A radio DJ once introduced Dr. Don Penney as the “Rock-n-Roll Surgeon from Atlanta.” He plays rock music in his operating room and insists on a cool, positive vibe. He tells his patients to picture themselves on a beach in the Caribbean, the sun coming up, the waves rolling in. Healing begins with positive thinking, he says.
Dr. Penney wears the iconic Rolling Stones logo on his surgical cap. The Atlanta Journal Constitution snapped a photo of Penney in his operating room and Mick Jagger happened to see it. He sent Penney two second-row tickets to an upcoming concert. Dr. Penney likes that story, one of many from a long and accomplished career. But it’s not a story that gives the neurosurgeon goose bumps. Those come from the patients and families he’s treated.
Like the woman from Peoria, Ill., who just happened to hear Dr. Penney on the live Atlanta radio show.
“I know Dr. Penney. He took out my father’s brain tumor,” she announced on air.
Dr. Penney didn’t really know what to say: “One thing in neurosurgery is you never ask anybody how they are doing, especially with a diagnosis of a brain tumor. So many of them are fatal, so it was the last thing I wanted to ask her.”
The DJ asked instead. My father’s doing great, the woman answered.
“I chatted with her on the radio and it gave me goose bumps. I thought, how can this be that all these years later a woman in Peoria, Illinois, would remember me? Out of all the calls, it was incredible,” Penney said.
Dr. Penney recently moved to Casper to join the team at Wyoming Brain and Spine Associates and Wyoming Medical Center. He sat down with The Pulse for a two-part interview about his career, some of his most memorable cases and the reason he closes every operation with ACDC’s “Thunderstruck.”
The Pulse: Let’s start with James Oxford – a patient of yours in Atlanta who developed a malignant brain tumor at age 35. You removed the tumor once and treated with radiation. When it came back, you were one of the first to implant wafers of chemotherapy drugs directly into his brain. Do you mind telling us about that?
Dr. Penney: You do not cure malignant brain tumors, so anything you can do to improve a patient’s quality of life post diagnosis and treatment, and increase their longevity, I am very aggressive in that manner. I will re-operate on someone, with their permission, that has a surgically accessible tumor to sustain life as long as that is what they wanted.
On television shows and things like that, they talk about diagnoses and about how long patients have to live. I am not a big believer in that. The internet, text books and libraries are full of statistics if you want to go and read those numbers. I am a great believer in the man above, and my patients know that. Mr. Oxford was somebody that came to me and I made the diagnosis of high-grade glioma which is a malignant brain tumor.
The Pulse: He was a teacher with two young sons, correct?
Dr. Penney: Yes. What do they say? A person does not get cancer, a family gets cancer. So, this involved all of them.
With Mr. Oxford, we first of all did the surgery. He did great. If you look statistically, the life span of somebody with a high-grade malignant brain tumor is in the ballpark of nine months. Again, those are numbers I do not use. I am very aware of them; but, at the same time, I really feel that we can help and improve their quality of life.
The advent of chemotherapy wafers suggested that implanting these wafers within the brain on recurrence of tumor can sustain life.
The Pulse: What do you mean by wafers?
Dr. Penney: Actually, they are the size of a nickel. If you look at a host that a priest would give you on Communion, they look exactly like that. They are white and very friable and breakable. The down-side is that six of those tiny wafers cost $25,000. So, at the beginning, the company was allowing us to get them because they wanted some success stories. I was the first one to approach. When Mr. Oxford recurred, and it was a point that I was going to re-operate, we approached them and got the approval.
I implanted those chemo wafers right in the resection cavity. With a tumor, you can only remove what you can see macroscopically. You cannot see microscopically where the cancerous cells are.
That nine month statistic ended up being three years for Mr. Oxford. When you think about somebody who is dying and they know it, that is kind of significant. It allows them to spend time with family, to get their things in order. Patients are most appreciative of that.
The Pulse: Is the wafer technique more common now?
Dr. Penney: It is a treatment that is available. In all truthfulness, it has become very difficult to try to get it pre-certified (for insurance coverage). It will take a fight from myself, a fight from the patient who has been paying for insurance for the past 30 years or whatever.
The Pulse: Let’s talk a little about Ashley Brown. Two months before high school graduation, she was in a car crash and treated for broken legs. But small globules of fat made it to her brain, and she had a stroke. When her brain swelled, you performed a decompressive craniectomy – basically removing part of her skull and implanting it in her abdomen until the brain swelling went down. Tell us about this technique.
Dr. Penney: When I was in Chicago, one of my partners at Cook County was John Oldershaw who was a neurosurgeon out of Vietnam. During the war, they had a lot of American soldiers with traumatic brain injuries with swelling of the brain. After surgery, doctors were often not able to re-implant the bone that was removed from the skull because it was either thrown away or it was wrapped in gauze, put in a plastic bag and put in the refrigerator. A lot of times in Southeast Asia, the skull bone did not make it back with the patient.
John Oldershaw taught me that you can actually have the patient carry their own bone flap. You could go in the abdomen, make a little incision and open a subcutaneous pocket, put the bone in there, and then close the skin. The patients became their own containers. Then, in three months or so after the brain swelling went down, the bone could be removed and re-implanted. You would not have to worry about infectious risks, sterilization and all because it was their own tissue. That was a great thing.
If you look at that story on Ashley Brown, she had no brain injury, but she had two femurs that were broken. When the orthopedists rodded her femurs to do an internal fixation, she got a fat emboli. This is a known problem when working with bone. The emboli went to the left side of her dominant hemisphere and caused a stroke.
Here she was with a left-sided stroke and not able to talk. Her right arm and leg were paralyzed. I can remember that I was not the neurosurgeon on that case. The father met with the neurosurgeon who said, “Look you need to go pick a box as your daughter is not going to make it.”
They brought me in as a second opinion. I said “There is a controversial procedure that is out there,” and I told them about it. The father was horrified. He said, “You want to take half of my daughter’s head off and put it in her belly?” The family didn’t want to do it.
What ended up happening was my wife and I were going to church at 4 o’clock the next day, Sunday. She was driving when I got the page. They said that Ashley Brown just blew her left pupil, which is a sign of herniation. They said the father wants you to come back.
I went in and did the procedure and three days later she was moving two fingers. She went off and finished her high school, and so it was a life saved.
The Pulse: That’s amazing. How often do you think of these stories? Or do you only think of them when asked, like right now?
Dr. Penney: Those moments, I think you carry them around with you; especially those special cases. Those early occurrences are never lost, you never lose them. They are always there for me.
Now, the practice of doing this and putting bone in the abdominal wall cavity has become very common. At first, there was not a lot of evidence to show that by doing this procedure you could save lives. The evidence has come out. Now, on middle cerebral artery stokes we are able to go in and do the same thing. I’m not recommending this for 70- and 80-year-olds, but for young people, it has become very commonplace throughout the country and is well known as acceptable technique to treat this. By doing this procedure, you can save a life.
The Pulse: Finally, tell me about Ebony Brown, the young mother who lost her sight seven days after giving birth to a daughter.
Dr. Penney: I happened to be in the office when I got a call from the ER. They said they had a woman that just delivered a baby, and was one week postpartum. They said she had gone blind and had a pituitary tumor. As soon as I heard that, I knew it was a pituitary apoplexy and said to get a stat MRI. I ran over to the hospital and I met her on a gurney there. I put two fingers ten inches in front of her eyes, and she could not see them.
To remove pituitary tumors, I usually go transsphenoidal through the gum, or you can go alongside the nose. That is how we get to the base of the skull. I usually let an Ear-Nose-Throat doctor do this because nobody wants a funny looking nose afterwards. Dr. Roth came in and he did the approach to the skull then I went in and took out this tumor.
After the surgery, I was wiped out. The surgery did not begin until 10:30 or 11 at night and I did not get out of there until about 4 in the morning. I went home and crashed. The next day I came in around 2:30, and on rounding, I was wondering whether or not we did anything to help her. I remember sitting on the bed, and I can remember the clock on the wall. I said to her, “Can you tell me what time it is?” She looked up and said, “It is 4:20.”
Wow. I got goosebumps. That was unbelievable to me.
The Pulse: Have you ever heard of a case where a surgeon restored someone’s sight in a case like this?
Dr. Penney: Not me personally. I am sure they are out there, but that was a first for me. Behind all this is that she had a known pituitary tumor and she was on a drug to make it shrink. She went off it because she got pregnant and it just blossomed, but she did not know it.
It’s so funny because about three months ago, before I moved here, my secretary in the office said a lady was there to see me. I went out and there was this woman who had a girl who was now 7 or 8.
She said, “Do you remember me?” I said, “Sure I do.” She hugged me and all that. It was cool. That girl was her daughter who had grown up, and she got to see her grow up.
The Pulse: Do you ever find yourself in awe of the brain, and what, as a neurosurgeon, you do for a living?
Dr. Penney: I am in awe. As a funny anecdotal comment on that, when I am in the operating room and finishing surgery, I have closing music. My closing music is “Thunderstruck” by AC/DC. I feel that for the human nervous system; That song signifies that for me.
Yes, it is a job. You become very familiar with the processes. But at times you take steps back and there is an amazement and appreciation of what goes on. We know so very little about the brain. We are decades behind the cardiac surgeons because they know so much more about the cardiovascular system than we do about the nervous system. We are growing and gaining, but we are not there yet.
Dr. Don Penney, M.D.
Family: He and his wife have four grown children.
Education: Dr. Penney attended medical school at McMaster University in Montreal, Canada and completed a surgery internship at Montreal General Hospital, McGill University. He completed his residency and fellowship at the Montreal Neurological Institute, McGill University.
Experience: Trained in and practiced emergency medicine at the University of Illinois and Cook County Hospital in Chicago and joined the teaching staff as an Assistant Professor of Neurosurgery. He ran a solo practice in Atlanta, Ga., for 17 years where he was also a full professor of emergency medicine at Medical College of Georgia, Augusta. In 2006, he helped establish the Philadelphia College of Osteopathic Medicine, Georgia Chapter where he directed the neuroscience program. He has authored numerous chapters in textbooks and scientific papers in addition to delivering multiple national lectures for the American College of Emergency Medicine.
Practice:Wyoming Brain & Spine Associates, (307) 266-2222
1020 E. Second St., Suite 200, Casper, WY 82601.
Meet our Docs is an occasional series introducing the physicians of Wyoming Medical Center. Click here for interviews.