More MS news articles for March 2001

Doctor kills nerves to set patients free

March 19, 2001 - 12:55 AM
Staff Writer, (609) 272-7213

GALLOWAY TOWNSHIP — Like the rusted Tin Man in “The Wizard of Oz,” Sally Soper’s muscles slowly have frozen into place.

Her left bicep is perpetually flexed, pulling her forearm against her chest. Her left hand is in a fist.

“The only way I can use my left hand now is to open it up with the other one,” Soper says as struggles with a pained face to pry the fingers out of her palm.

Her legs, too, are inflexible.

The inner thighs constantly push against each other and her calves keep her toes pointed down.

“I feel like I’m closing in on myself sometimes,” Soper says. “It takes so much energy, I feel like my body is in a constant state of isometrics.”

Soper, 53, suffers from spasticity, a common condition in people who suffer as she does from multiple sclerosis, or MS, an incurable neurological disorder that affects about 350,000 Americans.

Stroke victims also can develop spasticity. As with MS, neurological damage from a stroke can cause the brain and spinal cord to signal the body’s muscles to contract against a person’s will.

With physical therapy, Dick Evans, 71, of Absecon, eventually was able to walk again after a stroke that affected the left side of his body in 1993. But spasticity left his hand in a useless fist.

“This arm was dead, so to speak,” Evans says.

When his wife, Joan, died last May, his condition kept him from even cooking for himself.

So Evans returned to Dr. Abraham Alfaro and physical therapist Laura Lee Smith, the team at Bacharach Institute for Rehabilitation in Pomona that previously helped him recuperate from his stroke.

His timing couldn’t have been better. Last year, Alfaro began offering a procedure provided by few others in the country.

Dorothy oiling the Tin Man

By injecting protein-destroying drugs into nerves that carry improper messages to the body’s muscles, Alfaro is able to loosen a spastic patient’s contracted limbs.

Think of Dorothy applying oil to the Tin Man.

“It’s not like we are bringing the person back to the original state,” Alfaro said. “Far from it. But we are making them more functional.”

The procedure has enabled Evans to remain independent.

During a recent visit to Bacharach, he details the dinner he cooked for himself the prior night: roast pork with mashed potatoes and homemade sauerkraut.

Then he high-fives Alfaro with his formerly fisted hand.

There are other ways to treat spasticity, but they have their drawbacks.

Most patients start on oral medications, such as Baclofen and Zanaflex. While those drugs may be effective, they leave many patients fatigued, said Nancy Holland, vice president of clinical programs at the National Multiple Sclerosis Society.

Baclofen doses can be lowered through a surgically implanted pump that delivers the drug directly into the spinal fluid, Holland said. But that’s a highly invasive procedure.

In recent years, many doctors have begun offering injections of botulinum toxin, or Botox, to destroy hypercontracted muscles, Holland said.

But Botox injections can cost $800 to $1,600 every three months. And only limited amounts can be used before an antibody reaction renders the treatment useless, Alfaro said.

That makes Botox out of the question for severely spastic patients such as Soper, whose only option was taking pills and enduring the fatigue that goes with them.

“I was not satisfied with the way patients were being treated,” Alfaro said.

So last year, Alfaro resurrected a technique that had fallen out of favor with many doctors. He injects phenol into a nerve, weakening many muscles with a single shot. The medicine costs only $30 per patient and it remains effective twice as long as Botox, Alfaro said.

Because phenol must be injected into a small nerve that’s often sandwiched among blood vessels, it requires much more skill than injecting Botox into a relatively large muscle, Holland said.

“Not many doctors are comfortable with it,” she said.

But Alfaro is, so when Soper learned the local doctor could offer her an alternative treatment, she was game.

“I’m probably going to have MS for the duration, so anything I can do to give myself more mobility, more relief, I’m up for,” Soper said when she arrived for the procedure. “It’s better than popping pills.”

‘Wow. I’m getting chills.’

Fifteen years ago, Sally Soper was running road races in San Francisco. When she first sensed her muscles behaving oddly, she thought she was just training too hard.

It was some time until she learned she has MS, the cause of which remains unknown.

Now living near her sister and mother in Barnegat Township in Ocean County, Soper gets around in a wheelchair.

She is smiling when she wheels herself into Alfaro’s office for the first of what will be two visits to get phenol injections in her left arm and both legs.

First, the doctor tests her muscles for electrical activity, so he knows which ones are weak and which ones are overactive.

Then, he probes under her arm with a syringe, searching for the nerve that carries impulses to her clenched fist. The syringe is loaded with lidocaine, an anesthetic whose affect lasts only an hour or two, allowing him to make sure he is targeting the right nerve before injecting the nerve-destroying phenol.

As he probes, he shoots ultra-low levels of electricity into Soper through the tip of the needle. He injects the drug only after he can make her fingers twitch with less than one milliamp of electricity.

“There it is,” he says in a singsong voice.

Finding a nerve is like trying to find a coin in the sand with a metal detector. It requires almost daily practice, he said.

He injects the drug, and almost immediately her hand begins to open. Next, he injects phenol into her bicep.

Within seconds, Soper can extend her arm normally.

“Wow. I’m getting chills,” she says as her arm relaxes. “It feels like I don’t have to use so much energy. It’s awesome.”

A couple of weeks later, Soper returns to get phenol injected in her cramped legs. Just having her arm and hand relaxed, has given her more self-confidence, she says.

A couple of hours later, the phenol allows her legs to part.

“This is amazing,” she says, beaming.

An effort to walk, however, fails. Her spastic calf muscles cause her toes to scrape the ground and her legs are still somewhat stiff.

The procedure, however, will allow Soper to maintain better hygiene, Alfaro says. One day, with physical therapy and additional injections in her calf, she may be able to trade in her wheelchair for a walker.

“That’s my goal,” Alfaro said.

Soper is clearly pleased with how things are going.

“All my energy isn’t going into my arms and legs,” she says. “It’s cool. I feel better already.”

But on this day, she’s not quite ready to get a recommended Botox shot to help her thumb open up, or phenol shots in her calves.

“I’m going to live with this a little bit and let it all sink in.”

Then she heads down the corridor.

Copyright © 2001 South Jersey Publishing Co.