Carole Kline of Annville enjoys living close to Lebanon Valley College, where she swims three times a week and takes in the beauty and bustle of the campus.
Patient uses remote control to suppress pain and restore motion
Carole Kline of Annville is the kind of person you’d be glad to cross paths with. Brimming with energy, she sees the best in people and is quick to share information or lend a helping hand. She embraces life full tilt, defying limitations to her active lifestyle with a vitality that belies her 71 years.
She was a full time Teacher’s Assistant until her retirement in 2006, working with learning-disabled children at Lancaster-Lebanon Intermediate Unit 13. An enthusiastic walker, swimmer and volunteer, she is active with her church, United Church of Christ, Cleona and with Eastern Star of Lebanon. And each year she looks forward to helping out at the Annville Memorial Day Parade, “the largest in Pennsylvania,” she says with pride. Her biggest delight is spending time with her two married daughters, their husbands and her three grandchildren who all live nearby.
“I’ve always been a very healthy person who never had any medical issues,” Carole explained, “I took care of myself and kept up with a lot of activities.” Then six years ago, she suffered an injury that threatened to curtail her vigorous daily schedule. She fell from a stool while decorating her Christmas tree. She tried to let her usual can-do spirit override the discomfort of the injury, hoping it would resolve itself. “But my fall had serious consequences,” she said, “and as the weeks and months passed I was dealing with debilitating nerve pain.”
The injury sent this determined woman on a search for the best course of treatment for maximum relief. As is true for so many people with back pain, the answer can be very difficult to pinpoint. Carole did not want to become dependent on strong pain medications. Injections, nerve blocks and 24-hour monitoring didn’t prove effective. She lived with chronic pain for several years. “It got to be daunting,” Carole admits.
A year ago she was referred to Dr. Eric Finkelstein at Lancaster NeuroScience & Spine Associates and he was able to suggest an alternative that puts the control of the pain in the patient’s hands. He told Carole that she might be a good candidate for a medical device called a spinal cord stimulator (SCS). As it turns out, Carole had read an article on alternative treatments for back pain in Reader’s Digest and one of them was the spinal cord stimulator. She was encouraged to learn that Dr. Finkelstein, a Physiatrist who is Fellowship-trained in Interventional Spine and Pain Management, had comprehensive experience and impressive results with his SCS patients in Lancaster County and beyond.
The size of the implanted generator is not much bigger than an Oreo cookie. The patient sends a signal to the generator through a remote control, which reduces pain by sending mild electrical impulses to nerves along the spinal cord.
How spinal cord stimulation works
There are three parts to the SCS, two of which are implanted. Through a minimally invasive outpatient procedure, a neurosurgeon embeds a small generator similar to a pacemaker in the patient’s flank. Dr. Finkelstein describes the shape and size of the generator in simple terms: “It’s like a double stuffed Oreo cookie,” he says. The generator sends mild electrical impulses via very thin wires or leads to nerves along the spinal cord. Low-level electrical signals are then transmitted through the wire to the spinal cord or to specific nerves. The action blocks pain signals from reaching the brain.
The third component of the SCS is a programmable transmitter, a remote control that is similar to other electronic devices like cell phones, ipods and pagers. The patient operates the transmitter, choosing the intensity and pattern of the pain-blocking impulses and turning the current on and off as desired.
A person’s decision to go forward with an SCS is a careful process that is guided by patient-and-doctor communication and testing. Before a spinal cord stimulation system is permanently implanted, Dr. Finkelstein conducts a trial that is the standard of treatment for patients considering one. A temporary external system allows individuals to evaluate how much pain relief the stimulator will provide, and if they are
comfortable with the sensations of spinal stimulation. Patients who respond positively can choose to move forward to a permanent stimulation system.
Carole’s first response during the trial? “I could actually feel my foot for the first time in a long time,” she says, acknowledging she was convinced right away that the SCS would bring her long-sought pain relief. “Dr. Finkelstein was very good at explaining,” she continued. “He answered every question in great detail, and I was confident that I could master the mechanics of the device.”
Neurosurgeon Bill Monacci of Lancaster NeuroScience & Spine Associates performed Carole’s surgery to install the SCS using a local anesthetic to numb the area and inserting the wire lead through a small incision. Once he had implanted the lead, he activated the stimulation system and guided Carole through the steps to determine the most effective placement.
A year after receiving the SCS, Carole is totally comfortable with her choice. She jokes that when she recently flew out west and told the security person about the implant, “she was really curious to feel it. She told me ‘I wouldn’t have known it was there’.”
“It’s extremely gratifying to see Carole, who had been in a lot of pain, reach a point where she is doing the things she loves to do again,” Dr. Finkelstein says with great satisfaction. “We have patients who come in who are very limited in what they can do, having lived with pain for 10, 15 even 20 years,” he explained. “We are having very good results with people suffering from chronic pain, leg pain, pelvic pain and diabetic neuropathy.”
“For many of my patients, it’s a major step toward a more active, fulfilling life.”
