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New technology can help an ALS patient breathe easier

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Bruce Kramer
Bruce Kramer, center, and Dr. Jeffrey Strommer, left, watch a computer display showing how Kramer's breathing is improved with the use of a diaphragmatic pacing system Tuesday, Dec. 3, 2013 at Saint Marys Hospital, which is part of the Mayo Clinic, in Rochester. Watching are Anna Batterson, a medical student, and resident doctors Kristin Garlanger and Kelly Armstrong, left to right. Kramer is one of only a few ALS patients in Minnesota using a diaphragmatic pacing system, which was approved by the FDA last year.
MPR Photo/Jennifer Simonson

Editor's note: This is part of our continuing series of stories about Bruce Kramer, the former dean of the College of Education, Leadership and Counseling at the University of St. Thomas, as he copes with life after being diagnosed with ALS, also known as Lou Gehrig's Disease. You can read all the stories in the series by clicking here.

This month marks the third year since Bruce Kramer of Minneapolis received a medical diagnosis that changed his life in an instant. Kramer, who was 54 at the time, had noticed his left foot feeling heavy and a little floppy. His ordinarily muscular thighs would tremble noticeably, and he had taken a couple of falls and found it tough to get back up.

The diagnosis hit hard: It was ALS, Lou Gehrig's Disease, a fatal illness that slowly shuts down the body's muscles. The disease is doing just that to Kramer's body. His limbs have little use now except for small movements of his wrist and fingers. Even his breath was getting more shallow -- until recently. 

Kramer has had a device implanted that's like a heart pacemaker, but for a diaphragm. It's called a "diaphragmatic pacing system," or DPS and he's one of only a handful of Minnesotans with ALS to have had one implanted. Dr. Jeffrey Strommen, the Mayo Clinic physician overseeing Kramer's use of the DPS, says, "he's more energetic. He feels stronger and we do have some evidence, albeit, limited that this may actually prolong survival."

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Bruce Kramer
Dr. Jeffrey Strommer, foreground, re-calibrates Bruce Kramer's diaphragmatic pacing system to give a greater jolt to the diaphragm Tuesday, Dec. 3, 2013 at Saint Marys Hospital, which is part of the Mayo Clinic, in Rochester. Much like a heart pacemaker, only with the power source outside of the body, the diaphragmatic pacing system stimulates the diaphragm helping the patient take deeper breaths.
MPR Photo/Jennifer Simonson

Here are some highlights from what Bruce Kramer had to say about this new development. Click on the audio link above to hear the full conversation.

QUICK DECISION

"I have a friend in Kansas City that I Skype with every now and then who actually had the system put in pretty early with his ALS. The reason he did is because it hit his breathing pretty quickly, but he told me at that time that I really ought to consider it because it felt a lot better. And, since that time, I've been doing a lot of research on it and, you know, gone to the websites.  And I've talked to people with ALS who have had the DPS put in all over the country, and to a person they have felt that it has improved their quality of life, so when it looks like the things that were going to come together finally came together I had to make a decision quickly and I decided to do it.  It's done laparoscopically with five incisions in the belly and you end up with a series of electrical leads coming out of your belly."

Bruce Kramer
Bruce Kramer, who has ALS, listens to his doctors during a check up Tuesday, Dec. 3, 2013 at Saint Marys Hospital in Rochester. Kramer is one of only a handful of ALS patients in Minnesota using a diaphragmatic pacing system to help him take more powerful breaths.
MPR Photo/Jennifer Simonson

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Bruce Kramer
Bruce Kramer talks with Dr. Lisa Beck after a check up Tuesday, Dec. 3, 2013 at Saint Marys Hospital, which is part of Mayo Clinic, in Rochester.
MPR Photo/Jennifer Simonson

  THE FEELING

"It's an electrical shock that's being delivered. Its electrical supply is outside the body and the electrical shock actually contracts the diaphragm so I feel the electrical shock all the way around.  There are four electrodes on my diaphragm; one on the front, two on the side and one in the back. I feel that shock, but then I feel the diaphragm contract. If you are at all aware of a diaphragmatic contraction, it makes you feel the need to haul in air. ... I have it turned off right now because it fires every five seconds and when it fires, you know, your diaphragm contracts and when your diaphragm contracts it's like guhhhh, so you kind of sound funny when you're trying to talk around it. But, I'm learning how to."

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Bruce Kramer
Bruce Kramer, who has ALS, talks with Dr. Jeffrey Strommer about finding a device to help him straighten his fingers Tuesday, Dec. 3, 2013 at Saint Marys Hospital in Rochester.
MPR Photo/Jennifer Simonson

  QUICK RESULTS  

"It was almost immediate. From the time they turned it on I could feel my brain picking up. I felt like I was getting oxygen again, and I've been feeling pretty tired. I've been feeling like my voice is really going, really, really soft, and now I can actually get some diaphragm underneath my voice.  And so, I'm feeling better, but I want to emphasize that this is not a cure. We're not even sure if it lengthens life, but quality of life is what I'm looking for, and so far, so good. ... What I see is, is that technology has a lot more to offer us in ALS right now than drug therapy. And it's through technology that we're able to work around these physical problems that we're presented with. This is a piece of technology. It aides the breathing, and breathing is one of the things that goes.  And so, I see this as being something that could become a treatment of choice for people with ALS, particularly if they can get good data on people like myself."

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Hands
Bruce Kramer's fingers are fitted with plastic rings that sit at his knuckles and help keep his fingers straight Tuesday, Dec. 3, 2013 at Saint Marys Hospital, which is part of the Mayo Clinic, in Rochester.
MPR Photo/Jennifer Simonson

DISEASE PROGRESSES

"I'm so used to getting up in the morning and realizing that I feel a little worse than I did the day before, and the day after I started DPS I got up and felt better. And, it just threw me for a loop. I thought, wait a minute, you can't feel better, because you have ALS and you're going to feel worse. I feel like I have the perseverance again to hang with this a little longer and so then the question is well, does that make you feel hopeful and it's a place I mustn't go. I think I need to remain hopeless. ... There is a difference between hope and possibility. Possibility is about the...it's rational. It's about the things that you can concretely grasp that make your life meaningful, worthwhile and better. Um, so, my body continues to get worse, there is no question, but there is possibility in the DPS that within the worsening of ALS I still have some energy. I still wake up feeling like I'm still here, I'm okay and I can do this, and that's not really hopeful. I'm not holding out for a cure. It isn't going to happen in my lifetime I'm pretty sure, but I'm hopeless in the possibility."