From Despair to Deliverance: Surgery Ends a 26-Year Nightmare
Essential tremor disorder ate away at Dirk Hoch’s small motor skills for more than 25 years. What started as a slight difficulty with his handwriting progressed slowly but steadily to the point where about the only thing he could eat was oatmeal out of a large plastic mixing bowl, held in his arms instead of his unsteady hands.
“I began to realize that if I was going to survive, I was going to need someone to feed me or I’d need to be in a nursing home,” recalls Mr. Hoch, 53.
When the symptoms first appeared in 1982, a physician near his home in Indiana accurately diagnosed his condition, but offered only prescription medication as treatment. The medication and lifestyle modifications helped Mr. Hoch, a local postmaster, cope with the tremors for many years, but every time a new stressor arose in his life, the symptoms worsened. A divorce in 1997 led to an intensification that lasted roughly six years.
As his condition deteriorated, he kept asking his doctor to increase his medication dosage. The doctor agreed for many years but, finally, they decided that letting the patient “self medicate,” in effect, was no longer working. The doctor referred Mr. Hoch to another neurologist, who sent him to another one and yet another. The main advice he received? Retire from the Postal Service.
Learning about DBS
By then, Mr. Hoch’s medication level was so strong that he was having trouble finding his way home from work, yet the tremors continued to worsen. In 2007, as his second marriage failed and he faced the prospect of going on disability, he read on the Internet about deep brain stimulation (DBS).
“I cried when I first learned about it. It was so scary to think about a four-part surgery, being awake for some of it, with them drilling holes in my head and inserting wires,” Mr. Hoch says. “But then I decided that if it was my only option, I wanted to go to the very best place.”
He called a long-lost friend from childhood who is now a physician in Kansas City, and their collective research led to a clear answer: Cleveland Clinic. Mr. Hoch contacted a nurse in the Neurological Institute and, six weeks later, traveled to Ohio for a three-day series of appointments to “go over me with a fine-tooth comb.”
When he was ultimately approved as a candidate for DBS, he was still skeptical about the restrictions he would face afterward. After the staff assured him that the limits were not significant (don’t play touch football, stay away from welders, plan on extra delays at airport security), he decided to proceed.
The Miracle of Normalcy
Mr. Hoch’s first surgery was October 2008 and the second was April 2009. For Mr. Hoch, the result has been “complete relief” from the long-standing symptoms.
“I can now do so many of the things most people just take for granted,” he says. “I can eat. I can write. I can drink from a glass. I can button my own shirt and I can shave! My life is as normal as anyone’s now. It’s so amazing.”
He would like to return to work in a customer service job similar to his former position as a postmaster but now, instead of his health holding him back, it’s the economy. While he waits for something to come along, he fills his days with hobbies, such as working on or riding one of three Harley-Davidson motorcycles he owns or playing blues harmonica.
Neurologist Ilia Itin, MD, has followed Mr. Hoch both before and after DBS surgery. “Mr. Hoch is young and in otherwise excellent health,” says Dr. Itin. “He made significant improvements after DBS surgery, including being completely taken off of any medication, and there is no reason why he cannot go back into the workforce and have a second career. He still has a lifetime ahead of him.”
Mr. Hoch also has resumed an activity he had to give up for years: cooking. He frequently shows up for his follow-up appointments at Cleveland Clinic with baked goods to share with the staff.
“My mother was a fantastic cook and I really enjoyed learning from her,” he recalls. “But for years, I couldn’t handle things like measuring spoons. This has come back to me now, and I am so grateful to the Cleveland Clinic staff for giving that back to me, so I give back to them."
“The whole team stood shoulder to shoulder with me. I can completely count on everyone there. They have become like part of my family.”