For Caruso’s cashier, a ‘stepping stone’ to Parkinson’s cure

Mike Dean, of Chestnut Hill, underwent deep brain stimulation this week. He is one of about 50 patients from the region participating in a national study.

by MICHAEL J. MISHAK

As an outside plant engineer for Verizon, Mike Dean led a life of detail. Work orders, bid proposals and inventory levels were all a part of the veteran assistant manager's everyday duties. So when Dean found himself unable to knot a tie or twirl spaghetti, he realized he had ignored a series of subtle clues that announced a devastating illness.

“All of a sudden, you know something’s wrong,” Dean said.

At 43, he was diagnosed with Parkinson's disease.

Still, the affliction didn't prevent him from another 12 years of work. Drug therapy helped mitigate the progression of debilitating symptoms. Dean retired in 2003 after 35 years on the job.

Now, nearly 14 years after his diagnosis, the longtime Chestnut Hill resident, who has quickly become a community fixture as a part-time cashier at Caruso's Market, is making history. He is one of approximately 50 patients from the region participating in a groundbreaking national study on deep brain stimulation (DBS), a relatively new surgical procedure aimed at quieting the overactive areas of the brain that trigger symptoms like tremors.

For Dean, 57, the surgery carries the promise of relief. He takes as many as 13 different medications daily, most Parkinson's-related, to combat symptoms like joint stiffness, muscle spasms and "freezing," a condition that temporarily locks him at a standstill.

But as drug therapy alleviated some ailments it created others. Soon after diagnosis, Dean found his Parkinson's drug cocktail had brought on anxiety attacks. He takes Prozac to counter the panic bouts, but the antipsychotic drug subsequently caused dyskinesia, or involuntary spasms, in his legs.

Though only 10 to 20 percent of cases are eligible for DBS, a confluence of factors make Dean a prime candidate. He often has trouble walking and his response to medications has varied.

Approved to treat Parkinson's by the U.S. Food and Drug Administration in 2002, the surgery has considerably improved life for scores of patients, some of whom were able to stop taking medication entirely, said Dr. Matthew Stern, director of the Parkinson's Disease and Movement Disorders Center at the University of Pennsylvania and a principal investigator in the new study.

"While it's clearly not for every patient, for those that qualify, it's definitely offered a real advantage over what he had before," said Stern, also a Chestnut Hill resident.

The procedure can take up to 10 hours and is performed while the patient is awake. Neurosurgeons insert a hair-thin electrode into one of two areas in the brain that control movement. A wire, which is run through a small hole in the skull, is then threaded under the skin and attached to a pacemaker-like device near the clavicle called a pulse generator. The patient then controls the electrode with a small, wireless external device.

A deficiency of a chemical called dopamine in one of the two areas is believed to result in overactivity. With DBS, doctors can restore the balance through a series of electrical impulses.

While not a cure, the procedure represents an important advancement in Parkinson's treatment, Stern said.

The national study, which is expected to include more than 300 patients from six medical centers across the country, began three years ago and examines how two parts of the brain each respond to the DBS procedure, he said. It is the largest, most comprehensive study of its kind.

Still enrolling patients, the study is years away from completion. Patients will be monitored for up to three years after the procedure, Stern said.

Researchers hope to refine the surgery for maximum benefit. The study will match particular symptoms to specific parts of the brain, he said.

Also, doctors are looking to determine whether the procedure permanently slows the disease's progression. If so, Parkinson's patients could undergo DBS earlier in the course of the disease.

Last Friday, Dean received notes from well-wishers and chatted with customers about his impending operation while tending the cash register at Caruso's. For a man three days from a 10-hour brain surgery, he appeared remarkably staid, even joking with shoppers.

“I did all my worrying before,” said Dean, in between bites of a hot roast beef sandwich on his lunch break. “When I made the decision to get into the study I was fully ready.”

But he almost didn't apply. Approached by Stern two years ago, Dean passed on the opportunity. Later, his neurologist pushed the issue. And after some careful research and a long conversation with his wife Marian, Dean opted in.

A visit to a Lafayette Hill man who had undergone DBS sealed the deal. Clicking a remote control device, the man began to "shake like a leaf," Dean said. With another push of the button, the tremors ceased. "I came off the fence after talking to him," Dean said.

Last month, he was told he qualified for the DBS study, and given three weeks to prepare. "I was shocked," Dean said last Friday.

On Monday, he underwent surgery at Pennsylvania Hospital. After a short period of side effects like slurred speech and hiccupping, patients typically recover in two to six months, during which time doctors refine the electrical signal.

Dean hopes the procedure will abate some of his more aggravating symptoms, and possibly reduce his intake of medication.

“This is a stepping stone to a cure,” he said.

Given his popularity with Caruso's coworkers and shoppers, Dean will be missed. He took the part-time job at the local market last year when, like many retirees, he tired of retirement.

What started as a relaxing vacation turned into numbing boredom. He had spent more than three decades climbing the rungs at Verizon, from lineman to manager. For Dean, a Navy veteran born and raised in Olney, the stillness of retirement didn't sit well.

And Marian, his wife of 33 years, gave him extra incentive. “She told me to get out of the house,” he said.

In a little more than a year, Dean, who helped raise three daughters in Chestnut Hill, became a beloved community fixture often mistaken for "Mr. Caruso."

He's grateful for the community's support and prayers, and has placed the regular customers on notice. “I tell them I’m going away for awhile,” Dean said. “Just like Arnold [Schwarzenegger], I say, 'I'll be back.'"