From Shaky Hands to a Steady Future: Breaking New Ground in Neurologic Care

For more than 15 years, Rick Van Vliet couldn’t sign his name, hold a glass of water or tie his shoes without his hand shaking. Today, after a single focused ultrasound treatment, he can do all three.

Van Vliet says that every morning since he received focused ultrasound treatment at Lehigh Valley Health Network (LVHN), part of Jefferson Health, he wakes up, walks downstairs and signs his name on a piece of paper.

“I want to make sure the results I saw that day are still there,” he says.

Focused ultrasound may be an option for people with essential tremor or Parkinson’s disease whose symptoms are no longer controlled with medication.

Now Van Vliet can not only write his name, but he can also write an entire love letter to his wife Donna. They’ve been married for 53 years and he hasn’t been able to write something to her for over a decade.

“My right hand was unmanageable,” he says. “I could no longer tie my shoes, so I wore loafers. I couldn’t do anything mechanical. If I wanted to use my right hand, I had to hold it steady with my left hand.”

The tremor wasn’t something that came and went. It was constant. Rick would often sit on his right hand to try to hide it, a sign of his resilience in dealing with his condition. 

Thankfully, LVHN began offering an innovative, incisionless treatment option called focused ultrasound (FUS). LVHN is currently the exclusive health network in the eastern half of Pennsylvania to offer this treatment and the second center in the state of Pennsylvania.

FUS uses targeted sound waves to treat the part of the brain causing tremors, without incisions. Recovery from FUS requires minimal downtime. The fact that it is available right here in the Lehigh Valley, was icing on the cake.

“Rick was a good candidate for FUS because his tremor was severely impairing his ability to use his hand for eating and drinking and other day-to-day tasks and hobbies,” says neurosurgeon Vishal Patel, MD, PhD, with LVH Neurosurgery, who performed the procedure, “and his tremor was not responsive to medications.”

A 30-year Navy veteran, Van Vliet first noticed his hand shaking in 1997 when he was a senior officer in charge of a warfare training group. His job required a lot of writing and his hand would shake in the morning. At the time, he chalked it up to too much coffee.

Then in 1999 when he retired from that position he was diagnosed with essential tremor, but no treatment was offered. It wasn’t until nearly a decade later that the tremor became significantly worse. He gave up coffee, but eventually lost his ability to write and do anything that required his fine motor skills, including tying flies for his favorite hobby of fly fishing.

He was prescribed a variety of medicines, but nothing helped. 

Early in his military career, Van Vliet served two tours in Vietnam. He didn’t know it at the time, but the herbicide (Agent Orange) he was exposed to is linked to Parkinson’s disease, a disease known to cause tremors. After many years working with other clinicians, Van Vliet was finally referred to neurologist Munazza Sophie, MD, with Lehigh Valley Fleming Neuroscience Institute.

Dr. Sophie reevaluated him, diagnosed him with Parkinson’s disease, and eventually referred him to the FUS program. 

One of the unique aspects of FUS is that people are awake and aware of everything that’s happening during the procedure. A large care team is present and includes doctors, nurses, MRI technicians, the nurse navigator and many others.

“People should know that they shave your head prior to the procedure,” Van Vliet says, “and part of the time you’re inside an MRI machine. That can be noisy and make some people uncomfortable.”

Shaved heads are necessary because hair can trap air and interfere with the ultrasound energy. Van Vliet says the procedure wasn’t pain-free, but the pain was minimal and well worth the outcome. 

Before the procedure they gave Van Vliet a bottle of water and asked him to take a drink. They gave him a marker and asked him to draw a spiral on a piece of paper. He couldn’t take a drink and his spiral was all over the place. 

Almost immediately after the procedure, he lifted the water bottle to his mouth and was steady enough to take a drink. His spirals on the paper were smooth and round.  

“As clinicians it is always rewarding to see patients have positive outcomes, and it is sometimes hard for us to not become emotional about the difference being made in patients’ lives in real time,” Dr. Patel says. “It provides me tremendous pride to be part of a team that help these patients gain such dramatic improvements in their quality of life.”

If you or someone you know is interested in exploring FUS as a treatment option, you should first establish care with a neurologist who specializes in movement disorders. They will evaluate you, maybe try other treatment options first and refer you to FUS if appropriate.

The FUS program has a nurse navigator, Crystal Smith, who walks patients through every step of their journey – from making appointments to being present at the procedure.

“It is a privilege to participate and witness someone's life improve before your eyes,” Smith says. “We love to line up on the walkway and clap for the patients when they leave.” 

FUS is a breakthrough treatment in that may be an option for some people on blood thinners or those with other risks that make surgery impossible depending on individual health factors. 

Van Vliet is extremely grateful for the expert care he received at LVHN, and he appreciates the opportunity to be one of the first in our region to benefit from this innovative treatment. 

“After the procedure they brought my wife in and showed her the spirals. She broke down in tears. People were lined up and cheered and clapped when we left,” Van Vliet says. “The joy that I felt in that room – the joy was overwhelming for everyone there.”

Today, Van Vliet is looking forward to getting back to life. At his most recent follow-up appointment he was given permission to drive. He and his wife have already planned several trips. And he’s most looking forward to the simple things – wearing his shoes with shoelaces again, drinking and eating with his right hand and writing many more love letters to his wife. 

Start with a consultation. 

Call 610-402-1055 or request an appointment online.