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The Charlotte Observer Posted on Mon, Mar. 18, 2002 Deep inside Deborah's brain: Ready for surgery KAREN GARLOCH Staff Writer A week before Christmas, Deborah Setzer and her husband, Robert, drove to Margaret's Beauty Shop in Belmont. In two days, she would have brain surgery for Parkinson's disease. She came to get her head shaved. Instead of letting the surgeon do it, Deborah had asked Margaret Thrower, Robert's 86-year-old aunt, to cut her shoulder-length auburn hair. She wanted to donate it to Locks of Love, a charity that makes wigs for children. As Deborah climbed into one of the old shop's swivel chairs, Robert stood by with a video camera. It was quiet, and that made Deborah nervous. "I'm gettin' scalped," she said, forcing a smile. Deborah told jokes to relieve tension, but it was harder today. Thrower cut thin strands of hair and spread them neatly on her workstation. A tear rolled down Deborah's cheek. "I'm just telling myself I'm doing some good for some little girl," she said. `Let's try your hat on' On Friday, Dec. 21, at 8 a.m., neurosurgeon Stephen Tatter met Deborah and Robert in a large room outside the operating suites at Wake Forest University's Baptist Medical Center, 80 miles north of Charlotte. Deborah lay on a gurney. "Let's try your hat on," Tatter said. He slipped a heavy metal frame over Deborah's bald head. Like a halo, it rested precariously on her nose. As odd as it looked, it would serve two important purposes. Once attached to her skull, the frame would be bolted to the bed and hold her head still during surgery. It would also serve as a map to compare to the X-ray scans of her brain. Tatter would use the frame's coordinates to help plot the spot in her mid-brain to implant the electrodes. "Most people say this is the worst part of the whole procedure," Tatter said. He showed Deborah the needle for injecting anesthetic into four spots on her head. She grabbed the rails at the bedside. Tatter held the needle in her right temple for several seconds. Then he stuck again at the back. "Ow. That one hurts," she said. Her eyes watered. Gently but firmly, Tatter kept working. When he had injected all four spots with lidocaine, he screwed in thick pins, pushing the pointed tips through Deborah's skin and against her skull. Deborah couldn't see this, but she saw fear in the eyes of another patient watching across the room. She tried to think of other things. "Parkinson's is wasted on me," she told the doctor. "Just think. If I was a guy, I wouldn't need Viagra. I'm stiff all the time." 1st phase of surgery Shortly after 9 a.m., following another CT scan, Tatter pushed Deborah and her gurney into the white light of the operating room. The first phase of surgery -- implanting electrodes in her brain -- would soon begin. In the second phase, she would be asleep for the implanting of a stimulator near her collarbone. But she would stay awake for the first part. Tatter needed to ask Deborah questions as the electrodes went in. A nurse fastened Deborah's head frame to the end of the bed. Off to the side, Tatter and neurosurgery resident Dr. Sabatino Bianco reviewed computer scans of Deborah's brain. They looked for the subthalamic nucleus, a lima bean-size spot in the center of the brain where the electrodes would go. Deborah smiled and talked as the doctors and nurses moved around her. She asked Tatter how long she'd have to wait after surgery until she could let people write on her bald head. She planned to raise money for Parkinson's patients by collecting autographs. He said she'd have to wait at least three weeks to make sure she didn't get an infection. They're rare, he said. About one in 100 for brain surgery. Deborah knew the risk. She wanted this operation. She told Robert many times, she'd rather die than live with the pain. About 10 a.m., Tatter announced that Bianco was ready to drill. "You'll hear a sound now, and you'll feel movement," Tatter said. "It'll vibrate but it won't hurt. ... It sounds like we're rotating the tires on your car." The buzz drowned out conversation. Bianco made a 11/2-inch cut in the top right of Deborah's scalp and stretched her skin apart. Then he drilled the hole, the size of a dime, in her skull. Tiny chips of bone, light pink from blood, flew. Deborah smelled flesh burning. She wondered if the drill was cordless and what size drill bit he used. If she hadn't been the patient, she would have liked to watch. She liked putting things together and taking them apart, the way she did computers. When the drilling was over, Tatter moved to Deborah's side to test her muscles. His "before" test: Make a fist, he said. Open your hand. Hold a cup. Deborah complied with stiff, jerky movements. Tatter held her left leg and circled it around. He felt resistance from her rigid muscles, on and off, in the cogwheeling effect typical of Parkinson's patients. "It's tight. It's so tight," Deborah said. "I'm in so much pain all the time." Then, Bianco worked at Deborah's head. He pushed a long thin catheter carrying the four pencil-lead-thin electrodes into the center of her brain. If the operation worked, her stiffness and pain would be gone, at least on her left side. A second implant might come later for her right. At Deborah's side, Tatter pressed buttons on a keypad. It would send electricity to her brain, just as the chest implant would do later. He warned she might feel tingling. "Oh, wow," Deborah said, touching Tatter's arm with her left hand. Her left side relaxed. But the rush was almost too much. "That makes me really dizzy," she said. Tatter adjusted the current until he found the voltage that seemed right. "Wow. I just felt my arm relax," she said. It was the first time she'd been without pain for as long as she could remember. Tatter lifted Deborah's left leg for another circle -- the "after" test -- and there was no resistance. "Your leg is perfect now," he said. "You're just as loose as you can be. ... I think it's going to do the trick for you, on the left side at least. We may be back and do the other side someday." Deborah wished she could jump off the table and give him a hug. She had her life back. Tuesday: Deborah celebrates pain-free days. SOURCE: The Charlotte Observer http://www.charlotte.com/mld/observer/2882714.htm The Sunday Charlotte Observer (Mar. 17, 2002) has started a Four Part Series on Deep Brain Stimulation. Part 1/4 Deep Inside Deborah's Brain http://www.charlotte.com/mld/observer/news/2876779.htm Part 2/4 Deep Inside Deborah's Brain: Ready For Surgery http://www.charlotte.com/mld/observer/2882714.htm This is a very detailed personal story designed to increase Parkinson's Awareness. Go to this site for photos of Deb and her surgery... http://community.webshots.com/user/tenacitywins (click on thumbnail photo to access the series, then click on those thumbnail pics to enlarge...) Great photos Deb! Here is a somewhat related site... ARTICLE: Brain Stimulation Becoming More Common http://www.charlotte.com/mld/observer/news/2876783.htm Thank Deb at: Deborah Henderson-Setzer <[log in to unmask]> (support her, but please don't try to sell her something) or click on and sign any of the guestbooks on the above photo site.... Stay tuned for Part 3 tomorrow... cheers ...... murray * * * ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn