Flying HighJune 21, 2010 10:02 am Comments Off on Flying High
Sarasota Magazine – Download “Flying High”
How deep brain stimulation rescued one Parkinson’s patient. By Su Byron
Dan Wohlers, 57, loves to fly. Before he obtained his pilot’s license, he took up parachuting, clocking in about 260 skydives over the years. By the mid-1970s, he was piloting his own small planes, including a 1949 two-seater Aeronca Champ.
As the years flew by, he owned a series of planes, including a Cessna 172 and a Piper PA-11.
After graduating from Kettering College of Medical Arts in Kettering, Ohio, with an associate degree in respiratory therapy, Wohlers met and fell in love with Sue, a fellow pilot. She shared something else with Dan; she was also involved in the medical field, as a nurse. They married in 1977 and moved to Punta Gorda in 1979, where they both found work at an area hospital, They settled into a happy family life, bringing up two children, John and Sarah, and flying around the country whenever they could.
Combining his skills as a respiratory therapist and pilot, Dan began moonlighting for the Air Trek Air Ambulance corporation, headquartered in Punta Gorda, Sit with him for an hour and he’ll mesmerize you with stories from the more than 10,000 hours he logged in transporting sick and injured people. In 1995, he became full-time captain of Air Trek’s corporate jet in Punta Gorda. “I loved my work,” he remembers. “I was helping other people and doing what I loved best—flying.” The only downside: It often interfered with his family life. At a moment’s notice, Dan could be called away at any time of day or night.
In 2003, the Federal Aviation Administration offered Dan a full-time position as a safety inspector in Albuquerque, N.M. After so many years of irregular hours, the couple welcomed the idea of a nine-to-five job and decided to move to Albuquerque.
This is where personal history turns into medical history. After a year at his new job, Dan had to take a standard flying test. For a few months, he hadn’t been feeling like
“My hands were shaking and I couldn’t stop them. Needless to say, I flunked the flying test.”
himself. His handwriting was changing—it looked small, scrawled and barely readable. His voice sounded more subdued. He says he also noticed that when he walked, “My arms hung stiffly at my sides. Something seemed off.” Dan shrugged it off, thinking it was just stress.
But it wasn’t. During the flight test, he knew it. “My hands were shaking and I couldn’t stop them,” he says. “Needless to say, I flunked the test.”
On his drive back home, “It just hit me that I had Parkinson’s disease,” he says. At home, he quickly found the answer on the Internet. “I had every symptom listed. It was a no-brainer,” he says.
Dan’s initial research told him both his brain and body were under attack. Here’s some of what he discovered:
Parkinson’s disease (PD) results from the depletion of certain brain cells. When they’re healthy and plentiful, these cells produce dopamine, a neurotransmitter that stimulates muscle-regulating nerve cells. Think of dopamine as a traffic cop in the constantly shifting traffic of brain chemistry. With the right amount of dopamine, the body’s muscles and movements stay coordinated. When they lack dopamine, the motor system’s nerves can’t control movement and coordination. According to studies, symptomatic PD patients have lost 80 percent or more of their dopamine-producing brain cells. The symptoms, which become progressively worse, include tremors, rigidity, slurred or slow speech, a mask-like facial appearance and an awkward gait. There’s no cure for Parkinson’s—only treatment—and the earlier, the better.
Dan and Sue tried to rally. “We didn’t want to believe this was happening,” he says. “I’ve always prided myself on being a realist who can deal with emergencies. But this hit us hard.”
They saw a doctor, who confirmed his worst fears. Dan did have Parkinson’s disease—and it was progressing rapidly. Soon the symptoms began to interfere with everything—eating, dressing, driving. But Dan was determined to fight back. “I felt some relief in knowing that it had a name. 1 knew who the enemy was and was prepared for the battle,” he says.
He and Sue returned to Punta Gorda. Dan’s doctor there put him on a regime of Parkinson’s drugs. These eased his symptoms—for a while. Besides taking medication, Dan religiously adhered to a daily exercise schedule and a healthy diet. He went to a speech therapist and worked with other professionals to keep his body in shape. But as his symptoms worsened, his doctor had to put him on stronger drugs, which caused increasing side effects, the worst of which were severe involuntary muscle spasms in his neck. Dan began to despair.
Then he heard that something called deep brain stimulation was helping some Parkinson’s patients, and his doctor referred him to a neurosurgeon and neurologist in Sarasota who were experienced in performing that procedure.
Deep brain stimulation (DBS) may sound like the stuff of a Michael Crichton novel, but it’s been around for awhile. Developed in 1987, this surgical procedure can treat a variety of disabling neurological symptoms, including Parkinson’s disease. In the initial operation, a neurosurgeon inserts electrodes within the affected brain area, and then connects them via an insulated wire to a battery-operated impulse generator (IPG), implanted just below the collarbone—much like a pacemaker. Once activated, the device targets continuous electrical pulses to the areas in the brain that control movement. The batteries in the IPG need to be changed every two to five years—which means the patient has to undergo minor surgery that often. In addition, the patient’s neurologist must closely monitor the IPG every three months.
How does the surgeon know where to implant the electrodes? Dean Sutherland, M.D,, Ph.D, is a neurologist and the founder and medical director of Sarasota’s Southeastern Center for Parkinson Disease, Parkinson’s disease is his specialty; fighting it is his passion. His comprehensive, integrative
“It’s not a miracle cure. But it will give the patient more control of his or her life.”
approach to Parkinson’s disease has received national attention.
Sutherland works closely with Dr. James Schumacher, a local neurosurgeon who has performed nearly 1,000 DBS procedures. As a team, they perform at least one DBS procedure a week at Sarasota Memorial Hospital in an operating room specially equipped to facilitate the procedure.
The hospital was one of the first institutions in the state to acquire the leading-edge technology in 1996, thanks to support from Sarasota Memorial Healthcare Foundation, Inc. Over the years, the foundation has provided nearly $1 million in grants to support the latest DBS equipment and program.
Sutherland explains that ideal candidates for DBS are people who respond well to medication but are suffering debilitating side effects. “It’s not a miracle cure,” says Sutherland, but it will lessen side effects and give the patient more control of his or her life. We felt that Dan, with his relatively young age and active lifestyle, was an excellent candidate,” They scheduled him for surgery three months down the line.
“Three more months of misery,” says Dan. “But now I had hope.”
In June 2007, Dan went in for surgery. Sutherland explains that the first part of the DBS procedure is exploratory. Before permanently implanting the electrodes, the neurosurgeon has to determine where they go. Despite what we may see in science fiction movies, the brain is not a circuit board. Targeting a precise area of the brain involves some surgical trial and error. Patient feedback is also a must.
First, Sutherland and Schumacher inserted an electrode into the deepest part of Dan’s brain, allowing them to record electrical impulses in the areas of the brain involved in PD. “We could actually listen to and see the electrical firings of the neurons,” which sound like popping noises or static, Sutherland recalls. As they tried to find the exact location of the abnormal signaling, Dan was lightly sedated but conscious enough to raise his arm or fingers. “We need feedback as we try to find the afflicted area of the brain,” Sutherland explains. Sutherland then used electrical impulses to stimulate the areas affected by PD, noting Dan’s responses.
After the electrodes were properly placed, Dan was put under anesthesia. Next, Dr. Schumacher inserted the impulse generator or brain pacemaker, attached to electrodes beneath his collarbone. In Dan’s case, the surgeons first implanted electrodes on the right side of his brain. They performed a second procedure, on his left side, a few months later.
Sutherland notes that DBS carries a small but potential risk for bleeding, infection, seizures or stroke. Thankfully, Dan experienced none of these, Soon after, his tremors subsided. His doctor lessened his medication dosage, which meant that his involuntary movements also subsided. Eventually, Dan was taken off most of his medication.
A few weeks after the second operation, Dan and his wife took their grandson to Jungle Gardens. “I reached into my back pocket to pull out my wallet. Didn’t even think twice,” he says. “Sue almost yelled, `What are you doing?’ I hadn’t been able to do that for years. Next day, I bent down to tie the lace of my shoe. It was a miracle.” A few weeks later, Dan flew to Alaska on a family vacation. Putting himself to the test, he hiked 30 miles in one day—and felt great.
Dan had his life back.
Most patients on DBS also see improvements. The largest DBS research trial to date, published in the Journal of the American Medical Association last year, showed that DBS patients do better than patients on medicine, with up to 4.6 more hours of good motor function per day.
At the same time, DBS is not a foolproof medical procedure, It requires expert monitoring and adjustment, and things can and often do go wrong.
Almost a year after his surgery, Dan’s tremors and stiffness began to return. He tested the batteries in his pacemakers and discovered that the battery powering his right pacemaker was dead. He made an appointment to see Sutherland. But a few days before the appointment, he fell out of bed and couldn’t get up. Apparently, the second pacemaker’s batteries had died as well. Without the help of the stimulators or medication, Dan was virtually frozen.
Dan was rushed to Sarasota Memorial Hospital, where Sutherland confirmed that the batteries needed to be changed. He scheduled the surgery and put Dan back on temporary medication so that he would at least be able to move and eat. After the surgery, Dan remembers lying in the recovery room and feeling a rush of relief. “I could move again,” he says. It was like night and day.”
True to form, to celebrate the successful surgery, Dan and Sue went on another family vacation—this time to Colorado. “I skied downhill nine times in one day,” Dan remembers with a big smile.
These days, Dan is living life to its fullest. He knows he’s not cured, but he’s grateful to have most of his life back. He feels so strongly about DBS that he spreads the good news wherever he goes. When he sees someone with trembling hands in a restaurant, he’s quick to go up to him or her and share his story—and his phone number.
“Without DBS, 1 would be lying frozen in a nursing home. People are afraid of the surgery. But if you could have a better life because of it, why not? I would do it even if it meant surgery every four months,” he says. “DBS isn’t the answer for everybody. But it was for me. Anyone with Parkinson’s should think about it.”
To see a Neuro Challenge Foundation online video: tinyurl.com/sarasotaDBS
For more information about DBS or Parkinson’s disease services in Sarasota, contact: Laura Magnusson, OM, Neuro Challenge Foundation; (941) 946-6413; neurochallenge.org
Southeastern Center for Parkinson Disease: 5880 Rand Blvd., Suite 209, Sarasota; (941) 487-2160; southeasternpd.com
Neuro Challenge Foundation, Inc.: 4411 Bee Ridge Road, Suite 246. Sarasota; (941) 926-6413; neurochallenge.org
Dean P. Sutherland, M.D., Ph.D: 1921 Waldemere St., Suite 701, Sarasota; (941) 487-2160; nsshneurology.com