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Focused Ultrasound Procedure Gives Wyoming Fly Fishing Guide a New Lease on Life


Mark Armstrong grew up in Colorado, where he spent his days hiking and fishing the lakes and streams. He eventually turned that love of fishing into a full-time job offering people guided fly fishing tours in Wyoming, where he lives today. Several years ago, he started to notice his hands shaking. At first, it wasn't too bothersome, but it got progressively worse.

Mark was diagnosed with essential tremor (ET), a nervous system disorder that causes involuntary shaking in your body, often affecting your hands and making even simple tasks difficult. The condition isn't typically life-threatening, but it does get worse over time and can significantly impact a person's life.

About half of all essential tremor diagnoses appear to be from a genetic mutation called familial tremor. For those without the genetic condition, it's unclear exactly what causes tremors, but the risk of developing it increases with age (most people diagnosed are over 40). The condition is often mistaken for Parkinson's, but the two are separate.

For a man who was featured in hundreds of articles in Fish & Stream magazine and Denver newspapers for his ice fishing and fly fishing expertise and described as the "modern-day guru of Colorado ice fishing" in Bob Saile's 1999 book Trout Country: Reflections on Rivers, Fly Fishing & Related Addictions, the diagnosis was devastating.

"I was born and raised in the mountains," Mark says. "It was a part of me since I was a child, hiking the high country in Colorado. Without that in my life, I'm not whole."

As the tremors progressed, they impacted more areas of his life. Mark had trouble eating, drinking, shaving, and even getting dressed in the morning. His handwriting got so bad that he couldn't read his own notes. About seven years ago, he went on disability when the tremor prevented him from doing his job as a fly fishing guide.

Mark, who likes to post his ice fishing exploits on YouTube, started using that video platform to research his condition and treatment options. His doctors were treating the symptoms with medication, which was the best option available, but the sedatives to reduce the tremors left him feeling like a shell of himself. The only alternatives at the time were an invasive brain surgery (thalamotomy) or a deep brain stimulation device to target the part of the brain thought to be causing involuntary movements.

Then, in 2016, the Food and Drug Administration approved a non-invasive procedure called focused ultrasound to treat essential tremor in patients whose condition did not improve on medication.

First, neurosurgeons use magnetic resonance imaging (MRI) to find the tissues inside the brain that are causing tremors. Then, they use several focused beams of sound to target and destroy those tissues with extreme precision. Each individual beam can safely penetrate the tissues in the patient's brain without doing any damage, but the focal point where all the beams meet creates a small area that burns or destroys the tissues. The exact size of the area to be destroyed depends on the condition and the patient, but could be as small as 0.5mm.

Initially the procedure was only performed at hospitals on the East Coast and was not covered by insurance (including Medicare, which Mark had). Then, in 2019, University of Utah Health became the first hospital to offer it in the Mountain West region. At nearly the same time, Medicare began covering the procedure, along with most other major insurers.

When he learned about the approval and availability in Utah, Mark immediately scheduled an appointment. He spent two full days going through tests and evaluations with U of U Health neurologists, physical therapists, neuropsychologists, and neurosurgeons, then came back for surgery in November 2019.

The surgeon placed a "crown" around Mark's head and attached it with small screws to his skull to prevent any movement and ensure the beams are focused on the exact right spot. He was on an MRI table for less than three hours for the procedure.

"After they pulled me out of the MRI tube, I could draw a perfect spiral circle and write my name like I've never seen before," Mark says. "They handed me a glass of water and I was able to bring it to my mouth with the skill of a surgeon."

Mark stayed at the hospital for observation for about 30 minutes, then drove himself back to the hotel. Doctors said he may feel a little weak and have some numbness for about three weeks while recovering, but once that was gone he felt completely normal.

"The focused ultrasound procedure resolved about 95 percent of the tremors in Mark's right hand," says U of U Health neurosurgeon John Rolston, MD. "And the other five percent is barely noticeable."

"There is absolutely no reason somebody should not have this procedure done," Mark says. "I'll be 69 in August and it has given me a new lease on life and absolutely changed me. I'm able to cook again, eat, make notes, and write. I even caught a seven-pound rainbow trout all by myself."

Today, Mark is back outside doing the things he loves. He's not able to travel as much as he'd like due to the COVID-19 virus, but he's grateful he can spend his time "social distancing" by fly fishing. He's hoping that in the coming months he can bring back some of his clients for guided fishing tours.

"Having [the tremor] taken away from me opens a huge door to go forward," Mark says. "I'm ecstatic about this and I wouldn't trade it for anything.

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