Bonnie Carr loves cooking, but for the past 10 years she’s had tremors so bad that she couldn’t cook without breaking dishes and making a mess of the kitchen. She also couldn’t write legibly, get coffee out of the microwave or go out to eat without feeling embarrassed. “At buffets, I’d spill (food) from one (container) to another,” she said. She’d watch people drink coffee with one hand and think, “They don’t know how good they have it.” She had to use two hands to drink a glass of water.
Photo: After Bonnie Carr's surgery, she and her husband Jim can again enjoy farm chores together, such as caring for "Sugaree's Legacy" and their other champion Arabians.
About a year ago, when the tremors worsened, a friend told her about a procedure that Benjamin Gelber, MD, of Neurological & Spinal Surgery has been doing at BryanLGH to help people, like her. Dr. Gelber, a Lincoln neurosurgeon, and neurologist John Puente, MD, work together to treat people with Parkinson’s disease and tremors by using deep brain stimulation — implanting electrodes in the brain to stimulate areas of the brain and block signals that cause tremors. The electrodes are connected by wires to a pulse generator — similar to a pacemaker — that’s implanted in the chest.
But the idea of having brain surgery can be daunting for patients. “At first I thought, ‘Oh no, I don’t think I’ll do that,’ ” said Carr, who is 70. “I didn’t think it would be brain surgery.” Not only that, but the patient is awake during the first part of the surgery to help the neurosurgeon determine the right place to put the electrodes to confirm the accuracy of the MRI and CT scan targets. “If it works, we’re in the right place,” Dr. Gelber said. “Their tremor goes away and rigidity goes away. If we’re in the wrong place, they get double vision, burning or stinging in the arm. Then we reposition the electrode until we get the desired response.” The more Carr thought about it, the more she decided, “I’ve got to do something.”
Photo: Bonnie, with Pomeranian Pepi, says the local hay-baling crew that came to the farm this year “couldn’t get over the difference in me. Every day, from the time I wake up, I’m glad I had this surgery!”
First, they tried it on her right hand, which was most shaky. Dr. Gelber made two cuts on top of her head and implanted the electrodes, but left them unconnected. After she recovered from the surgery about a week later, the neurosurgeon implanted a battery in her chest and hooked up the pulse stimulator. The procedure worked for Carr right away. “It came out so good, I’m telling you, I was just so excited,” Carr said. So they did the left hand a couple of months later and Carr now brims with excitement about how well the surgery worked. “It’s just heaven. I don’t shake at all,” she said. “I’m so glad I went to Dr. Gelber. I can’t thank him enough.”
Photo: Dr. Benjamin Gelber introduced a neurosurgical procedure that’s making a big difference for Bonnie Carr of rural Otoe County.
Dr. Gelber started doing the procedure at BryanLGH about five years ago, after a year of preparation. He and physician assistant Todd Sorensen went to the Cleveland Clinic for training by one of the world’s experts and his fellows, according to the neurosurgeon. Dr. Gelber said deep brain stimulation has been around for more than 10 years and stemmed from an old treatment for Parkinson’s dating to the 1950s, in which basically you “burn a little hole in the brain.” He’s done the procedure on more than 50 local patients with Parkinson’s disease, Essential Tremor or Dystonia.
Dr. Gelber, Sorensen and Dr. Puente conduct a multidisciplinary clinic at the Neurological & Spinal Surgery office once a month. Dr. Puente decides which patients would be good candidates for the procedure; Dr. Gelber performs the surgery, and both provide follow-up care. “Overall we’ve had good results with people having significant improvement in their symptoms,” Dr. Gelber said.
Dr. Puente first learned about deep brain stimulation while working at the Omaha VA Medical Center about 10 years ago. When he began practicing in Lincoln in 2004, he and Dr. Gelber began working together on brain stimulation. Dr. Puente says he’s like a gatekeeper, identifying which patients would likely benefit from the surgery.
Photo: Dr. John Puente calls deep brain stimulation a breakthrough for treating Parkinson’s and other conditions.
Often the best candidates find medication is effective, but not for very long. They have “off and on” times throughout the day. “Most patients aren’t excited about the prospect of brain surgery,” said Dr. Puente, but he says physicians have found it can provide a “real breakthrough.” Deep brain stimulation particularly benefits people with Parkinson’s. According to Dr. Puente, “It doesn’t for sure cure the disease, but it kind of turns back the clock a few years.” Often the procedure controls tremors indefinitely. Carr is hoping that will be the case for her. She controls the electrodes with a “little remote control thing,” shutting it off at night and then firing up the electrodes again during the day.
She says she “can do anything I want to” on her 77-acre farm near Douglas, Neb., where she and her husband raise Arabian horses and put up hay. “I can write again. I can go out to dinner. I can do anything in the house,” she said. “That surgery is fantastic.” Dr. Puente said it’s unusual for a city the size of Lincoln to be able to offer this treatment. “Lincoln is pretty fortunate to have this, because it can make a big difference for patients,” he said.