TEMPERANCE - Her knee tingles.
Cortney Hoffman looks at the inert leg and wonders what the feeling means. Some days she feels that prickly shiver in her feet. On other days, the feeling - like a limb gone to sleep - is in her other leg. These sensations are her Morse code, tidings from a body trying to tell her something about her future.
She can't make out the message. Its syntax eludes her. She hopes the tingles say that she'll get up from her throne-sized motorized wheelchair and walk again; that her hands, now curled like sleeping buds, will open, and her fingers will answer her commands; that her bladder will stop its childish betrayal and operate at her will; that she will no longer be paralyzed.
Earlier this month, this 18-year-old from Temperance left her home on Smith Road and flew to Lisbon for 15 days. There, a surgeon removed a tiny nodule of tissue from deep inside her nose. This olfactory tissue was diced and set aside. Another surgeon sliced a tidy incision along her spine from her hairline to her back, cut into her spinal column, and cleared away the scar tissue formed since her accident two years ago. Finally, he packed the olfactory cuttings, which contain nerve stem cells, around the inch-long injury site.
Now, if things work the way the Portuguese doctors believe they do, these new cells will slowly knit her body back into intimate contact with her brain.
But there is no proof that this will occur. There are no scientific papers that spell out how any concoction of cells can perform such a trick. There are no published studies that show this has worked in animals.
In short, the bedrock that American medical science relies upon to distinguish good treatment from poor treatment from charlatanism, is absent.
Still Cortney and 40 other people leapt into this chasm of unknowns. Carlos Lima, the neurologist who invented the procedure, says the surgery is allowing patients to regain some use of their arms and legs.
With this scant testimony, and despite the skepticism of researchers who study spinal cord injuries, desperate patients are traveling overseas in hopes of having cruel fate reversed.
The afternoon of June 30, 2002, was warm and sunny. Cortney got into her car to run an errand. She was supposed to meet her friends in a half hour. She was running late.
She turned onto a street she never used, hoping it would be a shortcut.
That's the last thing she remembers before waking up in the ditch. Behind her was her car, overturned. Six feet overhead was the deserted road.
"I have to get out of this ditch,'' she thought. But somehow, she just couldn't. Over and over she just told herself, I have to get out of this ditch. I don't want to die in this ditch.
In the ambulance, she still didn't realize what was wrong.
"They said, 'Can you feel this?' and I said 'No.' They said, 'We're flying her.' And I kept saying, 'Why? Why? Why? Why? Why?' And they wouldn't answer me."
They bundled her into a helicopter, and in her distress Cortney got mad at everything. The paramedic had headphones. Why can't she have headphones? This is my first flight and I can't see out the window. She demanded to look out the window. They landed at St. Vincent Mercy Medical Center, and she began shouting, "I want off of this backboard now!" She thought it caused the pain in her head.
Tammi Roe arrived at St. Vincent's in a panic, knowing only that St. V's called and said they had her daughter Cortney.
But the person at the desk in the emergency department told her that no Cortney Hoffman was there. Tammi's alarm rose. When the mix-up was resolved, the woman told Tammi, "The chaplain will be down to talk to you.''
"I thought she was gone,'' Tammi said. She choked back tears as she relived the moment she thought her daughter was dead. "I'm thinking, I'm busting through them doors and finding my baby to hold her.''
She learned quickly that her daughter was alive. But within two hours, she knew the truth: Cortney was paralyzed. Every year, some 11,000 Americans are disabled through traumatic spinal cord injury. Now her baby was among them. "It was overwhelming," Tammi said. "It was a nightmare. Am I going to wake up? This isn't real.''
Cortney stayed in St. V's for 13 days before moving to the Medical College of Ohio Rehabilitation Hospital for a month. There, sadness overwhelmed her.
Cortney's room faced the parking lot. "I could see all the cars, and everybody walking out to their cars, and I remember telling my mom and dad to shut the blinds, because if I couldn't walk, I didn't want to see anybody else do it either.''
But before long, her natural pluck took over.
She decided to work hard at therapy. She wasn't giving up.
"I was determined. I will walk again,'' she declared.
Although she missed her junior year of high school, she managed through a tutor and correspondence courses to catch up. She attended Whiteford High School her senior year and stayed on the honor roll. A nurse came to school with her, waiting through the day in the school library for the moments when Cortney needed her for things like going to the toilet.
An estimated quarter-million people in the United States have suffered spinal cord injuries. Lifetime care for even one of these patients can run into millions of dollars.
Despite this sizable population and the enormous cost of their care, advancement in the treatment of spinal cord injuries is slight. The late Christopher Reeve generated a resurgence in interests in new approaches to therapy, but the most prevalent advances have been in things like wheelchair technology.
"I've been working rehab since 1978 ... Fundamentally, the outcomes [of rehabilitation] are no better today than they were back then," said Steven Hinderer, medical director of the Center for Spinal Cord Injury Recovery at the Rehabilitation Institute of Michigan in Detroit.
The institute is trying to reverse this stagnation in injury care with new therapeutic approaches. Cortney became a patient there in September and quickly started to see improvement. Not long after, the institute held a press conference with the Portuguese creator of the controversial spinal-cord repair surgery. Cortney and her mother were there.
Meeting Dr. Lima clinched a decision they had been pondering. Cortney would go to Lisbon for the spinal cord surgery. She was lucky; insurance would pay for the trip and the operation.
As exciting as the surgery seemed, it frightened her.
"I was scared that I would lose something that I had already. But I couldn't really think about the bad things, I had to think about what I had to gain, not what I had to lose,'' Cortney said.
Tammi Roe was fretful when they arrived at the Hospital Egas Moniz in Lisbon.
She walked down the hospital halls noting the missing floor tiles and the metal wash basins in patient rooms. Most of the rooms held six beds. People smoked in the hallways. But Tammi noticed that everything was very clean. And the staff was so attentive. Cortney's room was modern, with a handicapped-accessible bathroom and a TV.
Although Tammi had done a lot of research about this surgery, she worried. She knew it was controversial.
"You're putting your baby's life in someone else's hands,'' Tammi said. "I don't want her to come home worse than when she went there.''
There may be evidence - still unpublished - that the surgery deserves a serious look. Jean Peduzzi-Nelson, a researcher at the University of Alabama, met Dr. Lima two years ago. He taught her his spinal-repair technique, and she tried it in six rats.
"I got the best functional improvement I've seen in 12 years. I was very excited. I actually didn't expect this,'' Ms. Peduzzi-Nelson said.
Ever cautious, she tried it again, this time on 10 rats. She compared their improvement to improvements reported in other animal experiments. The Lima-method rats fared the best. They couldn't walk normally, but they were able to support their own weight.
Just how the olfactory mucosa transplant works to lessen paralysis isn't yet clear. It could be the work of stem cells or growth factors within it. Ms. Peduzzi-Nelson plans to report her results in a scientific journal when she completes a relocation to Wayne State University school of medicine in Detroit.
But publishing doesn't mean the work will be accepted. That will take identical experiments in labs across the country.
Throughout the day of Cortney's surgery, Dr. Lima stayed in touch with her worried mother, reassuring Tammi as each phase of surgery concluded.
But it wasn't until Cortney recognized her mother in the intensive care unit after surgery that Tammi's anxiety melted. Excitement bubbled in its place.
"Oh boy, this is a new start, a whole new start again," Tammi thought. "I didn't have any negative thoughts at all."
In the intensive care unit, Dr. Lima touched Cortney's leg.
"I could feel him touching," she said.
But why? Nerves cannot grow that fast. But such postsurgical sensations seem to be fairly common among people who have this surgery. Dr. Lima doesn't know why this is.
"I'm still thinking about this. I don't know how to explain this,'' he said.
Ms. Peduzzi-Nelson said it may be something as simple as the removal of scar tissue, which may have pressed against the spinal cord.
A couple of days after surgery, Tammi grabbed Cortney's knee.
"I yelled at her and told her to get her hand off my knee," Cortney said. " Of course, she started crying."
Now, her limbs keep tingling, a signal she thinks is positive.
On Jan. 19, Cortney returned to Temperance. She's still too sore from the surgery to begin rehabilitation. And she knows she's lost muscle after a month away from rehab. But she's energized by the possibilities before her.
"This gave me a new goal. Now I have something to work extra hard for again. Now I can try my hardest to get to walk again.
"I tell myself every day I'll walk again," Cortney said. "I sit in this wheelchair every day, but I can't accept it. I'm not ready to accept that I'll be in it for the rest of my life. I will walk again. It's just a matter of time."
Contact Jenni Laidman at: email@example.com or 419-724-6507.41.77877 -83.56882