Lisa is wheeled in at 9:45 am. It is a Monday morning, and the procedure had been scheduled for 10:00. She is, fashionably, a tad early.
Lisa is 45 years old. She has three children, one a girl with cerebral palsy who is
entirely dependent on her for care. Lisa used to own and manage a daycare center in
the Gainesville area, but for the last few years has been unable to work or tend to her
business. Lisa has sickle cell disease, a disease characterized by chronic
pain with acute intermittent episodes of pain crises. Suffice it to say, Lisa is almost on a
first name basis with Alachua County Emergency Medical Technicians.
Statistically speaking, a sickle cell anemia patient’s health care costs typically reach $1 million by the age of 45 – costs primarily attributed to the pain that goes hand in hand with the disease. Lisa has neuropathic, or nerve-generated, pain as well as radicular pain (from a compression of the nerve as it comes off the spinal cord) from multiple herniated discs. Lisa called it excruciating, exacerbated by a fall 3 years back that left her unable to function to support herself and her family, to walk outside and breathe the air, and, most importantly, to care for her daughter. Despite the many setbacks, the one thing that Lisa has not lost is hope.
“Other doctors in Tampa and Jacksonville gave up [and] said they couldn’t help. I don’t think they cared if I was wheelchair bound or not,” she said. “It was my hematologist who finally said ‘enough,’ and referred me to a pain doctor, Dr. Sassano. He got me right
in.”
John J. Sassano, M.D., is an interventional pain management specialist in Gainesville Florida, Medical Director of Level 1 Pain Management, PA, and is affiliated with North Florida Regional Medical Center. After seeing Lisa for six months and first advising that they would be taking baby steps to determine a proper course of action for optimal pain relief, the two discussed the possibility of a spinal cord stimulator implant.
Lisa embraced the concept and chose trial implantation of a new spinal cord stimulation system to alleviate her pain.
The system consists of two parts: an electrical lead wire thread up through the
epidural space of her spine and an external battery unit that will be programmed and
used to cut off the pain signals constantly bombarding her brain. Lisa’s case is special
though – a first of its kind in Gainesville and for NFRMC. This is the first time a pain management specialist will implant two electrical leads containing 16 contacts each – one wire in the cervical (neck) region and the other in the lumbar area.
I’m both thrilled and scared for Lisa – she has described the pain and how it encompasses her body as well as the want and the need to be free from it. I am holding out all hope for her.
A spinal cord stimulator is essentially a small battery-operated computer that provides pinpoint delivery of small doses of electricity directly to nerve sites. Put simply, spinal cord stimulation interferes with the way the central nervous system processes pain
signals. A spinal cord stimulator (SCS) sends pain inhibiting signals down the spine while at the same time sending “feel-good” signals back up to the brain. The lead wires
implanted during Lisa’s procedure are called “Infinion” leads, the world’s first 16-contact
leads. They are controlled by the new Spectra IPG, or Implanted Pulse Generator, and both are made by world-renowned medical device manufacturer Boston Scientific.
Boston Scientific has more than one representative present for the procedure, and comments start to filter back to me about the uniqueness of Lisa’s case:
the fact the team was able to cover nine vertebral levels using 32 individual power sources, completely and seamlessly capturing multiple areas of pain; the smoothness of the case, in spite of the anatomical challenges complicated by scar tissue left behind in
Lisa’s spinal column; the accurate placement of the Infinion leads by Dr. Sassano
during what was described as a difficult procedure. But the best comments of all
belonged to Lisa herself during the intra-op test period of the Spectra, as she let
everyone in the room know it was working – her pain was being reduced in each of the
targeted areas
I find out later in the day that Lisa’s case truly is quite unique, not only in that two Infinion leads were used to send pulses in opposite directions, but also that this is the first time spinal cord stimulation has been utilized in the Gainesville area to treat pain from
sickle cell disease.
“We truly are an innovative community using rapidly advancing technology, and the research is ongoing,” Dr. Sassano explained.
He went on to sum it up: “Just one year ago this wouldn’t have been possible. This is brand new technology, and the fact we can provide even one patient with full-body pain relief is a tremendous innovation. We might be a smaller community, but big miracles happen here.” And he’s right
As I watched the implant procedure unfold, I couldn’t help but wonder how Lisa was feeling and what she was thinking. I know she was awake, and had to be in order to provide feedback to both Dr. Sassano and the Boston Scientific team. But, did it hurt? Was she worried about recuperating? What about her goal: how did she expect to feel after the initial procedural discomfort faded?
“It was bearable,” Lisa later said. “A little uncomfortable, but not as much as I
expected. Dr. Sassano kept making sure I was okay, adding more anesthetic to my
back.”
Lisa’s mother and son will be helping out in the initial days following the implant,
the days when Lisa has to be careful about how much she takes on.
“They’re very excited about the possibilities. They support me completely. They just want it to take my pain away.”
Ultimately, that’s what Lisa wants, too.
A trial implant like Lisa’s involves monitoring her pain for a period of about 7 days
following the initial procedure. She reported an immediate reduction of pain when the
Spectra was being programmed and tested that Monday, and she again reported further
reductions the following day.
“My back still hurts today from the leads going in, and from the needles, but the pain I had before from the sickle cell is already better. And I know it’s supposed to get even better now. I slept until 9:30 this morning and that’s unheard of for me.”
She even said that, for the first time in years, she felt like going out for a walk. She is also considering reopening her daycare business. Lisa, like her family, is very excited about the possibilities.
Lisa will be scheduled for a permanent implant of the Spectra in the coming weeks*, an operation set to take place at NFRMC, to be performed by neurosurgeon John Stevenson.
“Dr. Sassano and I have worked together on difficult pain cases for some time, and this team approach is really working well,” he says. “We’re going from successful trial implants to successful permanent implants, and that means successful outcomes for pain patients. It’s very gratifying.”
Once this permanent procedure is undergone, Lisa will be able to get back to her normal daily activities within a very short period of time with her pain alleviated.
“I have loads of confidence in my choice and am forever grateful,” she
said, adding that her pain is immensely reduced, and she knows that her life is coming
back.
Spinal cord stimulation is giving Lisa not only relief for the present, but also hope for a brand new future.
She can’t say enough about Sassano: “I thank God I was referred to
him. He kept encouraging even when others gave up. I feel I’m where I’m supposed to
be…in the hands of a guardian angel.”
But perhaps the final comments best come from Boston Scientific, which said in a statement that: “Dr. Sassano’s willingness to attack even the most difficult case is what really sets him apart. The combination of his expertise, and Boston Scientific’s innovation and advanced technology, really is a perfect one.”
You see, miracles do happen, right here in Gainesville. Big ones. All it takes is the
courage to embrace the latest technological innovations, and the support of a fantastic
team of medical professionals.
*NOTE: The initial procedure took place in September 2013. Information regarding the follow-up procedures mentioned in this story was not available before this issue was printed.