Spinal implant helps Marine deal with pain from Iraq injury
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Beep. Beep. Ahhh.
Bobby Joseph straightens his back, letting out a sigh of relief as electrical signals pulse through his leg, giving him respite from the piercing pain that has racked his body since Nov. 11, 2006.
“Oh, yeah,” he says, grinning.
Before the surgery, 27-year-old Joseph woke up in pain every morning. Every step with his left leg brought with it a “shocking, stabbing pain.” The drugs and the nerve blocks helped, but they didn’t make the pain go away. Still, when Dr. Rick Foltz first proposed implanting a device in Joseph’s spine to send pulses through his body, Joseph was skeptical.
“I’ve seen Robocop … I was like, I don’t want to be half man, half machine,” he said.
Then he did the seven-day trial.
“I felt like I was Superman,” he said. “I loved it. I wanted the real thing right then and there.”
In early July, Foltz and another surgeon put the device in Joseph’s spinal cord. Wires and electrodes send electric signals to his nerves, changing the way the pain is transmitted to the brain, Foltz said. Joseph controls the signals with a remote device, changing the pulses based on whether he is sitting, standing or walking.
“It is basically tricking your brain, so there’s no pain there,” Joseph said. “It is like a pulsing massage.”
From machine gunner to wounded warrior
Joseph was three months into his fourth deployment, patrolling a street in Anan, Iraq, when the bomb went off. The blast blew him from the road’s median, as shrapnel pierced his legs, his face, his arms.
“It ripped me apart,” he said, showing off the massive scars on his left thigh and calf.
Other injuries weren’t visible. In addition to the nerve damage, Joseph suffered a traumatic brain injury and has post-traumatic stress disorder.
At Bethesda Naval Hospital, Joseph didn’t remember much about what had happened. But he knew he didn’t want to stay. The hospital “had crappy food,” and he figured his mother could take care of him at home.
In late December he got a call, telling him he needed to report back to Camp Lejeune.
“They said they had a new thing that would take care of me,” he said.
He arrived at Wounded Warriors Battalion East still using crutches and occasionally an electric wheelchair. He couldn’t concentrate, he couldn’t sleep and he was always in pain. He rarely left his room.
“I was living miserably,” he said. “I would not talk to nobody.”
The only thing that made him smile was playing with his two sons. But even that was difficult.
“I (could) take them to the park, but I (was) crutching around,” he said.
Joseph met a lot of doctors, but they came and went. Then he met Dr. Foltz.
“He said he’d take care of me,” Joseph remembers. “I was like, ‘Yeah, right.’ But he did.”
Road to recovery
Joseph has worked hard to recover. Sudoku and other puzzles, combined with speech therapy and cognitive therapy, have helped him get back much of the brain function he lost. The nightmares stopped in May, but he can’t watch gory movies and the crack of fireworks or boom of thunder still gives him a start. He’s closer, he said, but not where he’d like to be.
“You gotta crawl before you walk,” Joseph said. “I’m in the process of still crawling.”
Literal walking is a different challenge. Joseph suffers from complex regional pain syndrome, a syndrome in which a patient has pain that is disproportionate to the wounds. The syndrome is more common in patients with severe injuries, and Foltz said he sees more of it in wounded warriors because of their injuries.
In addition to the pain, patients may be so sensitive they can’t even stand to have a bed sheet brush their leg or arm, Foltz said.
“It’s very difficult to treat,” Foltz said. “If we don’t treat it right away, it can turn into a debilitating, long-term pain syndrome. So when the wounded warriors come back, we want to be very aggressive in the treatment, to get them better as fast as we can.”
Joseph tried a number of treatments – including nine nerve blocks. At one point, he was taking 12 types of medication every day.
“I hate pills,” he said. “You should only be on medication after surgery. That’s why I try to stick with the Marine Corps saying: Pain is weakness leaving the body.”
So Joseph tries to deal with the pain. If it becomes too much, he’ll take a Tylenol. Later, if he needs it, he’ll take one of the prescribed narcotics. He’s seen buddies get addicted, and he doesn’t want to be a “zombie.”
The medications can also be very expensive, Foltz said. Just one of the pills Joseph takes costs $8 a day – or $3,000 a year. So while the implant is pricey – $25,000 to install – it can pay for itself in two or three years.
The implant does have drawbacks. There is a higher-than-normal infection rate, and sometimes the device moves. Joseph also must be able to recharge the battery – so he couldn’t be deployed or out in the field for long periods of time – and can’t go through metal detectors or go SCUBA diving.
But he’s down to just five medications, most on an as-needed basis. And the device will allow him to use his leg more, which makes it less likely he will develop arthritis or bone loss, Foltz said, plus it will improve his quality of life.
“He will be able to play with his kids more, and that’s the most important thing,” he said.
Foltz came to the Naval Hospital in August to start the pain management clinic and work with wounded warriors. Joseph’s is the first such surgery at Camp Lejeune, but both men hope the success will encourage other warriors with chronic pain to consider the implant.
The procedure is a last resort, a way to treat the pain syndrome when nothing else works. Right now, about 1 in 4 patients with complex regional pain syndrome end up getting the implant, and it is about 70 to 80 percent effective, Foltz said, “for a pain syndrome that has been very, very resistant to good treatment.”
“It’s very helpful to see good results,” Foltz said. “It can be sort of scary, the treatments to these things.”
Joseph plans to re-enlist and tries to help other wounded warriors, many of whom he says are focused solely on getting out of the Corps. He wants to make sure guys know that they don’t have to be like he was, angry and holed up in his room.
“I’m trying to set the example,” he said. “There’s more choices than just hating life, trying to get out of the military.”
Contact interactive content editor Jennifer Hlad at firstname.lastname@example.org or 910-219-8467.