Ablation Brings Relief After Bullet In Head

An accidental shooting gave him endless headaches. This procedure halts pain signals to the brain.

Joseph Larry Bassett

One autumn morning in 1996, Joseph Larry Bassett entered the woods near his northern Polk County home with some friends to hunt deer. Before the day was over, Joseph exited those woods on a stretcher with two bullets in his cranium, his life forever altered.

“My cousin asked me to go hunting with him,” Joseph remembers. “He had a friend who went with us. The friend accidentally shot both my cousin and me. My cousin didn’t make it; he passed away. I was shot in the head.”

Investigators said the friend mistook Joseph and his cousin for deer.

“I was airlifted to Orlando Regional Medical Center, where they operated on me,” Joseph recalls. “Of the two bullets that went in, they got one out. The other one is still in the back of my head. That’s what caused all the migraines I’ve suffered with.”

Migraine is a disabling neurological condition characterized by intense, pulsating headaches and sensitivity to light, sound or smell. While it’s considered a type of headache, a migraine has different symptoms and treatment approaches compared to tension and cluster headaches.

In the mid-1990s, treatment options for migraine headaches were limited, consisting mainly of oral pain medication. That was prescribed for Joseph for nearly two decades.

“Initially, the doctors put me on DEPAKOTE®, an anti-seizure medication,” reports Joseph, 65, and now a resident of St. Johns County. “After that, I went to many different doctors who just prescribed pain medication, including opioids. Still, I was having serious migraines every day. Not once a week — every day. They were so bad that I had to lie down and go to sleep to get rid of the pain, which was a 10 on a scale of one to 10 all the time.”

In 2014, after the neurologist he had been seeing died, Joseph came under the care of Kai McGreevy, MD, a board-certified neurologist, pain management specialist and founder of McGreevy NeuroHealth, who took over the deceased physician’s patients.

“I was a total mess when Dr. McGreevy took me on as his patient,” Joseph admits. “I was on many heavy-duty pain medications. I told Dr. McGreevy that I wanted to get off the meds, and he said he could help me with that. I believed in him and trusted him.”

Definitive Treatment

“RFA is a game-changer for me. It’s given me back my quality of life.” – Joseph

To achieve the objective, Dr. McGreevy began by treating Joseph’s migraines with BOTOX® injections, which block chemicals called neurotransmitters that carry pain signals from the brain. BOTOX acts as a roadblock in the pain pathway.

“The BOTOX injections resulted in a 50 percent reduction in Mr. Bassett’s opioid use,” Dr. McGreevy discloses. “There was also a considerable reduction in headache frequency and intensity, and he had substantially less disability. Over time, however, he developed a tolerance for the injections and the effectiveness of the BOTOX teetered off.

“At that point, we looked deeper into Mr. Bassett’s headache problem. We obtained an MRI of his cervical spine. It showed that on top of his migraines, there was degenerative arthritis in his upper cervical facet joints, which connect the bones of the spine (vertebrae) in his neck. This arthritis was radiating pain from his neck up into his head, causing cervicogenic headaches.”

To address that condition, Dr. McGreevy performed a series of diagnostic nerve blocks to identify the nerves involved. This involved injecting a local anesthetic near the nerves supplying the facet joints in the neck. The injections resulted in almost instantaneous relief of Joseph’s head pain until the anesthetic wore off.

“Mr. Bassett received dramatic pain relief, greater than 80 percent, following each diagnostic injection,” Dr. McGreevy recalls. “That allowed us to proceed with a treatment called radiofrequency ablation, or RFA, as a definitive treatment for his cervical arthritis.

“We concentrated the RFA on the nerves of Mr. Bassett’s upper cervical facet joints. The goal was to target the source of his head pain, which ultimately led to relief of his migraines and chronic daily headaches.”

Radiofrequency ablation is a minimally invasive, nonsurgical outpatient procedure during which patients remain awake but are lightly sedated to minimize discomfort and reduce anxiety. During the procedure, radio waves produce heat that is delivered through a probe to the specific nerves. The heat creates a lesion, or wound, on the nerve tissue that interferes with the transmission of pain signals to the brain, reducing discomfort in the troubled area.

“By targeting and damaging the nerves responsible for carrying pain signals, RFA can effectively reduce or eliminate a patient’s pain for a few months or even years,” Dr. McGreevy informs. “And the procedure can be repeated as necessary.”

Dr. McGreevy has performed radio-frequency ablation on Joseph three times at intervals of six months to a year. Joseph is thrilled with the results of the treatment.

“The last time Dr. McGreevy performed RFA on me it changed everything,” he enthuses. “This is the first year since I was shot that I haven’t had a migraine during the summer. And since the last RFA procedure, I’m no longer taking pain medication.

“Originally, my pain was a 10 out of 10. BOTOX brought it down to about an eight, but with RFA, my pain is zero. I don’t have any headaches. RFA is a game-changer. It’s given me back my quality of life.

“I’m so thankful that I don’t have to take all those pain meds anymore. And I’m thankful that I had Dr. McGreevy to help me reach that goal.”

Spinal Cord Stimulation

Cindy Papajohn’s father was dedicated to the military. While stationed in Alaska, he homesteaded in The Last Frontier, where Cindy was born. When the opportunity arose to relocate to Florida, her father seized it.

Cindy Papajohn

“He had a chance to work at the military affairs headquarters in St. Augustine, so he moved us here and we never left,” elaborates Cindy, 58. “I was 2 years old when we moved to Florida. I was raised in St. Augustine.”

As an adult, Cindy temporarily left Florida for jobs in Michigan and North Carolina, where she organized therapy groups at psychiatric hospitals. After 20 years in that field, she returned to the Nation’s Oldest City.

After making that return, Cindy was forced into retirement by rheumatoid arthritis and excruciating lower back pain, the latter of which she blames on years of running, surfing and the physical demands associated with playing basketball, volleyball and softball.

“I didn’t injure my back per se,” Cindy expounds. “But I participated in so many sports growing up that it caused disc issues. My low back pain was the result of damage caused by playing all those sports. It finally caught up to me about 10 years ago.

“I had numbness down my left leg to my ankle and heel. I initially thought the problem might be diabetes, so I went to my doctor to be tested. The tests showed that I had spinal stenosis and that a disc in my lower back was herniated.”

Spinal stenosis, which commonly occurs in the neck and low back, is the narrowing of the space within the spine. The constriction puts pressure on the spinal cord as well as the nerve roots that exit the spine through the foramen, the openings in the vertebrae. The condition is typically caused by age-related wear and tear.

“The pain in my lower back was terrible,” Cindy reports. “On a scale of one to 10, it was above a 10. It wasn’t like that 24/7, but it was like that a lot. It was so bad that I was unable to sit or stand or really do much of anything.

“One thing I’ve always loved to do is go to the beach and look for shark teeth. But my pain was so bad I couldn’t bend over to do that. I couldn’t do much of anything outside of the house because I could only walk for short distances before the pain set in.

“And when it did, it would usually get so bad that I’d have to sit or lie down for a while. It eventually got to where I was in bed almost all day every day. I couldn’t sleep, either. I just tossed and turned all night.”

In her quest to find relief, Cindy tried multiple treatments, including painkillers, anti-inflammatory medication, epidural steroid injections and physical therapy. When none of those approaches provided the desired results, Cindy agreed to undergo spinal fusion surgery. Even after surgery, however, the pain remained.

By that time, Cindy was at her wits’ end. Then she received more bad news.

“The pain clinic I was going to suddenly stopped taking my insurance,” Cindy shares. “So, I called around to find another neurologist or pain clinic that would provide pain medication because at that time they were really cracking down on prescribing it. I asked my regular doctor for a recommendation, and he suggested Dr. McGreevy.”

24/7 Treatment of Pain

“Ms. Papajohn came to us in 2019 as a new patient struggling with chronic low back pain,” Dr. McGreevy recalls. “An MRI showed areas of foraminal stenosis, or narrowing around the spinal nerves, and some degenerated discs in her lumbar spine.

“We initially treated her using conservative measures that included pain medication, various injections and physical therapy, and she made short-term gains. But she ultimately decided she wanted a treatment that would ease her pain on a more consistent basis, something that would give her longer-lasting relief.

“That’s when we decided to move forward with a spinal cord stimulator.”

Spinal cord stimulation, or SCS, was introduced about 40 years ago, and has been evolving ever since. Today, SCS is used to treat back pain, neck pain, pain down the leg or arm from nerve damage, diabetic neuropathy, crush injuries and even angina.

“Spinal cord stimulation is one of the only interventional pain therapies available to provide 24/7 treatment of chronic pain,” Dr. McGreevy contends. “It’s been shown to be effective for the majority of patients, including those who have already undergone spine surgery, as Ms. Papajohn had. It can also reduce a patient’s need for long-term narcotic medication.”

With spinal cord stimulation, a small device that applies electrical impulses to the pain source is implanted in the epidural space around the spinal cord. SCS can reduce the feeling of pain and replace it with a more comfortable tingling sensation called a paresthesia. The device can also be programmed to have no replacement sensation at all.

Dr. McGreevy began by recommending a trial to predict the success of the spinal cord stimulation in providing meaningful pain relief and functional improvement. The three-day trial is a “test drive” before a permanent stimulator is implanted surgically.

During the trial, Dr. McGreevy uses x-ray guidance to place small electrodes into the epidural space where the pain is generated. When the system is turned on, pain signals from the problem area to the brain are hindered.

“Ms. Papajohn’s stimulator trial produced about 80 percent relief of her low back pain, which was exciting,” Dr. McGreevy observes.

“In the past, SCS was used most often for extremity pain, such as pain down the leg, and was hit or miss for the back. But recent studies have shown that the newer versions are highly effective for pure low back pain.”

Based on the trial results, Dr. McGreevy proceeded to implant Cindy’s permanent stimulator. During that procedure, a small paddle electrode was placed along Cindy’s spinal cord near the origin of her pain. The lead was connected to her stimulator’s charging unit, which was implanted just beneath the skin near her hip.

“We were able to implant her within a few weeks of completing the trial. I performed the procedure myself,” Dr. McGreevy reveals. “She did extremely well. As with the trial, she reported an 80 percent reduction in pain, along with improved functioning and improved quality of life.”

“Living Again”

“The stimulator has completely changed my life. Instead of lying in bed all day every day, I’m living again.” – Cindy

Using the non-paresthesia programming option, Cindy doesn’t feel any replacement sensations from her spinal cord stimulator, but she is feeling much better overall since being fit with the device. Her back pain is greatly reduced, and she’s resumed an active lifestyle.

“The stimulator changed everything,” Cindy enthuses. “I can now ride my bike, take long walks and go shopping. I can also spend hours at the beach looking for shark teeth and swimming.

“I can stand and do things in the house, and I have a lot more endurance. I’m sleeping much better, too, because I’m not in constant pain. The stimulator has completely changed my life. Instead of lying in bed all day every day, I’m living again.

“I’m not out there playing two-on-two beach volleyball or full-court basketball with a bunch of men anymore, but the stimulator is allowing me to do most anything else I want to do because I’m no longer being held back by pain, which barely rates a one or two now. And if I overwork or tweak my back, I just turn up the stimulator and it blocks the pain.”

Cindy gives the credit for her success with SCS to Dr. McGreevy. She says she’s grateful that he was so dedicated to relieving her pain and helping her resume an active life.

“Dr. McGreevy is terrific and his nurses are awesome,” she concludes. “My treatment at McGreevy NeuroHealth has been an absolute success. I would highly recommend Dr. McGreevy and his spinal cord stimulator to anyone with back pain. In fact, I’ve already referred my mother, father and sister to him.”

Like Cindy, Joseph is impressed with the pain management specialist.

“I really like Dr. McGreevy. He sits down and talks with me. He explains things I want to know. He takes time with me. He’s a caring doctor,” Joseph praises. “If you listen to him and trust him, he’ll do the best he can for you. I trusted him, and he’s helped me out every way he could.

“Dr. McGreevy is very knowledgeable. His credentials are awesome. And he knows how to put things in laymen’s terms so his patients can understand. I absolutely recommend Dr. McGreevy, McGreevy NeuroHealth and radiofrequency ablation.”

© FHCN article by Patti DiPanfilo. Joseph’s photos by Jordan Pysz. Cindy’s photos courtesy of Cindy Papajohn. mkb
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