoperable obstruction in her airway. Doctors at a major medical center in North Texas had run out of options, so they sent her by helicopter to Georgetown. “It was funny because we didn’t have a landing pad at the time, so they literally landed in a field where they saw the post office in one direction and cattle grazing in the other,” he recalls. “I can only imagine where this woman thought she’d landed.”

truFreeze Spray Cryotherapy

Inside the hospital, Dr. deKeratry was waiting to perform CSA therapy on the patient immediately, reducing the size of her tumor so much that she was able to go back to north Texas within five days. “It was then,” says Mr. Brown, “that I realized the miraculous power of this technology.”

Because cryotherapy prevents the patient from having to undergo repeat procedures, Linda Eckert, who owns Ink Images with her husband, Bill, was able to wait six years rather than six months to have the procedure again. “That was in November 2016, and almost immediately I was able to start leading a normal life—running my business, gardening, and doing other things I enjoy,” she says. ‘I’m not limited at all, and I feel great!”

As part of CSA Medical, physicians from across the U.S. with truFreeze expertise work together to develop curricula to train other doctors to use the system. The doctors often collaborate to counsel patients and family. They also work closely with anesthesiologists, nurses, doctors, and other hospital technicians. “This procedure is not intended as a sole therapy,” Dr. deKeratry says. “Rather, it is intended to augment the effects of chemotherapy and/or radiation therapy.”

For patients like Linda, CSA freezes unwanted tissue to open the blockage in the airway, improve breathing, and prevent the tissue from re-scarring. Drs. deKeratry and Fields use CSA/truFreeze in conjunction with other treatment plans. Dr. deKeratry explains, “A cancer patient will see his or her oncologist as well as the pulmonologist, who will help him breathe better and stay healthier during chemotherapy.”

Dr. Dominic deKeratry and Dr. Esther Fields

Recently, a patient traveled to St. David’s Georgetown from Cedars-Sinai Medical Center in Los Angeles to have the procedure done to clear benign but critical scar tissue blocking her airway. “She was in crisis,” says Dr. deKeratry. “We treated her with truFreeze, and she was able to return to California to safely continue the rest of her treatment closer to home.”

As of January 2017, approximately 50 pulmonary physicians had been trained in the U.S., and approximately 4,500 cases had been completed using truFreeze. “This is a sophisticated technique that works only when you have a dedicated team of doctors, nurses, and technicians who are knowledgeable about the technology and the patient’s specific problem. The group at St. David’s is well-trained and compassionate,” says Dr. deKeratry.

While the ability to provide this specialized therapy is unique to a small hospital, Mr. Brown and Dr. deKeratry agree that what matters is not just having the tool or even the doctors with the expertise to use it. It’s having a team of people who work well together and love what they do.

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