The Giant Killer
Myles Honda took some of his first steps on a judo mat while watching his older brother practice. By the time he was 4, he’d spent countless hours around the martial art and was ready to take it up himself. “Myles was a natural,” says his father, Alan, a black belt who has coached both of his sons in what he calls “a family sport.”
At 12, Honda was ranked No. 1 in the nation in his age and weight group and had made the U.S. team, competing in Panama City, Panama, at the Pan-American Infantile Championships. He continued to perform at a high level into his teens, traveling to all parts of the country to participate in national tournaments. Along the way, an opposing coach gave him the nickname “Giant Killer” for his ability to bring down much taller opponents.
But in the summer of 2012, the Torrance, Calif., teen began to feel fatigue and weakness in his left arm during practices. Several months later, a heart murmur once considered benign was sounding louder. His parents took him to UCLA pediatric cardiologist Dr. Ruey-Kang Chang M.P.H. ’93, who saw that Honda likely had a circulation problem and referred him to the UCLA Aortic Center.
There, a team of experts concluded that Honda’s symptoms were caused by decreased blood flow to his left arm and side. He had been born with an aortic coarctation — a narrowing of part of the major artery leading out of the heart, which can affect the flow of blood to the body. CT scans showed that the main artery in his left arm wasn’t properly connected to the aorta.
“Myles, with the athletic demands on his body, was exceeding the ability of his blood supply to sustain muscle activity,” says Dr. William Quinones-Baldrich, professor of vascular surgery and director of the UCLA Aortic Center.
So in August 2013, Quinones-Baldrich and his team took an unusual step — joining Honda’s unconnected arm artery to his left carotid artery to improve his circulation. Since the carotid artery connects directly to the aorta, the procedure effectively restored blood flow to the newly connected arm artery. The strategy worked: For the first time, Honda registered a normal blood pressure in his left arm.
Today, he struggles to find the words to describe the feeling that washes over him when he competes. “You’re releasing all this tension,” he says, “just showing off what you’ve got after months of hard work.”
When he remained on the sidelines for the better part of a year while doctors evaluated his condition, Honda’s spirits dropped as his ranking plummeted. “It got boring,” he says. “I was restless all the time.” To his father and coach, the most important thing wasn’t getting his son back into competition. “Tournaments were secondary to his health,” Alan Honda says. “We were worried that he would have a stroke or a heart attack. If he didn’t have surgery, there was the possibility he could have an aneurysm in his 20s.”
In the months following the successful surgery, Honda took it slow. His return to competition in early 2014 didn’t go well. But by summer he had regained his form, and his father could see the return of his son’s enthusiasm and focus. Honda competed in nationals in Hawaii on the July 4th weekend, winning eight of nine matches to place second. He began training for his black belt.
The pinnacle would be the World Junior Championships: At 16, Myles is barely old enough to qualify and would be going against competitors as old as 21. But now that he’s symptom-free, no order seems too tall for the Giant Killer.
A Velvet Voice
For most of four decades, Sandy “The Sandman” Fagin pleased listeners with his soothing baritone. He was a prominent disc jockey in New York in the 1970s and ’80s, at a time when rock ’n’ roll deejays had the power to influence the charts and jump-start careers. More than a dozen trade publications monitored his playlists, which included the likes of then-new artists such as Bruce Springsteen, Steely Dan, Tom Petty and the Heartbreakers, The Police and Cheap Trick.
When the business changed and deejays began losing the freedom to play what they wanted, Fagin ventured into commercial real estate. But he continued to use his voice, hosting a talk show called Real Estate Insider on several New York stations. By 2013, he was back to playing the music he loved as creator, producer and host of Classic Alternative, a weekly program on KX 93.5 FM in Laguna Beach.
But the man with the velvet voice was also harboring a ticking time bomb — a tennis ball–sized aneurysm near his heart that was threatening to burst. In 2006, when he was hosting his real estate program on New York’s WOR 710, he had developed searing back pain from an aortic dissection — a tear or weakening in the aorta, causing its inner layers to fill with blood. The resulting aneurysm was growing with time, increasing the risk of a potentially fatal rupture. Emergency surgery saved his life, but doctors told him the dissection was so extensive that the operation was in effect a Band-Aid; the aneurysm would have to be monitored and at some point re-treated — if it didn’t kill him first.
During his six weeks in the hospital, Fagin made a decision. “I didn’t know if I had one more day or 20 more years, but I was no longer going to be bound by normal conventions,” he says. The first priority was to get healthy. Fagin moved to Florida, started an exercise routine, and soon felt fitter than he had before the aneurysm. But all along, California beckoned. Ultimately, he drove the California coast in search of a new home. When he got to Laguna Beach, he knew he’d found it.
Now Fagin had his health and his paradise, but his aneurysm was swelling. As it approached six centimeters doctors said it had to be dealt with. On top of a risk of rupture, his condition affected the arteries carrying blood to his kidneys, placing him at risk of kidney failure.
Doctors referred him to one of the few places capable of tackling the complicated case, the UCLA Aortic Center. There, Quinones-Baldrich explained that he would place a tubular stent graft made of special metal wire and sealing material, which would act like scaffolding to support the damaged inside walls of the aorta and block the flow of blood into the aneurysm — reducing the pressure, and thereby the risk of rupture. But to get there, the surgical team had to perform a procedure that few other centers can offer: operating on Fagin’s neck to connect the right carotid artery to two nearby arteries whose access to the aorta was going to be blocked when the stent graft was placed. This procedure would establish an alternative blood flow to the brain and arm. The surgery carried a risk that Fagin hadn’t fathomed: damage to the delicate nerves that control his voice, resulting in permanent hoarseness or, worse, paralysis of his vocal cords. He might never be a deejay again.
Well before he went into broadcasting, Fagin had grown accustomed to people telling him he had a voice for radio. Now his livelihood was at risk, but containing his aneurysm was a no-brainer. “I could live without my voice, but I couldn’t live if my aorta burst,” he says.
Fortunately, it didn’t come to that. Fagin doesn’t remember the first words he spoke when he woke up after the first procedure, performed last February. It didn’t really matter. With his initial utterances, everyone breathed a sigh of relief: The Sandman’s voice was intact.
The UCLA team performed the second procedure on Valentine’s Day. Once the stent graft was in place, they extended it, providing support to the weakened aortic walls and stopping the aneurysm in its tracks. Although doctors continue to monitor the aneurysm, it has shrunk, and Fagin’s kidney function has significantly improved. Just a few weeks after the surgery, Fagin was back in the deejay chair, living in his paradise, no longer waking up wondering whether that day would be his last.
A Steady Hand
Brad Carter first noticed shakiness in his right hand in the summer of 2006. At first it was subtle, but with time it became impossible to ignore.
An estimated 10 million people in the United States have the progressive neurological disorder known as essential tremor. For Carter, a Georgia native who had moved to Southern California to pursue a career as a TV actor, this seemed the cruelest fate: He was landing roles (Sons of Anarchy, Ascension, True Detective, CSI, Longmire, True Blood, The Mentalist and more), but he couldn’t enjoy his success. “As an actor, you need to stay in the moment, but half my brain was always concentrating on how I could hide the shaking,” he says.
Then there was Carter’s first love: music. He wrote songs, performed live and planned to record an album. But his “finger-picker” guitar-playing style relied on precise movements. “The person I am is so wrapped up in activities I do with my hands,” he says. “Where am I without that?”
Carter no longer asks that question. In 2013 he underwent deep brain stimulation (DBS) surgery at UCLA. Doctors strategically placed electrodes in his brain and implanted a pacemaker in his chest. In much the same way that the heart pacemaker corrects an aberrant cardiac rhythm, the brain pacemaker sends continuous pulses to correct abnormal patterns of activity in the brain for patients with neurological disorders — most often, Parkinson’s disease or essential tremor — when medication is insufficient.
At leading medical centers, DBS is relatively routine. Carter’s was the 500th performed at UCLA, but this one was unlike the previous 499.
During DBS, doctors awaken patients while they are anesthetized so their feedback on fine motor tasks can help the neurosurgical team optimally position the electrodes. Before the first of his two surgeries, Carter approached Dr. Nader Pouratian ’96, M.D. ’01, Ph.D. ’01, head of the team and director of the UCLA Neurosurgical Movement Disorders Program, with an idea: During the awake part of the surgery, he’d assist by playing his guitar. Pouratian agreed to the unusual request, and then offered Carter his largest audience yet for the musical performance.
For the first time, UCLA Health invited followers to observe the six-hour procedure on social media to educate the public about deep brain stimulation. In addition to live-tweeting the operation, UCLA Health posted Instagram photos and short clips via the Twitter application Vine. The event, during which Carter played two original songs, went viral and attracted widespread attention from mainstream news media.
Pouratian’s goal was to demystify the procedure. “This is a technology with the potential to help many more people if they just knew about it and had the right information,” he says.
Carter is back to acting (he will be appearing in the Johnny Depp gangster film Black Mass later this year) and, with the help of a crowd-funding campaign through Kickstarter, he’s raised money to make his first album. He calls the last year the best of his life. “This isn’t a cure, but I’m so much steadier now,” he says. “I have my confidence back.”
