Wireless Technology Erases Pain, Saves Patient's Leg

Dan and Carol Murray talk with Anureet Walia, MBBS

Until just a few years ago, Daniel and Carol Murray of Lakesburg, Iowa, never had to cope with more than the occasional cold or stomach bug.

That changed in the spring of 2016. Dan woke up one morning to find that his left leg was purplish-black from the knee down. Carol took him to the hospital in Fairfield. Doctors there couldn’t find a pulse in his foot, so they sent him to University of Iowa Hospitals & Clinics, where he underwent emergency surgery to repair an aneurysm in the popliteal artery.

“It was the middle of the night, and the surgery took six hours,” Carol Murray recalls. “Dr. Maen (Aboul Hosn, MD) told me, ‘The longer I take, the better it is for your husband.’ He said half of patients die during this type of surgery.”

The mortality rate indeed can be high, usually because of the patient’s age and/or other health conditions. Amputation of the toes, foot, or leg also is a common outcome because of prolonged lack of blood flow.

Dan Murray survived the surgery, but two days later, he developed compartment syndrome in the leg, and the surgical incisions on both sides of the lower leg ruptured. Skin grafts and four weeks of negative-pressure wound therapy (commonly called “wound vac”) followed.

Carol says both of them were naïve about how long it would take Dan to recover.

“We had never had any serious illness before, and we were very stupid about this whole thing,” she says. “We thought we’d go home and in a couple of weeks everything would be back to normal.”

That didn’t happen.

Instead, Dan developed a number of complications. His body rejected the artery graft doctors had placed; he developed bile stones as a result of the medications he was taking; and his appendix ruptured. Meanwhile, blood flow to his foot and toes was so poor that his doctors anticipated having to amputate them.

And then there was the pain.

“I’d go out to feed the dog, and the pain was so bad that I was done for the day,” Dan says. “I couldn’t sleep; I’d take a 15- or 20-minute nap, and then the pain would wake me up.”

Conventional painkillers didn’t help.

Hosn finally referred him to the University of Iowa Hospitals & Clinics’ Pain Management Clinic. The clinic performed a peroneal nerve block, which “worked great, except I couldn’t move my foot,” Dan says.

“I don’t get depressed, and I never thought about suicide. But I probably would have if this hadn’t come along.”

“This” is a device called a wireless peripheral nerve stimulator, or WPNS. Peripheral nerve stimulation was first developed in the 1960s, but, until recently, it involved implanting a battery and connecting wire electrodes to stimulate the target nerve.

The wireless PNS Dan received consists of a wire electrode about the thickness of a thread, which is implanted in the muscle near the target nerve. A disposable patch equipped with gel electrodes, called an external pulse transmitter, is placed on the skin over the wire. The patient then holds a wireless handheld programmer on the patch to deliver an electrical charge to the wire.

Justin Wikle, MD, and Anureet Walia, MBBS, implanted the wire in Dan’s leg in December at the Pain Management Clinic. As far as Dan and his wife are concerned, it’s an answer to prayer.

“He always came into the clinic in a wheelchair,” Carol says. “The day they put that thing on, he walked from the clinic back to the truck, and that night he slept for six hours, which he hadn’t done for two years.”

Walia, who specializes in chronic pain medicine and who treats Dan at the Pain Management Clinic, says the WPNS “is a more novel technology, but it’s less invasive than many other options, and it works.”

The Pain Management Clinic has performed more than 40 of these procedures with highly promising results.

In Dan’s case, it also presented an unanticipated benefit: It restored the blood flow to his foot and toes.

“When I saw Dr. Maen after I had this thing put in, he looked at my foot and said, ‘What are you doing different?’ I said nothing except this (the WPNS), and he said my blood flow was back to 100 percent,” Dan says.

Walia says she didn’t expect that result, but because the wireless technology isn’t commonly used, “we’re still learning about what it can do. In this case, it ended up saving the leg and avoiding the financial, physical and emotional pain of amputation.”

Dan, now 58, worked in a salvage yard before his health issues began. In March, three months after the implant, he signed up for vocational rehab training. He’s looking forward to going back to work, and to a couple other things.

“I spent the last three birthdays in the hospital, so I’m looking forward to having one somewhere else,” he says. And, if the weather cooperates, “I’m going to ride my motorcycle to my next appointment.”

 

Date: 
Friday, September 27, 2019