Section: Monmouth Medical Center News

A Step Forward: Monmouth Medical Center Physician Helps Patient Improve Ability to Walk After 15 Years of Difficulty

10/04/2013
Dr Holland and Robert Pall
Patient Robert Pall, right, credits his regained ability to walk comfortably to Neil Holland, M.D., a neurologist at Monmouth Medical Center.

Long Branch, NJ – Fifteen years ago, exactly one week after his 50th birthday, Robert Pall lost all feeling below his waist in just hours. He underwent lumbar punctures, MRIs and countless tests. He received injections and oral medications, was transferred to various facilities and began extensive physical rehabilitation. Three weeks after the onset of symptoms, Robert was diagnosed with transverse myelitis – or inflammation of the spinal cord – and was told by his doctors that he probably would walk again, but they did not know how well or with what kind of assistance.

Today, at age 65, Robert swims more than one-mile laps daily and enjoys walking his 70-pound golden retriever – without a cane. “I feel better than I have in 15 years,” said Robert, who credits Neil Holland, M.D., a neurologist at Monmouth Medical Center, with his progress.

After being diagnosed with transverse myelitis (TM) 15 years ago, Robert visited several doctors and did what he could to minimize the pain and fatigue brought on by walking. “The improvement was constant for the first six months, then it continued to a lesser extent over the next six months, and then I just stopped improving,” said Robert, who founded and has led the Transverse Myelitis Support Group in New Jersey for the past five years as a way to cope with his condition and to share with others suffering with daily activities as a result of TM.

That’s where he first heard of Dr. Holland. “A lot of people in the support group spoke about how great Dr. Holland was and how much he had helped them – and many of those people were dealing with pain and stiffness worse than mine,” said Robert. “It wasn’t until my wife was referred by our family physician to Dr. Holland for severe headaches that I finally made an appointment.”

After reviewing Robert’s case history, Dr. Holland suggested the baclofen pump as a possible solution to Robert’s banding, or extreme stiffness. Baclofen is a muscle relaxer used to treat muscle symptoms such as spasticity, pain and stiffness.

“I explained that I had tried baclofen orally but it didn’t work for me because of the side effects – extreme fatigue, nausea and headaches,” said Robert. “Dr. Holland explained that the pump was different than the oral medication because I would be receiving a small dosage that would be delivered directly to my spinal lesion, so those side effects would not be an issue.”

“Those being treated with oral medications often see improvements in their strength, but they are left with spasticity – increased muscle tone causes extreme tightness or banding, making it difficult and often painful to walk. Treating spasticity by administering baclofen directly into the spinal canal improves function without causing unwanted side effects,” said Dr. Holland.

Dr. Holland urged Robert to undergo a trial at Monmouth Medical Center, during which Dr. Holland administered an injection into Robert’s spine. “Within 20 to 30 minutes, my leg felt better than it had felt in 15 years,” said Robert.

Although Robert wasn’t sure he wanted the pump – a slim titanium disc similar in design to a pacemaker that would be inserted parallel to his naval – he spoke to others who had undergone the procedure, as well as his family physician, and decided there was no downside.

“This procedure allows baclofen to be infused into the spinal canal via a programmable pump that is implanted beneath the skin. The supply is replenished by injecting the baclofen into the pump’s port with a small needle,” said Dr. Holland, noting that Robert will likely come in about once or twice a year for this injection.

On June 28, Robert underwent surgery with Timothy Link, M.D., a neurosurgeon at Monmouth Medical Center. “I liked that Drs. Holland and Link worked together to make sure everything was covered by my insurance. The procedure itself was no big deal, and I felt good afterwards,” said Robert, who spent 24 hours in the Intensive Care Unit at Monmouth Medical Center following the surgery.

“Monmouth Medical Center was great. The nurses at were by far as good as I could have ever hoped for – every single one. And Dr. Holland is phenomenal. I never feel rushed with him. He listens, makes suggestions. His bedside manner is exceptionally good,” said Robert.

During the trial, only a small dose of baclofen is injected into the spinal canal. Once the pump is in place, a neurologist can adjust the dosage non-invasively by using a magnet. Since the initial dose administered during the trial, Dr. Holland has doubled Robert’s dosage, and they are both very satisfied with the results.

“Before the trial and the baclofen pump, Robert’s gait was comparable to driving with the handbrake on – the spasticity held him back. Now, with the baclofen pump, I’m elated with how well Robert is walking. He has an entirely new quality of life,” said Dr. Holland.

Robert’s new quality of life has opened the door to hobbies he didn’t think he could ever do. “I’ve been able to return to the activities I love, like walking my dog and swimming laps and generally just being more active,” he said.

“This has come as close to being a miracle as anything I’ve ever experienced. I’d do it again in a second. Going forward for as long as I live, Dr. Holland will be my neurologist. I’m so grateful to have found him.”

About Monmouth Medical Center
Located in Long Branch, N.J., Monmouth Medical Center, a Barnabas Health facility, along with The Children’s Hospital at Monmouth Medical Center, is one of New Jersey's largest academic medical centers and has been a teaching affiliate of Philadelphia’s Drexel University College of Medicine for more than 40 years. From its earliest days, Monmouth Medical Center has been a leader in surgical advancement and has introduced many technological firsts to the region, including robotic surgery and other minimally invasive techniques. The hospital is routinely recognized by HealthGrades, the nation’s largest premier independent health care quality company, for excellence in both emergency medicine and maternity care. U.S. News & World Report has recognized Monmouth as a regional leader in cancer, geriatrics, gynecology, neurology and neurosurgery. For more information on Monmouth Medical Center, visit www.barnabashealth.org.

Date: October 4, 2013

Contact: Elizabeth Brennan
732-923-5005
ebrennan@barnabashealth.org

Categories: Neuroscience,Orthopedic,Press Releases