My DBS Surgery: Short Version

I recently had surgery to address symptoms related to Parkinson’s disease. This article is a relatively brief overview of my experience. (The two large photos are courtesy of Dr. Irene Osborne, the lead anesthesiologist and official shutterbug.)

Thursday, Nov. 12, 2009

Suzanne received the call from Mt Sinai admissions around noon, and was told we could show up as late as 3 or 4 that afternoon. My brother Tom, Sally (family friend), Suzanne (my indomitable wife) and I had a good lunch at Corner bakery, and then moseyed over to the hospital after 4 p.m. Intake was swift and uneventful, notable for the GPS location device on my bracelet (unique to the neurology floors, to find wandering patients). By dinnertime, I was set up in room 109B, a semi-private room with a spectacular view of Central Park.

I took the last of my meds around 8:30, and the last food/fluid intake around 9:30. During the course of the evening, I had a parade of nurses and doctors troop through the room. One nurse took a questionnaire, two other started an IV and drew blood, another nurse came for more blood, all of them pausing now and then to scan my hospital bracelet.

The nurse who came to do an EKG informed me that I would have to take off some clothes. When pressed, I was able to determine that she’d prefer all to be off. I asked for a gown—which officially deprived me of modesty and made me a ward of the hospital—and we took care of business. It was obvious she’d done this many, many times, because she was fast. An anesthesiologist stopped by for a cursory interview; the neurosurgeon’s resident stopped by to see how things were going.

My roommate was an older gentleman, C, who had had a major stroke about a year ago. He was being transferred after a full day in the emergency section, where he presented with seizures. The poor fellow was incontinent at the time and prone to moaning, at least that first night. His primary caregiver was a charming older man who had once been a speechwriter to three consecutive chairmen of a major banking corporation. A PR executive for three decades, he was now a heavy-duty recruiter and advisor to corporate boards. He had promised his mother that he would look after C, who had been an internationally renowned concert pianist in his day.

It was hard to complain about the hustle and bustle on the other side of the curtain, especially when the nurses came every so often throughout the night to take vitals. Between the ambient clatter of uncarpeted, busy corridors, the nurses, my roommate, and my own tension, it was a largely sleepless night.

Friday, Nov. 13, 2009

The night nurse fibbed. My 5 a.m. vitals were done at 4:30, and I was now fully awake. The activity was more or less non-stop from about 6 onward, highlighted by a crowd of residents whose first question was about the Porsche (said as a single syllable—talk about nails on a blackboard!). This crowd would be in attendance during the surgery, as would another visiting surgeon and probably a few others.

Ready to go: 7:49 am

Ready to go: 7:49 am

My brother Tom arrived first, offering me a cinnamon roll and then apologizing after I reminded him of the no-eating policy. He then ate it anyway, in front of me! (I had no appetite at that point.) Suzanne and Sally arrived moments later. And then it was time to roll, about 8 am. They walked with me as my stretcher was rolled along at least a half-mile of corridors until we reached our destination on the eighth floor. The pre-surgery prep area was vacant except for us. Dr. Alterman’s PA greeted us, then told me that my week-old buzzcut wasn’t going to be short enough. He pulled out the clippers and got busy shaving off what little I had left.

Then he began unpacking the halo—the stereotactic head frame that would be used with an MRI to determine the coordinates, in three dimensions, of my sub-thalamic nucleus (STN). (This reusable device costs around $40,000, and is made by Medtronic, the company that money coming and going.) It was now time for my visitors to leave—for reasons that would soon be obvious.

I was introduced to the anesthesia resident and the attending anesthesiologist, Irene, who also agreed to share her pictures (she had compiled a lovely book filled with images from past DBS surgeries as a book for Dr. Alterman).

Dr. Alterman walked up to say hi and asked if I was ready. I nodded yes, and he said that installing the halo was the hardest part, from a patient point of view. He was right. The process began with local anesthetic into the scalp, at what seemed like pretty much indiscriminate points. The point was to totally numb the area, and it worked, except in the rear, where the halo was at an angle such that the screws were closer to the suboccipital part of the skull, where there is more “meat.” They were quick to add much more local into that area, eventually turning off the pinprick sensation back there.

I wasn’t ready for the intense pressure of the four screws. I felt like a Christmas tree being propped into its stand, except the tree didn’t have this level of torque applied to its screws. Finally, Dr. Alterman paused, and I thought we were done.

halo frontal view

The halo, installed. Note the displaced tissue surrounding the screws.

“Whoa!”

He’d grabbed the halo with both hands and jerked me up off the stretcher.

“I’m sorry about that,” he said. “But the last thing we want is for this to shift or come loose during the operation.”

OK, I said, and he resumed tightening the screws even further. By the time he finished and gave the rig one last yank, I was convinced that I could hang from the skylight indefinitely, held up by nothing more than the halo and those four screws.

It was a relief to know when it was all done, because my brain was going to extrude from my ears and nose. It was off to the MRI for the first MRI (under sedation, to calm the tremor)  then down to the OR, where we got down to business.

A view of the operating room. Not visible: the gallery of medical students and surgeons milling about on the left.

Dr. Alterman said I might feel some tugging as he began the incision with a scalpel, and I did. He was down to bone pretty quick, because I could hear him scraping bone and asking for tools and irrigation. Then came the drill. A sponge in my mouth to keep the teeth from rattling, maybe 30 seconds of drilling noise, and that was it. No big deal.

An undetermined amount of time later, no more than 15 minutes, I was aware that the lead was being placed. It didn’t take long, maybe 10 minutes, before I heard Dr. Alterman ask me what I was feeling. Nothing, nothing, then … my right arm tremor began to ease … it eased some more … a little further and … my shoulder relaxed, my arm was still, my right leg was calm. I noticed immediately that my right side back muscles were now unaffected, the left side was now the tight side. And the inner tremor, the one that never really goes away, had gone away. Before I knew it, tears were rolling down my cheeks. Forward motion of the lead resumed, and the easing started to fade, the tremor resuming. (Put it back!) A little bit more of this and then the lead was moving back in reverse along the same track. Dr A came around the table and asked for the usual evaluative drill—finger tapping, flex/extend your foot. Ok, but could be better. The lead settled in at or near the same point as before, and everyone came around for a look. It felt like the left arm had slowed down as well.

I thanked God.

Soon I became aware of the complication. Back when we first entered the OR, I told the PA that I needed to take a leak. The answer wasn’t a surprise, but I dreaded it. No one, no man, looks forward to a Foley catheter insertion, but somehow I must have had a sense that it wasn’t really a good idea for me. It wasn’t, because there was some unknown problem in the urethra—and then, mercifully, I was out. Thank you anesthesia!

That delay took about an hour to resolve—they had to call in a urology team to help deal with. There was blood and I had soaked the blankets and sheets in that chilly operating room. (I ended up going home to New Hampshire with that catheter still in me, cursing every pain in that sensitive region. But now that’s been out a couple of days, I think I’m actually functioning better in some ways than before.)

I was strong enough to help transfer myself between stretchers and the gurney for the second MRI, which was used to confirm the placement of the lead. At this point, I realized how skillful the anesthesia doctors had been. The MRI required sedation; they gave me just enough so that I was rousing as I was being withdrawn from the tube. The same thing had happened after the first MRI, with me waking up as I was being wheeled into the OR. Amazing.

The halo was removed in the anteroom of the MRI suite. I was completely unconscious for the second stage, the tunneling of the extension and the placement of the pulse generator in my left chest, just below the collarbone. Again, I woke up on the way to the PACU, feeling pretty darned good. Certainly a lot better than I felt after having a sedated MRI in Burlington—the same drug (Propofol) was administered, but with a heavy hand. I felt like a truck had hit me after that one.

But I was definitely zonked (Fentanyl?), because I had to spend the next five hours being “closely” monitored in the PACU. There weren’t any beds in the ICU and, besides, everyone could see I was doing fine. Awake and alert, with the blood-pressure cuff automatically inflating and deflating every 15 minutes, I pretty much zoned out. My first two visitors were Suzanne and Maybelle, an old friend and emergency room doctor in suburban Washington, DC. They were surprised at how well I looked, a theme that was repeated by just about everyone I saw during the next 24 hours.

I got my best hospital meal in the PACU: some kind soul had ordered me a kosher tray. The chicken thigh and leg were identifiable and appetizing, the broccoli wasn’t soggy, the mashed potatoes were a step up from wallpaper paste, and there were two giant challah rolls. There was a bit of something like gefelte fish that I steered clear of. And of course there was the ubiquitous applesauce. This goyim appreciated every bite.

The original plan was for me to spend the night in the ICU and then be discharged from there. Instead, we waited … and waited for a bed to open up on 8 West. One eventually did—in the same room I had the night before, except this time, my roommate had the window seat. I know his entourage appreciated it.

Another mostly sleepless night ensued, mostly due to my own discomfort, especially with the catheter. My entourage soon showed up, and by late morning we were thinking about getting out of there. No rush. My Aunt Pat, who lives on the Upper East Side, came by for a visit—which was terrific! I know she left feeling impressed by how well I was doing (really well at that point), and ready to relay the details to her sister Bonnie, who also has Parkinson’s but is doing all the right things to cope and delay this sort of procedure.

We cleared the hospital by 3:30, and headed straight to CVS to get the Percoset prescription filled. It had stopped raining, so I suggested walking the three or so blocks back to the hotel. I felt as though I could run the distance, but I knew better, especially with the catheter. I was increasingly uncomfortable as we got closer to the hotel. The quiet in our room was glorious. We ate in and crashed early. A happy birthday indeed!

Sunday, Nov. 15 and Monday, Nov. 16

Sunday was more rest and recuperation. We walked over to a Mexican restaurant for brunch, including a great big Margarita. Did a slow shuffle back to the hotel, where I realized that catheters, unlike Nancy Sinatra’s boots, aren’t made for walking. Watched football, ate in for dinner, and planned our escape to New Hampshire for the next morning. We were on the road by noon; no pain from the actual car ride. Had it not been for the catheter, we probably could have come home on Sunday, but the extra day of rest was nice.

Mission accomplished. Years of anticipation and hard work getting ready for this event, and it was now over. No letdown, no post-surgery crash, just relief at having avoided the worst-case scenario and a lot of cursing about that bag on my leg—the only spoiler to an otherwise flawless event. I knew I was getting the best in Dr. Alterman and his team. But hadn’t appreciated how far that team extended, to the anesthesiologists and the assistants and nurses. Thank you all for matching my commitment to creating the best possible outcome.

2 thoughts on “My DBS Surgery: Short Version

  1. Pingback: DBS Journal: The Surgery Story (draft) « pdBill

  2. Pingback: DBS surgery posts now on a single page | pdBill

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