When a doctor becomes a patient

Posted by Reeve Staff in Daily Dose on October 18, 2021 # Research

Dr. Richi Gill during the studyIn 2018, when Richi Gill was 37 years old, he broke his neck during a freak boogie boarding accident in Hawaii. A gastrointestinal surgeon in Calgary, Gill knew his injury was severe, but after he made his way out of the intensive care unit, he turned his focus toward maximizing his remaining function.

"As a physician, I always told my patients, 'You have to do the best with what you have,'" Gill says. "After the injury, I learned to say that to myself."

Unfortunately, spinal cord injuries (SCI) are challenging and they affect everything from when and how you move to how well you can control autonomic functions like blood pressure. To add insult to injury, blood pressure instability stemming from an SCI can lead to life-threatening complications such as heart disease and stroke.

"What many people don't realize is that spinal cord injury breaks the line of communication that allows the brain to regulate bodily functions automatically," Gill says. "My blood pressure dropped drastically, making me feel dizzy, lightheaded and unable to focus."

Desperate to maximize his remaining function and prevent long-term complications, Gill reached out to a colleague for guidance — Ian Rigby, an emergency room physician at the Foothills Hospital in Calgary, who had a SCI 10 years ago.

"Rigby shared two basics tenets that fueled my recovery: 1. The injury is physical, but the recovery is 100% mental. 2. Even if there isn't a cure right now, participating in clinical trials can push the science forward and potentially help people down the line," Gill says.

To that end, Rigby introduced Gill to Aaron Phillips, a principal investigator on several neurostimulation studies at the University of Calgary's Cumming School of Medicine and Gregoire Courtine at Swiss Federal Institute of Technology. Gill learned everything he could about targeted epidural spinal stimulation, an implantable device approved for treating chronic pain — and one that Phillips' lab was actively building upon to better address autonomic function deficits from SCI.

With epidural spinal cord stimulation, doctors program a device to stimulate the spinal cord from the surface of the skin. The idea is to record signals traveling down the spinal cord, above the injury site, and then uses those signals to drive spinal stimulation below the injury. At the same time, information from below the injury drives stimulation and signaling above the injury.

After researching epidural stimulation, talking to Phillips, and weighing the pros and cons, Gill traveled to Thailand to have an epidural stimulation device placed in his lower back. The device stimulates specific nerves mapped out by the medical team that allow patients to perform rudimentary movements.

"My goal wasn't to walk again," says the 40-year-old father of three. "But I thought if there's potential for improving my quality of life, it could be worthwhile."

For Gill, the surgery where doctors place the device on top of your spinal cord, was the easiest part of the process. The challenge was programming the device. Since no two spinal cord injuries are the same, investigators have to tailor programming to each patient's injury. Without data on how to optimize the device for rehabilitation purposes, investigators relied on trial and error to customize the device.

During a grueling schedule in Thailand that required four-hour daily sessions over six weeks, team members tried to configure the device to address Gill's specific needs: rudimentary movement in the legs, assisted standing and assisted stepping. The process was emotionally, physically and mentally exhausting.

By the time Gill returned to Calgary, Phillips had begun testing a new device to address the autonomic piece of the SCI puzzle — a neuroprosthetic close-loop communication system that allows doctors to deliver targeted electrical stimulation to the brain regions that regulate blood pressure.

During a series of experiments on rodents and non-human primates, Phillips' team used an implanted blood pressure monitor to measure blood pressure continuously and adapt the instructions sent to the device that in turn delivers electrical pulses over the spinal cord. "From a technical standpoint, it's like a pacemaker for the spinal cord," Gill says.

A panel on top of the device allows users to change programs and a generator beneath the skin connects to the power source — and you recharge it on a power device just like an apple watch. While electrical stimulation targeting autonomic functions hadn't yet been tested in people with SCI, Gill signed up to be a guinea pig in the world of neurological research.

"As a physician, I recognized the power of research to enhance lives and I wanted to be part of the solution," Gill says. "I thought maybe I could be proof of concept that could lead to an actual trial, which could lead to the device being approved — and, eventually, improvements in function."

While Gill recognizes that scientists have a long way to go to maximize this neuroprosthetic close-loop communication system, he also credits the stimulator with dramatically enhancing his quality of life.

"What we're working with right now is the flip phone version of the device, not an iPhone," says Gill, who uses the stimulator almost 24 hours each day. "And yet, it helps me manage my blood pressure and spasms, get more and better sleep, and allows me to accomplish more in rehabilitation than I would without it."

In fact, with the device, Gill has been able to return to work and he's enjoying more time with his family. If all goes well during the trial phase, this close-loop communication system could be available to other spinal cord injury patients within five years.

"There are going to be rough days and recovery is challenging," Gill says. "This device is not a cure but it has the potential to improve quality of life. If you keep that perspective, then it's a lot easier to move forward."

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