Trombone helps synchronize patient and surgeon during brain procedure

MADISON, Wis. – A neurosurgeon has a pretty strict checklist of tools and devices for surgery, but recently Dr. Wendell Lake, a neurosurgeon at UW Health, had one new tool added to his operating room: A trombone.

Brian Rust, from McFarland, spent his career as a marketing professional at DoIT, the information technology team that supports researchers, students and faculty at UW–Madison. This work had him at a keyboard for decades, but several years ago he developed a shaking in his hands, especially his left, that made it very hard to type, he said.

“I would have to hit the backspace key constantly,” Rust said. “I tried to work on it and prepare myself, but I couldn’t stop it.”

Social functions on campus also became difficult, almost embarrassing, he said, recalling one occasion at a reception with the university chancellor where he had to hold his drink with two hands to keep from spilling it. Eventually, more important things like home repairs also became unmanageable, Rust said.

“Using a drill almost became comical,” he said.

Soon, the shaking began to impact one of his passions: Making music.

He started playing the trombone in high school, and about 15 years ago he picked it back up again, joining several ensembles and bands.

When the tremors started taking over his body, Rust was playing in three groups; a band made up of DoIT employees, a brass ensemble at the church he attends and New Horizons, a band with branches across the United States that features retirees. The DoIT band evolved into a 10-piece horn rock band they call Six-Thirty Sharp that plays contemporary pop-rock hits like “Uptown Funk” and James Brown tunes.

“There’s nothing quite like the feeling of playing with other people and making music,” he said. “It’s really hard to describe. Even if you don’t play all that well, it’s still a wonderful feeling. I don’t want to give up that feeling just yet.”

Then, a moment occurred that sticks with him to this day. He wanted to pick up his infant granddaughter, but couldn’t because the shaking in his hands and arms made it too dangerous for her, Rust said.

Enough was enough, he said, and he sought help at UW Health, working with Dr. Kathleen Shannon, a neurologist at UW Health, and chair of the Department of Neurology, University of Wisconsin School of Medicine and Public Health.

He was diagnosed with an intention tremor, meaning when Rust tried to use his extremities, they would shake. Rust was prescribed blood pressure medication – not for abnormal blood pressure, but because it can help control tremors. Initially, the medication helped, but the dosage would become ineffective over time leading to increasing the dosage which made him very tired. He was also given an anti-seizure medication, but that did not work. After medication and therapy were no longer effective, Rust was left with two options, both surgical.

One choice was a type of focused ultrasound that would target the part of the brain thought to be causing the tremor, but that procedure could only be done on one side of the brain, which would only address his tremors on one side. The other procedure was deep brain stimulation, where wires are permanently implanted in Rust’s brain, delivering electricity to specific spots in the brain to disrupt the electrical signaling causing the tremors.

The tremors were making it very possible that he would have to give up making music. So, he decided to have deep brain stimulation surgery.

Lake, also an associate professor of neurosurgery, UW School of Medicine and Public Health, performed the procedure in November 2022. In meetings to prepare for the surgery, he explained how it worked and the goals of the surgery.

The surgery is performed with the patient awake. The top of the patient’s head is behind a plastic sheet in a sterile environment, and small holes are drilled in the patient’s skull to allow for placement of the wires, Lake said.

“We need them to be alert so we can ask them to do certain movements to ensure we are placing the wires where they need to be,” he said.

This gave Rust an idea, according to Lake.

“He asked if he could bring in his trombone,” Lake said. “We’ve used other tools to help patients in the past, like writing on a tablet, but never a musical instrument.”

The procedure was incredible to see, according to Dr. Whitney Fallahian, an anesthesiologist at UW Health, who specializes in neurosurgical procedures, and who worked on Rust’s surgery.

“During the procedure, the entire OR staff was gathered around to see Brian ‘playing’ his instrument,” she said. “I never thought I’d see anything like that.”

Rust couldn’t actually play the instrument because it could cause elevated intracranial pressure leading to bleeding or cause a venous air embolism, but he made the hand movements necessary to play the instrument to ensure the procedure was working.

And work it did, Fallahian said.

As Lake and his team tried different positions for the wires and varying amounts of electrical current, Rust’s hand began to steady.

Because of the incredible nature of the procedure and Rust’s ingenuity, Fallahian, who is also an assistant professor of anesthesiology, UW School of Medicine and Public Health, was encouraged to document the procedure in an academic paper, which was recently published in the journal Anesthesiology.

Rust’s recovery from the surgery took only a few months, and he was able to get back to playing the trombone and building his skills again to get back to what he loves: Mmaking music.

The device is now a part of him as much as the trombone is. The battery pack and stimulator were inserted in his upper chest just below his collarbone and he has a designated smartphone that controls the device. It has two settings, one for everyday life and one for playing the trombone.

“I just turn it on and go about my day,” he said.

Rust is gearing up for his next performance with Six-Thirty Sharp at the end of September. When people learn about his surgical team’s willingness to specialize his procedure to his love of music, Rust hopes it inspires them to learn more about deep brain stimulation as an option for addressing tremors, he said.

In fact, he has already talked with several people considering options to treat tremors, including members of New Horizons, Rust said.

“People who struggle with tremors or Parkinson’s need to know there are options to help them enjoy the things they love to do,” he said.