Friday, January 14, 2005

Tingles are signs of promise for teen who hopes to walk

BY PATRICIA ANSTETT

LISBON, Portugal - Cortney Hoffman woke up with a pain in her butt.

But that's a good thing.

"My butt tingles," she said two days after undergoing five-hour experimental surgery to repair a spinal cord injury from a 2002 auto accident that paralyzed her from the upper arms down.

"I never felt it before. It's like little pokey needles," she said.

Mostly, she felt groggy from anesthesia and pain medicine she received after the spinal cord autograft procedure Jan. 8 at Hospital de Egas Moniz in Lisbon.

The operation, performed only at that hospital, used Cortney's adult stem cells, harvested in tissue extracted from the upper reaches of her nose, and implanted over her injury site, high in her back.

Olfactory mucosal tissue from the nasal cavity is rich in stems cells, as well as nerve cells. Stems cells are cells in their infancy. They are capable of becoming nerve cells, and forming new neural connections and blood vessels when implanted in a spinal cord injury site.

The success of the operation is highly dependent on patients undergoing two years of aggressive rehabilitation to trigger new signals in the spinal cord.

But early on, paralyzed patients look for any sign, any new sensation, any change in the same-old, same-old routine.

SOME POSITIVE SIGNS

"Cortney is doing very well," says Dr. Carlos Lima, chief of the surgical team, after examining Cortney on Monday morning in her modest sixth- floor room in this aging public hospital.

Other positive signs that Cortney's recovery has begun is she has no postoperative bleeding from her nose or surgery site; no infection, and no drainage of spinal fluid onto a bandage over the six-inch incision in her back.

To determine whether Cortney lost any sense of smell - one temporary loss many patients experience after the surgery, sometimes for several months - Lima tells Cortney to close her eyes. He takes a film canister from his white lab coat, pulls off the cover and puts it under her nose.

"Can you smell this?" he asks.

Cortney pauses and tells him she can't.

"It's coffee," he tells her.

Lima then asks Cortney: "So what are your main complaints?"

"I want to feel better," she says. She is hot, groggy and feels pain in her nose, back and shoulder, despite pain medication.

Lima tells her family that Cortney should be sitting up in a day, and perhaps will be able to sit in her wheelchair in another day or two. She and her mother, Tammi Roe of Temperance, Mich., north of Toledo, Ohio, have booked a Jan. 19 flight out of Lisbon.

Cortney misses her two dogs - a Chihuahua named ChiChi and a black Labrador named Buck - and American food. She passed on a hospital meal Sunday because she thought it looked like earthworms, she says. When her sister, Krystal Hoffman, 21, talks about fast food, Cortney tells her: "Bring me something."

As an indication of what may be ahead for Cortney, in the room next door, Amy Foels, 20, of Elkader, Iowa, who had the same surgery Friday, reports constant tingling, from her legs to her toes.

"It's really intense in the toes," says Foels, who also was injured in a 2002 auto accident. "I'm seeing it as a good sign."

Cortney says she looks forward to completing driver's education next month. A Dodge Caravan equipped for her wheelchair waits for her at home.

And for the future?

She wants to live on her own someday.

And, most importantly, she wants to walk down the aisle at her own wedding.

First, it appears, she'll be part of her sister's wedding party.

A PROPOSAL IN LISBON

On Jan. 8, as Cortney slept at the hospital, Brandon Baker of Adrian, Mich., got down on one knee and proposed to Krystal along Lisbon's riverfront.

Asked if he got down on one knee or two, he quips: "One knee. I was asking her, not begging her."

Cortney's family had been told of the proposal before her sister knew about it. One of the first things Cortney asked after waking up from surgery was, "Did Brandon propose to Krystal?" The girls, nearly four years apart, have grown closer since Cortney's accident and Krystal helps Cortney's mother with care giving.

Cortney's dad, Doug Hoffman, her grandfather Norman Schmidt, and her friend Rachel Scanlon, also came with Cortney to Lisbon.

Lima tells Cortney's mother not to expect too much too soon. "The main things take months. It takes months, even years," he said.

"You have to be patient and Cortney has to be patient and determined."

When she asks whether Cortney can undergo the procedure again, Lima said: "If she's doing well, why would you want to do that? If it works for three years, why wouldn't it work for longer?"

He explains that, with rehabilitation, Cortney first will develop better strength in her fingers, arm and trunk, then after perhaps four months, be able to begin doing more leg exercises and possibly, taking a few steps with leg braces and help.

Cortney will resume three days a week of aggressive rehabilitation at the Rehabilitation Institute of Michigan in Detroit, where she's been going since the fall.

The institute is collaborating with the hospital team in Lisbon to evaluate and follow up patients and hopes to become the first U.S. medical center to offer the procedure, perhaps as early as next year. Soon, a hospital in Colombia and a hospital in Panama are likely to begin the operation, Lima says.

"We want others to learn how to do the procedure," Lima says. So many patients want the $47,600 surgery that the team in Lisbon is booked through the end of May. They have done the procedure 37 times.

Cortney suddenly stirs from her slumber and says: "I want to go home. I am ready to begin a new life."