Double Play

Doctor’s expertise relieves different conditions.

Pittsburgh, Pennsylvania natives David and Noreen Acheson moved to the Midwest after finishing their educations and marrying. They spent a few years living in Ohio and Illinois, then settled down in Michigan, where they remained for 30 years.

Dr. Kai McGreevy of McGreevy NeuroHealth in St. Augustine and Palm City treated David Acheson’s essential tremor with deep brain stimulation and Noreen Acheson’s neck pain with radiofrequency ablation.

David’s handwriting has improved significantly with DBS.

“We moved back to Pennsylvania, to the Gettysburg area, for a short time after living in Michigan,” recalls Noreen. “That lasted until five feet of snow one winter did us in. After that, we made the move to Florida.”

Retired professionals in their 70s, David and Noreen both prefer Florida’s weather and laid-back lifestyle. That lifestyle is one that was eventually compromised after each became incapacitated by a health condition.

David, 78, a former sales manager for an oil company, struggled to cope with the effects of a debilitating neurological illness called essential tremor, a nervous system disorder characterized by uncontrollable shaking, or tremors.

This trembling can affect almost any area of the body but is most often present in the hands. David, who says he and his sister both inherited the condition from their father, felt its effects most often in his hands and arms.

“The degree of the shaking rated a five or six out of ten on most days, but some days were worse and some days were better,” David shares. “That’s how the disease works. Because of my tremors, my handwriting was terrible. I couldn’t write my own name.

“Before I got the DBS stimulator, I rated my shaking a five or six out of ten. Now, I give it about a two.” -David

“I could scribble, but as far as writing numbers, that was impossible. I also couldn’t thread a needle or eat with a fork. By the time I got the food from the plate to my mouth, it was all over the place. I had to eat with a spoon, and sometimes, even that was difficult.”

As David’s condition deteriorated over time, he sought the help of several specialists. He became discouraged, however, because the treatments the various physicians prescribed didn’t really help him very much.

“A neurologist in Michigan put me on some pills,” David relates. “When we moved from Michigan to Pennsylvania, I saw a neurologist there who told me I was on the right treatment and that I should keep on taking the medication.

“After we moved to Florida, I saw another neurologist here, and he said the pills I had been taking were the best treatment they could give me for my condition. But that doctor eventually moved away, and so I began looking for another doctor.”

By this time, David was thoroughly frustrated with the care he was receiving. He wasn’t satisfied with the medications’ limited effectiveness, and he wanted a physician with different treatment ideas.

After expressing those thoughts to his primary care physician, David was referred to Kai McGreevy, MD, a board-certified neurologist and pain management specialist at McGreevy NeuroHealth, which has offices in Palm Coast and St. Augustine.

Dr. McGreevy has a wide range of advanced therapies at his disposal to treat pain and many other conditions associated with nerve disorders. Upon first examining him, Dr. McGreevy noted how the condition was negatively impacting David’s quality of life.

“He had a gradual onset of hand tremors that had worsened over the course of a few years and was making it difficult for him to perform many simple tasks, such as bringing a cup of water to his mouth without spilling it,” Dr. McGreevy reports.

“I ruled out other possible causes of the tremors, such as Parkinson’s disease, and confirmed his essential tremor diagnosis. He had already tried the medications approved to treat that condition, but didn’t have a good response to them, so he was frustrated and willing to do anything to have a better quality of life. That’s when I suggested deep brain stimulation, or DBS.”

DBS is an FDA-approved treatment for certain movement disorders, including Parkinson’s disease and essential tremor. It involves the surgical implantation of electrodes within the areas of the brain known to regulate movement. Stimulation of these areas helps to control abnormal movements such as tremors.

DBS is generally considered as a treatment option for essential tremor and other movement disorders in patients such as David who have not responded effectively to medication and have developed a quality of life that is no longer acceptable, notes Dr. McGreevy. It may also be considered when side effects of medication become intolerable.

“Dr. McGreevy was very personable, professional and smart, and he spent the necessary time with me to appropriately evaluate my condition,” recounts David. “Afterward, he asked me, Have you ever considered surgery for your condition? I wondered, Surgery? Then he told me about deep brain stimulation and explained everything about it. I said, Let’s go for it!”

Clean, Concentric Circles

DBS surgery involves implanting thin, metal elements called electrodes that are about the diameter of a piece of spaghetti into target areas of a patient’s brain. The electrodes are placed through small holes opened in the skull. Thin wires are then threaded under the skin from the electrodes to a computerized pulse generator that is placed under the skin near the patient’s collarbone.

“The electrode implantation is a minimally invasive neurosurgical procedure done using local anesthetic and sedation,” describes Dr. McGreevy. “The electrodes are strategically placed in areas known to cause movement disorders. Patients remain awake during surgery so they can help direct us to these areas in the brain, but they feel no pain.

“In David’s case, two main electrodes were placed. He was awake and alert during the procedure and in no obvious discomfort. The electrodes were easily placed with his assistance and the guidance of MRI-assisted brain mapping. In a separate procedure several weeks later, the pulse generator was implanted in his chest.”

Dr. Kai McGreevy of McGreevy NeuroHealth in St. Augustine and Palm City treated David Acheson’s essential tremor with deep brain stimulation and Noreen Acheson’s neck pain with radiofrequency ablation.

David and Noreen Acheson

After the procedures, Dr. McGreevy performed several neurological tests on David and programmed his DBS system to give him good control over his tremors. David was surprised by the ease of the procedures and how quickly he saw results.

“The DBS surgery was done at the hospital,” discloses David. “I stayed in the hospital overnight; I went home the day after surgery. That was it. About a month after putting in the stimulator electrodes, they implanted the battery pack under the skin around my collarbone and hooked me up. The difference was amazing.”

“Almost instantaneously, David realized significant improvement in motor control of his hands,” observes Dr. McGreevy. “His handwriting drastically improved; it was more controlled and much more legible.

“There’s a test of fine motor movement we use during which we have patients draw concentric circles. Before the stimulator was implanted, David’s drawing looked like scribble. After the implant, he drew clean, concentric circles. Ultimately, he had more control in his hands to perform his usual, daily activities as well.”

Wounded Nerves

Noreen spent years as a registered nurse, and although she’s 77 and primarily retired, she continues to keep her nursing license active in Pennsylvania. She worked in long-term care most of her career, which means she often moved patients who were largely incapacitated. It really wasn’t a surprise to her doctor when she began having pain in her cervical spine.

“About ten or eleven years ago, I started having some difficulty in my neck and shoulders,” she remembers. “I went to multiple doctors and was diagnosed with degenerative disc disease of the neck.

“I had a lot of pain in my neck, and it really hurt every time I moved. I couldn’t turn my head. I couldn’t walk with my head up. I couldn’t lift up my arms without pain. I dance with a senior dance group, and it was getting more and more difficult to do the dances because of the neck pain. Sometimes, I couldn’t even sit without resting my head on something.

“Dr. McGreevy really wanted David and me to get better, and that meant all the world to us.” -Noreen

“My neck just ached and hurt. The pain level was easily a six or seven out of ten.”

Over the years, Noreen tried many treatments for her neck pain, but none brought her significant relief. Like her husband, David, she became frustrated with the unsuccessful attempts to ease her pain.

“I did physical therapy, took pain pills, got the shots, everything,” she relates. “Finally, last September, I said to my primary care physician, I can’t tolerate this anymore. Who do you recommend? He recommended Dr. McGreevy, and David agreed.

“Noreen had severe arthritis in the facet joints in her neck, which caused discomfort to the point her quality of life was impacted,” informs the doctor. “Her range of motion was limited so that it was difficult for her to engage in simple activities, such as driving. She couldn’t turn her head to look around when she drove.

“After examining Noreen, reviewing her imaging and performing some diagnostic testing, I determined that a procedure called radiofrequency ablation, or RFA, would be the best fit to improve her pain control, range of motion and quality of life.”

RFA is a minimally invasive, nonsurgical, outpatient procedure during which patients remain awake but are generally sedated to minimize discomfort and reduce anxiety. Doctors considerate it highly effective in temporarily reducing the kind of severe back and neck pain that plagues nearly two-thirds of the world’s population.

Radio waves are used to produce heat that is delivered through a probe to a group of specified spinal nerves. The heat creates a lesion, or wound, on the nerve tissue that interferes with the transmission of pain signals to the brain, thereby reducing discomfort in the troubled area.

It is often used for patients who have not received sustained pain relief from other treatments, including epidural steroid injections, facet joint injections and nerve blocks. By targeting and destroying the specific nerves responsible for carrying pain signals, RFA can effectively reduce or eliminate a patient’s pain for a few months or even years.

“There are many chronic pain conditions that respond well to radiofrequency ablation,” notes Dr. McGreevy. “These include spinal arthritis and spine degeneration, as well as pain after spine surgery.”

Signals Unsent

“When Dr. McGreevy and I talked about the radiofrequency ablation procedure, he explained to me that the relief can last twelve to eighteen months. I agreed to it because I hadn’t been pain free for more than a decade. In April, he started with one side of my neck. A week later, he did the other side.”

Dr. McGreevy details the steps of the procedure:

“When we’re doing the RFA procedure, the patient lies on a table on their belly, and an x-ray camera is used to take pictures of the region we’re working on,” he describes. “That’s how we can see all the landmarks we need to safely perform the procedure.”

A local anesthetic is then administered to the skin and deeper tissues to provide comfort so that a needle can be inserted and directed toward the targeted nerves. When the needle is precisely positioned, a stylet is pulled out of the needle and replaced by a thin probe.

“The probe is directed to the targeted nerve, and a radiofrequency generator is turned on,” continues Dr. McGreevy. “That generator provides ninety seconds of radiofrequency waves, or energy, that are delivered to the targeted nerve and create the lesion that cauterizes the nerve.”

When the nerve is cauterized, it can’t send pain signals, so nothing is received and interpreted by the brain. Subsequently, no return message to feel pain is sent back to the affected area of the body, which in Noreen’s case was her neck.

“The cervical region is a complicated area, and many times, patients with arthritis in the neck also have pain into the shoulders, arms and up into the back of the head,” comments Dr. McGreevy. “The syndrome can be very complex, and Noreen responded even better than I expected with reduction not only in her neck pain, but also in her headaches.”

Dinner Dates

For David and Noreen, who had completely different health challenges to overcome, Dr. McGreevy’s expertise in neurology and pain management provided the solutions to both of their conditions. David’s uncontrollable tremors were brought under control through deep brain stimulation, and Noreen’s pain was relieved through radiofrequency ablation.

Dr. Kai McGreevy of McGreevy NeuroHealth in St. Augustine and Palm City treated David Acheson’s essential tremor with deep brain stimulation and Noreen Acheson’s neck pain with radiofrequency ablation.

For Noreen, even hobbies are easier to do without neck pain.

“The results of the DBS are amazing,” David marvels. “My handwriting is much better. It’s not perfect, but it’s better, and my hands don’t shake as badly. Before I got the DBS stimulator, I rated my shaking a five or six out of ten. Now, I give it about a two. I can eat with a fork and a spoon now, so my quality of life is much better.”

Noreen agrees.

“Before, we couldn’t go out to dinner because David couldn’t feed himself in a restaurant,” she states. “Now, we go out to dinner once or twice a week, and everything is good for him. I give Dr. McGreevy all the credit for that.”

The RFA procedures Dr. McGreevy performed on Noreen’s cervical nerves were equally effective for the arthritis pain in her neck. They provided her with significant relief, which enabled her to move her head to drive, dance and do other activities without difficulty.

“I’ve been pain free since I had the radiofrequency ablation procedures,” she enthuses. “I can lift up my arms. I can walk with my head up. I can do things I didn’t think I’d ever do again as far as exercises and activities, and I’m so pleased.

“The joke is I wake up every morning and wonder if I’m alive because nothing hurts anymore. I realize the pain can come back, but Dr. McGreevy released me for six months. That to me is such a blessing.”

Both David and Noreen rate the staff at McGreevy NeuroHealth as professional, friendly and helpful. Noreen says they’re “great,” and David describes them as “delightful.” However, Noreen saves her kindest words for Dr. McGreevy.

“Dr. McGreevy is so personable, professional and caring, and unlike some doctors we find at our age, he’s not condescending, saying things like, It’s alright. You’re going to be fine,” she offers. “He really wanted David and me to get better, and that meant all the world to us.

“I’ve already recommended him. I’ve taken flyers from McGreevy NeuroHealth and given them out to people because Dr. McGreevy does such a good job with his patients. He does his best to fix whatever happens to be wrong. He helped us and gave us both a better quality of life.”

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    • McGreevy Neuro Health

      Your neurological health is nothing to worry about when you visit McGreevy NeuroHealth, conveniently located between Saint Augustine and Jacksonville, Florida. Their facility hosts a qualified interventional pain physician who is also a board-ce... Read More

    • Kai McGreevy, MD

      Kai McGreevy, MD, is board certified in neurology and pain medicine by the American Board of Psychiatry and Neurology. The American Board of Independent Medical Examiners also certifies him. His medical training includes completion of a neurolog... Read More