TAMING TREMORS

AI’LL BE HONEST, I FELT KIND OF WORTHLESS. BECAUSE I LOVED WHAT I DID, AND THE JOY THAT I HAD ... NO LONGER EXISTED. WHEN I COULDN’T DO IT ANYMORE, I THOUGHT, ‘WOW, THIS IS THE END FOR ME. I DON’T HAVE VERY MUCH LEFT IN MY LIFE.’”

—DAVID SHERWOOD

Opposite page, from left: Dr. Yarema Bezchlibnyk and Dr. Oliver Flouty were part of the team who led David Sherwood’s focused ultrasound procedure. Dr. Theresa Zesiewicz is the TGH neurologist who initially evaluates potential patients before referring them to Bezchlibnyk, Flouty, or Dr. Donald Smith. This page: Bezchlibnyk, Flouty, and their colleagues prepare Sherwood for the procedure.

The stunning diamond was larger than 9 carats, featuring a pear-shaped cut and fancy cognac coloring. It rested precariously in a pair of tweezers that David Sherwood, then a veteran gemologist, held at his desk inside the Saks Fifth Avenue in Palm Beach. Preparing to examine it under a microscope, he summoned every ounce of willpower he had to steady his hands as his customer looked on, but the tremor that had become part of Sherwood’s life was unforgiving.

Suddenly, he involuntarily squeezed too hard, and the $175,000 diamond popped from the tweezers, tumbling to the fl oor completely out of sight.

“My thought in that moment was, ‘Well, this is the end of my career,’” he recalled. “Fortunately, I found it, but it took me a long time. So, I fi gured at that point it was best for me to retire gracefully, and that’s what I did. But it broke my heart.”

The scene unfolded a decade ago, leaving Sherwood’s world completely shaken. His tremor not only ended his career, but it made it impossible to pursue his passions for painting and cooking. Going out to eat with friends often became an ordeal, with the tremor causing the simplest task—like using silverware or holding a water glass—to become all but unimaginable to perform without making a mess.

“I’ll be honest, I felt kind of worthless,” he says. “Because I loved what I did, and the joy that I had—the joy that it brought to my customers—no longer existed. When I couldn’t do it anymore, I thought, ‘Wow, this is the end for me. I don’t have very much left in my life.’”

That has all changed thanks to a renowned neurosurgical team at Tampa General Hospital and an innovative procedure called

focused ultrasound, which has given him a new beginning, with plenty of living left to savor. In May, neurosurgeons with the USF

Health Morsani College of Medicine at the

University of South Florida employed the procedure for the first time in the Tampa

Bay area at TGH. And the first person to receive the outpatient, incisionless treatment was the gem master whose life had been upended by a condition called essential tremor or ET. A friend had urged Sherwood to visit

TGH and have his tremor examined. That’s 28 ADVANCES Awhen he learned that he was among the roughly 10 million Americans who suffer from some form of ET, which causes uncontrollable shaking of the hands, head, and voice. In the early stages, the tremor is mild, but it progresses over time. In some patients, the severity can become unbearable, interfering with daily activities, such as eating, dressing, or typing on a keyboard—or, in Sherwood’s case, handling precision tools to work with jewelry. Sherwood traveled from his home in Sebring to Tampa and was examined by Dr. Yarema Bezchlibnyk (pronounced Bezch-lib-nik), an

assistant professor in the Department of Neurosurgery and Brain Repair at USF Health Morsani College THIS DEFINITELY EXPANDS

of Medicine and a neurosurgeon at TGH. The bond WHAT WE CAN DO. AND IT that developed between them would ultimately lead

DRIVES OUR EFFORTS TO to a most remarkable development. “I’ve gotten my life back,” Sherwood said. “And I HELP TRANSFORM THE LIVES can’t say enough about Tampa General. I don’t think

OF PEOPLE LIVING WITH there’s any better place.” This is the story of what happened following that DEBILITATING NEUROLOGI- first doctor-patient encounter. It entwines the next CAL CONDITIONS. IT’S THE generation of care and commitment to innovation provided by TGH with a new tool that can improve

HIGHLIGHT OF MY DAY TO the quality of life for patients who struggle with dis-

SEE PATIENTS LIKE DAVID abling tremors, including those caused by Parkin-

WHO ARE HELPED BY son’s disease, without implanting a device. “This definitely expands what we can do,” said WHAT WE DO.” Bezchlibnyk. “And it drives our efforts to help trans—Dr. Yarema BezchliBnYk form the lives of people living with debilitating neurological conditions. It’s the highlight of my day to see patients like David who are helped by what we do.” Long before he ever heard the term “essential tremor” or felt a glimmer of hope over the explanation of focused ultrasound, Sherwood followed a path out of Corning, New York. Due south of Buffalo and nestled along the Chemung River, Corning is famous as the home of Corning Inc.,

Dr. Bezchlibnyk (center, at desk) and Dr. Flouty (right of center) consult their team during a training session for the focused ultrasound device (below).

which makes glass and ceramics products for technical use.

After Sherwood attended high school and part of college there, he decided to follow his passion for gems, enrolling in the Gemological Institute of America in Santa Monica, California, and becoming certified in the field. He eventually returned to New York and worked for Corning Inc., then moved north to Rochester to become a gem and jewelry buyer for various stores. But in time, he was drawn to the Florida warmth and opulence of Palm Beach to continue his career.

His work flourished, interrupted temporarily by a bout with cancer 15 years ago. He beat it with chemotherapy and radiation, but there was one consequential outcome. “It kick-started my tremors,” he said. “And things just progressed from there.”

Sherwood often sold jewelry in the range of $750,000 or more, and his high-end clients became his friends. But it got to the point where he couldn’t hide the tremors. “It’s very difficult when you’re shaking so badly that you can’t put a necklace or a bracelet on your customer, or put earrings in.”

At home, his love of paint morphed into a tormenting experience. “After my cancer treatments, my hands shook so much that I did one painting and destroyed it because I couldn’t stand to look at it,” he recalled.

Holding a screw to anchor it in the wall or using power tools proved too daunting. Gardening was a challenge. Meals he tried to cook in his kitchen often ended up falling onto the floor or spilling all over him. And going out to dinner, knowing people were staring, made him feel ashamed. “I did a lot of soul-searching, a lot of sleeping, and a lot of crying,” he shared.

The support of his partner made a big difference, but that wasn’t enough to keep Sherwood from worrying about his elderly parents, knowing how hard it was for them to see him suffer. To pass the time, he focused on his Corning glass collection and spent hours online researching various pieces and their prices nationwide. With a keen artistic eye, he helped neighbors with suggestions on how to rearrange furniture and modernize their homes. But privately, his anguish increased.

He might well have continued on that path if not for a friend who suffered from Parkinson’s and implored him to get evaluated at TGH

THEY ARE THE GREATEST PEOPLE I COULD POSSIBLY EVER BE INVOLVED WITH. EVERYBODY FROM TAMPA GENERAL AND USF WAS JUST MAGNIFICENT.” —DaviD SherwooD A In the focused ultrasound treatment, 10,024 individual ultrasound transducers focus ultrasound beams on specific targets, like the thalamus. The procedure

requires no anesthesia, incisions, or exposure to ionizing radiation.

in the hope that they could offer some relief. That led to an examination by a TGH doctor who ruled out Parkinson’s and diagnosed Sherwood with an essential tremor, referring him to Bezchlibnyk. That’s when the option of focused ultrasound was broached.

While the equipment was being put into place over the coming months, Sherwood developed a strong connection and sense of trust with the doctor he came to know simply as “Dr. B.” Finally, the call came from Bezchlibnyk’s office. The focused ultrasound equipment was ready and Sherwood was about to find out if there would be relief from his relentless misery.

When he arrived at TGH the morning of May 14, 2022, Sherwood encountered a group of some 40 medical workers prepared for the procedure—including the three-physician team of Bezchlibnyk, Dr. Donald Smith, and Dr. Oliver Flouty, associate professor and assistant professor, respectively, in the Department of Neurosurgery and Brain Repair at USF Health Morsani College of Medicine and neurosurgeons at TGH.

Sherwood recalled feeling a mix of excitement and nerves as his head was shaved for the procedure. He then lied down in an MRI machine,

Dr. Yarema Bezchlibnyk

with his head fitted into a helmet surrounded by a soft membrane filled with cool water. The procedure would direct high-intensity focused ultrasound beams guided by the MRI machine, requiring no anesthesia, exposure to ionizing radiation, or incisions. A computer would then calibrate 10,024 independent ultrasound transducers, arrayed around the head to precisely focus the ultrasound beams on targets such as his thalamus, an area of the brain that controls muscle activity and tremors.

As the lead neurosurgeon, Bezchlibnyk was as eager for this moment to arrive as his patient was. He had followed a path into neurosurgery after seeing how his grandfather had suffered and deteriorated from Parkinson’s disease. “It was so hard on my parents, too,” he recalled. “I would say that compelled me to enter this field.”

Smith was the senior member of the team, in terms of years of experience. He had implanted one of the first “leads” in North America in another approach to treating tremors, a surgical procedure called DBS for deep brain stimulation. Flouty joined the program in 2021, bringing extensive experience with DBS and focused ultrasound from Toronto Western Hospital, one of the busiest centers anywhere for both treatments.

Dr. Oliver Flouty Dr. Donald Smith

Results of his procedure were immediate. Sherwood, still flat on his back, was given a special pad attached to a tray on which to draw concentric circles, make lines, and then write his name—all without being allowed to rest his palm on the surface for extra balance. By the end of the tests, he was able to write his name twice with no shaking.

“When I did that, everybody in the room broke out in applause,” he said. “It was just an unforgettable moment.”

Bezchlibnyk had Sherwood use a walker for the first two weeks after the procedure, since he was leaning to one side when moving. But he quickly progressed past the walker and soon was embracing the tremor-free life he thought was gone for good.

Having recently turned 65, Sherwood has no plans to unretire from the gemology field, but he can cook, collect Corning glass pieces, tie his shoes, garden, and yes, even go out to dinner with no worries. “It’s like somebody took a magic wand and tapped me on the head,” he said.

One of his favorite daily activities is walking his Yorkie service dog, Fletcher, through the neighborhood—and once again being able to bathe him. “He’s the light of my life,” Sherwood said. “Throughout all this, he’s been a little bit of my salvation.”

Sherwood can still decide whether to have Bezchlibnyk repeat the procedure on the other side of his brain, since focused ultrasound on the right side controls the body’s left side, and vice versa. But for now,

Above: Sherwood took a writing test before and after the procedure. The 9 a.m. test (left) illustrates the degree to which his tremor limited his ability to write. The 12 p.m. test (right) shows the immediate improvment in his control of his right hand. Right: Dr. Bezchlibnyk with Sherwood.

he’s savoring a new lease on life, and thinking back on his most joyous Christmas in a long time. His tremors had prevented him from hanging ornaments in recent years. In 2021, he didn’t even bother with a tree at all. But all that changed this past December.

“I’ve collected some beautiful ornaments over the years,” he said. “I was so excited to hang them on the branches this time and not worry that they’d fall off.” And Sherwood didn’t need any gifts, because he had already received the one he dreamt of most, delivered by Bezchlibnyk and his TGH team.

“They are the greatest people I could possibly ever be involved with,” he said. “Everybody from Tampa General and USF was just magnificent.” Spoken by a man who knows a true gem when he sees one.