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Surgery gave this NH nurse control of her life again


BEDFORD - Life is good these days for Kelly Smith and her family. She is back at work, her tremors are under control, and she's looking forward to the birth of her first grandchild.

But daily life for Smith wasn't always rosy. Since childhood, she had suffered from uncontrollable tremors of her upper torso and hands, which also affected her voice. The symptoms became so debilitating that she had to give up her nursing career - until she underwent risky brain surgery.

Initially, her doctors thought the brain damage was from birth. Later, it was attributed to Parkinson's disease. Finally, she was diagnosed with a nervous system disorder called essential tremor, which affects about 3 percent of the U.S. population and 10 million people around the world.

"I wasn't correctly diagnosed until I was in my 20s, after I went into the Navy," Smith said. "A doctor in California diagnosed it as an essential tremor. He recommended I drink alcohol because alcohol temporarily suppresses the tremors."

Turning to alcohol, however, made Smith alcohol-dependent.

Then local neurologist Dr. Keith McAvoy introduced her to Dr. David Roberts, chief of neurosurgery at Dartmouth-Hitchcock Medical Center in Lebanon. In June 2004, Roberts performed the surgery, which gave her immediate relief.

"Dr. Roberts thought I was a good candidate, and it's been a miracle," Smith said. "I don't know where I'd be without Dr. Roberts and Dr. McAvoy."

The surgery entailed implanting a deep brain stimulator - a battery-operated device that produces electrical impulses and regulates abnormal signals in the brain - in her thalamus.

The two-stage procedure started with a small incision in the skull, which allowed for a thin wire, or lead, to be placed in the brain. Smith said she was awake for the brain surgery so she could respond to word recognition and perform simple motor skills, such as raising her hand.

About two weeks after the surgery, Smith's doctor implanted a neurostimulator in her chest, with leads connecting to the device in her brain. A few weeks later, nurse Carissa Thurston programmed the device.

"After Dr. Roberts put the leads in and hooked (the neurostimulator) up to the tester, all of a sudden the tremor stopped," Smith recalled. "I was crying. Everyone clapped, and they were crying.

"I could do all of the things that I used to do. It literally changed my life. Before, I couldn't even brush my teeth without hurting myself. I didn't want to eat in public. I had to put lids on drinks and could never go to buffets."

Smith had served in the Navy for 10 years before entering St. Anselm College to pursue a nursing degree, which she received in 1991. She worked in the college's health services department and then as an emergency room nurse, but the tremors progressed.

"I was afraid to work because of the tremors," she said. "Who wants a shaking nurse putting in an IV? I couldn't even put a Band-Aid on people."

Smith's deep brain stimulator has to be reprogrammed about every six months, but she's back at work as an internal medicine nurse at Dartmouth-Hitchcock Medical Center in Manchester and enjoying almost every minute of it.

"It's my twilight job. I really love it," she said. "I love the people I work with and the organization. I get up every morning and can't wait to go to work. Now, I can do everything."

An avid proponent of the surgery, Smith speaks about it to second-year medical students at Dartmouth College, at International Essential Tremor Foundation seminars, and at Parkinson's disease support groups.

"I tell them my story," she said. "Sometimes I cry when I see people with ET because most of them are shaking. A lot of people have had the surgery after hearing what I went through."

Smith and her husband, Peter, have lived in Bedford since 1988. They have three children, Brandi, 29, Laura, 24, and Molly, 19. Brandi and her husband, Chris Lerra, are expecting their first child today.

Essential tremor is hereditary. Smith's father has suffered with it, though he wasn't diagnosed until he was in his 60s. Smith's grandmother also suffered from tremors, and one of Smith's daughters is showing symptoms.

"I was the only one of four siblings with essential tremor until about five years ago, when my sister started having tremors," Smith said.

For more information about the disorder, seminars and how to donate in support of essential-tremor research, go to essentialtremor.org.


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