Dr. Ben Moodie, a plastic and reconstructive surgeon attached to the Cintocare hospital in Pretoria. (Photo: Jhua-Nine Wyrley-Birch/Maroela Media)
Dr. Ben Moodie, a plastic and reconstructive surgeon attached to the Cintocare hospital in Pretoria, recently made history with an experimental operation that may offer new hope for patients with dementia.
However, without the support of medical funds, this breakthrough may remain out of reach for most South Africans.
This operation, which was carried out earlier in April, focuses on the lymphatic system, the body’s natural “cleaning system”, and is, according to Moodie, a relatively new concept in brain research.
Where it was previously believed that the brain removes its harmful toxins without a lymphatic system, he explains that more recent research shows that there are indeed drainage routes in the brain that run to the nose and neck.
However, recent medical tests have shown that when this system does not work efficiently or is removed, toxic proteins associated with Alzheimer’s disease or dementia can accumulate and cause damage in the brain.
The idea for this specific operation arose after a patient in China, who was being treated for head and neck cancer, unexpectedly showed improvement in Alzheimer’s symptoms after a lymphatic procedure.
(Photo: Jhua-Nine Wyrley-Birch/Maroela Media)
This led medical researchers worldwide to look at the role of the lymphatic system – a field that Moodie describes as an “unexplored world” that could play a role in the treatment of this group of brain diseases.
“When something accumulates, it implies there is a drainage problem. We tried to see if we could create a way in the neck to improve that drainage,” he explains.
Moodie, one of a handful of South African specialists in this field, performed this six-hour operation in April at Cintocare on a 70-year-old dementia sufferer.
He prepared with the help of dr. JP Hong, his mentor during his postgraduate studies in Asia and also one of the few doctors who has already undertaken this procedure, and is moreover the first doctor in Africa to perform the procedure.
“The procedure involves connecting microscopic lymph vessels in the neck to small blood vessels to redirect the flow of lymph to the bloodstream. Although similar techniques are already used for other lymph-related conditions, it has never been applied specifically to dementia before, so it’s a new and exciting breakthrough.”
‘Goosebumps moment’
Moodie’s first patient is a long-awaited family member – a decision he says was taken with great consideration.
“At first I didn’t want to choose a family member,” he admits.
“But the other patients I considered were not safe surgical candidates. The ideal candidate is someone whose dementia is relatively far advanced, but who is still healthy enough to undergo the operation. In this case, it was also an advantage to know how the patient was before his illness and to be able to see first-hand how he weakened over time and now improves again.”
He describes the patient’s progress so far as a “goosebumps moment”.
“The uncle’s wife called me two days ago and told me that her husband woke up at four in the morning and told her that he loved her. It was the first time in two years that he could say a complete sentence to her,” he says almost moved.
“It sounds like something small, but for a family or spouse who sees their loved one slowly ‘disappear’, it is absolutely everything. People can adapt quite well to physical illnesses, but when your loved one no longer recognizes you, it is a unique kind of pain. It feels as if you are watching the life disappear from their eyes.”
According to Moodie, the patient appears “more awake”, moves more independently and slowly but surely responds more to his environment.
“He was here with us the other day, and all our staff simply say that the uncle’s eyes are shining again. Of course, he is not necessarily exactly as he was before his diagnosis, but he is definitely more present.”
Despite these encouraging signs, Moodie emphasizes that the procedure is still experimental and that standardized tests by neurologists and occupational therapists will be used over the next months to objectively measure the patient’s progress.
“From an academic point of view, we need numbers for further research and eventual approval from medical funds,” he says.
Bridge between innovation and access
According to Moodie, in the case of this procedure, there is a clear gap between medical innovation and access to it.
The operation is estimated to cost around R250 000 and was made possible in this first case, because the hospital and medical team offered their services free of charge.
“Everyone worked for nothing, so that we a case one could do For most patients, the amount is simply not feasible. Medical funds are currently the determining factor, and until they buy in, few doctors are going to be able to do this.”
He points out that even when research is available, it can take years for medical funds to approve new procedures. Only then will it also be able to be carried out in larger private hospital groups’ hospitals.
“Medical funds have a research panel that has its own criteria and will look at the latest statistics and whether the outcomes of the proposed procedure are good enough and make sense for them. Only then will the fund consider it.
“Inquiries from medics don’t always end up on the right table when it comes to medical funds, because we are not the paying customer. I have had similar paths with some of my other lymph procedures.”
According to Moodie, it can take up to four years before this new procedure is considered for payment by medical funds. In the meantime, he and his team – who are already inundated with requests and inquiries – are trying to find alternative solutions, such as special cost packages at Cintocare to make the procedure more accessible.
Despite the limited expertise in this field, Moodie is passionate about training more doctors in this type of specialized surgery.
He recently opened the doors of his practice to local and international doctors who would like to receive training in the relevant specialty field and serves on a distance learning panel at the University of Cape Town, while he is expanding his involvement with the University of Pretoria and Sefako Makgatho University of Health Sciences (formerly Medunsa).
According to Moodie, however, the field remains small, as many plastic surgeons focus on cosmetic procedures instead.
“And that’s right, not everyone has a passion for the reconstructive work, but the hope is that more students get exposure to it and maybe develop an interest in it, especially if people start to see its effect.”
Moodie believes awareness is now the key to making the procedure possible for more patients.
“We are going to do our part as medics towards the medical funds, but for now the onus is also on everyone who has a loved one with dementia or its group of diseases to make inquiries with their medical funds. If customers complain about something, it must be investigated.”
He hopes that the message will eventually reach the right decision makers.
“We’re just trying to bring a little light and hope into something that for many people is a very, very dark tunnel. There is now at least a possible option.”
