Tuesday, January 04, 2005

HELP FOR PARALYSIS: Cortney's wish is to walk again

BY PATRICIA ANSTETT - FREE PRESS MEDICAL WRITER
January 4, 2005

Cortney Hoffman, 18, of Temperance and her cousin Cassie Adney, 5, of Toledo shop last week at a dollar store.

Cortney Hoffman admits the painful truth. She wasn't wearing a seat belt the day her car flew off the road less than a month after she received her driver's license on her 16th birthday.

She was just going a few miles to her cousin's house. She insists she wasn't speeding, sleepy, drunk or stoned, but she has no idea how her 1996 Cutlass Supreme landed in a ditch on July 30, 2002.

She recalls calling for help from the ditch after being thrown from her car on a freshly resurfaced gravel road.

About 10 minutes later, a man driving by heard her muffled plea, followed her voice, found her and called for help.

Hoffman awoke in a Toledo hospital, paralyzed from her shoulders down.

Six days later, she was told she'd never walk again.

Today, she departs on a plane to Lisbon, Portugal, for experimental stem-cell surgery Saturday.

Her goal is to walk at her own wedding some day. "I'm not getting married until I can walk down the aisle by myself," said Hoffman, an upbeat 18-year-old from Temperance, north of Toledo, who likes to hunt, sing and shop, particularly for jewelry. She is 5 feet, 6 inches tall with bright blue eyes and blonde hair, a 21st-Century version of the girl next door, with a big smile and ear piercings.

Her strongest attributes are an upbeat personality and persistence, said her mother, Tammi Roe, a divorcee who lives with her daughter. She quit her job as a furniture maker to take care of Cortney after the accident.

"She always has a smile on her face every day," Roe said. "She has just rolled with the punches. She missed her whole junior year in high school but graduated on time. That's the kind of girl she is."

Hoffman will be among the first 40 people in the world to undergo the so-called Portuguese procedure. It uses her own stem cells, extracted from the tissue that provides her with a sense of smell, surgically implanted into the site of a spinal cord injury.

Second chance at mobility
Detroit's Rehabilitation Institute of Michigan plans to request federal approval to perform the surgery this spring. Approval wouldn't come until 2006 at the earliest. A half-dozen approaches using stem cells are under way worldwide for people with a variety of conditions, including Lou Gehrig's and Alzheimer's diseases and spinal cord injuries. There are no legal hurdles, but plenty of scientific reservations that so far have stood in the way of anyone applying to do the surgery in the United States.

Of all the stem-cell operations, the Portuguese procedure stands the best chance of coming to America, said Dr. Steven Hinderer, specialist-in-chief at the Rehabilitation Institute. "There are no ethical problems with this one," Hinderer said, theorizing that because the procedure uses a person's own stem cells it shouldn't attract the controversy associated with operations now being conducted in China, Australia, Brazil and Russia that use stem cells from aborted fetuses or frozen embryos from fertility procedures.

For now, patients in wheelchairs get on planes for long, arduous trips abroad for experimental surgery. The other challenge is finding ways to pay for the surgery, which costs $47,600 and often is not covered by insurance. Some patients, including Hoffman, have no-fault auto insurance that covers the expense. Her family raised $1,800 in a benefit last summer to help pay for the airfare for several family members joining her for this week's trip.

The Rehabilitation Institute has a formal agreement with the team at Lisbon's Egas Moniz Hospital to evaluate and follow patients for the surgery, and to provide the aggressive rehabilitation it requires for at least two years.

The Detroit program, expanding almost monthly for the past year, is attracting patients worldwide, and pushing a city known for cars and music into the center of attention in the spinal cord community.

"I'm from Detroit now," said Harold Bostick , 35, who moved recently from Los Angeles to participate in the Rehabilitation Institute program.

A law student, Bostick was injured while working out at a gym and the equipment toppled over on him and crushed him.

"I'm trying to manage my expectations," Bostick said, stopping as he lay on his back pushing hand and foot pedals on equipment known as a Giger machine. "I've had no new movement since May 2001."

Bostick already walks haltingly with leg braces and a walker. So, too, does William Vickers, 23, of Holly, who underwent surgery in Portugal Nov. 12.

The Rehabilitation Institute's crowded Center for Spinal Cord Recovery, where they all work out, is a room of hope and questions. Some of the biggest, which patients here are providing answers for, are:

- Just how much progress will a person make after undergoing one of the stem-cell procedures?
- Has anyone gotten worse or died as a result of the operations?
- Will having a procedure now rule a person out for advances down the road?

The Lisbon surgical team traveled to Detroit last fall to confer with Rehabilitation Institute staff and patients and to summarize results of the first 30 spinal-cord autograft operations, as they call them.

There have been no deaths or infections, and none of the patients has lost function as a result of the surgery, said Dr. Carlos Lima, the neuropathologist and lead team member. The operation could mean that a person wouldn't qualify for some other advance down the road, he said.

"It is feasible, safe and beneficial," Lima said in a one-hour interview with the Portuguese team. Magnetic resonance imaging tests of the patients up to three years after surgery show the stem cells integrate well at the site of a spinal cord injury, forming both new blood and nerve cells and neural connections.

Several Portuguese patients now can swing their legs or walk with a walker, Lima said. Several others have regained bladder control. Only one has plateaued, which Lima attributed to an unwillingness to continue weekly therapy. At least two years of rehabilitation is essential to the best outcome, the team said.

The Portuguese team prefers to operate on people who are 35 years of age or younger because stem cells are more plentiful in these younger patients. In older patients, the cells change function and take on more respiratory properties. The candidates' injuries must not be more than six years old.

Cortney Hoffman made up her mind to have the surgery after reading a story in the Free Press last year about Erica Nader, a Farmington Hills woman who was the first American to undergo the Portuguese procedure. Now, they work out next to each other.

"The thought of other cures coming down the road came to mind," Hoffman said. "But that could be 10 or 20 years. I have to think about right now. A cure may not happen."

She prepared for the surgery by undergoing aggressive rehabilitation three times a week. One machine requires her to be strapped with cloth bandages to hand and foot pedals of a bicycle-like machine for an hour. She can't use headphones because "we're supposed to concentrate. It's really boring," she said. She's so tired afterward she sleeps all the way home.

The work has paid off. Hoffman can put on her makeup, brush her teeth and hair and can help put on her coat.

But she knows she has several years, at least, of hard work ahead.

"I've done my hardest to get where I am and I can't walk yet. I'm not expecting to wake up from surgery and walk. I'm expecting to gain smaller functions first."

"I've got to take this chance."

For further information, visit or call the Rehabilitation Institute of Michigan's Spinal Cord Recovery Web site, www.centerforSCIrecovery.org, or call 866-724-2368.