New Hope For Victims of Leprosy - Dr. Stephen W. Wheat pioneers use of hand-held ultrasound

Dr. Steven Wheat - Health & Fitness

Sometimes it takes the isolation of a pandemic to allow a mind to journey uninterrupted to the farthest reaches of discovery. Such was the case for Sir Isaac Newton during the Great Plague of London, and such has been the case for Northwest Louisiana electrodiagnostic specialist Dr. Stephen W. Wheat during the Covid-19 pandemic. Isolation and socially distancing allowed Newton to make ground breaking discoveries including the development of calculus, that white light was comprised of all components of the spectrum, and to start his study of the laws of motion. Similar isolation during the recent Covid-19 pandemic inspired Dr. Wheat to continue on a path of exploration that he had begun early in 2019 hypothesizing that an emerging technology might give new hope to the greater than four million individuals worldwide suffering with undiagnosed leprosy.

With Dr. Wheat’s study and support from Barbara M. Stryjewska, MD, chief medical officer for the National Hansen’s Disease Clinical Center in Baton Rouge, and Michael Stephen Cartwright, MD, professor of neurology at Wake Forest School of Medicine, these often ostracized and mistreated individuals might now have a fighting chance for a cure against one of the world’s most dreaded maladies.

Throughout history, leprosy has been referred to as the world’s most feared and dreaded condition. Hansen’s Disease is caused by the acid-fast bacterium mycobacterium leprae and is most often diagnosed by typical skin lesions, nerve lesions and the presence of bacilli in tissue. Clinical manifestation of leprosy is largely confined to the skin, peripheral nerves, eyes, testes and upper respiratory system. For centuries, individuals diagnosed with leprosy, or Hansen’s Disease (HD), havesuffered needlessly from a disease thatrobs them of both life and limb and is so dramatically misunderstood that its victims are separated from society and marked as social pariahs.

In January of 2019, Dr. Stephen Wheat began to use the emerging technology of a hand-held ultrasound device known as the Butterfly iQ in his neuromuscular and skeletal electrodiagnostic specialty and was happy with the results and the portability. The Butterfly iQ is one the world’s first hand-held, whole-body ultrasound devices. It can be used with a smartphone or tablet. Having attended medical school in Louisiana and specialized in both internal medicine and physical medicine before becoming an electrodiagnostician, Dr. Wheat was also very familiar with the National Hansen’s Disease Clinical Center, the only institution in the U.S. exclusively devoted to leprosy consulting, research and training. He was aware of the challenges of diagnosing Hansen’s Disease and had learned that high-resolution ultrasound was a newer technology being brought into the diagnostic process. Dr. Wheat began to hypothesize how using a “pocket” ultrasound device such as the Butterfly iQ might change the efficacy with which the world diagnosed this terrible disease.

Michael Stephen Cartwright, MD, professor of neurology at Wake Forest School of Medicine and the person Dr. Wheat refers to as the “guru” of neuromuscular ultrasonography, having written the first evidence-based clinical practice guideline on its use, was also working with the National Hansen’s Disease Center in Baton Rouge and the Louisiana State University Veterinary Center, where the nine-banded armadillo was being used in leprosy research. Dr. Cartwright knew of Dr. Wheat’s work with ultrasound in his electrodiagnostic specialty and asked if he would travel to Baton Rouge to test his theory of the efficacy of using the hand-held ultrasound on the nine-banded armadillo, the only other natural host for leprosy besides humans, at the Vet Center in diagnosing Hansen’s Disease.

Barbara M. Stryjewska, MD, chief medical officer for the National Hansen’s Disease Clinical Center in Baton Rouge, a member of the national Health Resources and Services Administration and an agency of the U.S. Department of Health and Human Services, also learned of Dr. Wheat’s work and invited him to come to the Center in Baton Rouge to discuss his ideas and to work with researchers at the center. Dr. Stryjewska wanted to see and assess first-hand Dr. Wheat’s use of the “pocket” ultrasound in testing for Hansen’s Disease in order to be able to compare and correlate its results as compared with standard ultrasound.

The Butterfly iQ sells for several thousand dollars rather than the tens of thousands of dollars price tags on the larger ultrasound devices used in many medical settings. It is estimated that in 2020 three million people worldwide are living with irreversible disabilities resulting from leprosy, 200,000 new cases are recorded each year, and greater than four million individuals are suffering with undiagnosed leprosy – many in emerging countries with limited medical diagnostics or the resources to access them. The greater than four million undiagnosed leprosy victims was the target group that Dr. Wheat wanted to help diagnose and, thus, cure.

After many months of research, human and nine-banded armadillo trials, and much discussion among Wheat, Stryjewska and Cartwright at the National Hansen’s Disease Clinical Center, this esteemed team is ready to propose noteworthy discoveries for using a hand-held ultrasound, like the Butterfly iQ, to effectively diagnose the enlarged nerves that are pathognomonic for Hansen’s Disease and a limited number of other polyneuropathies. This is a tool that has never been used to diagnose this disease. It is less powerful than the larger and 10 times more expensive ultrasound machines, but has proven just as worthwhile as a diagnostic tool – and it works by simply pulling it out of your pocket without even plugging it in. It can make the diagnosis of Hansen’s Disease affordable in any city in America, any location in the world, and promises to transform medical missionary work – an area Dr. Wheat is especially mindful of having served as a medical missionary working in Kenya, East Africa. In Wheat, Stryjewska and Cartwright’s study, the pocket ultrasound even picked out three nerves that are highly specific to finding Hansen’s Disease that had not been identified previously. The proposed use of the hand-held ultrasound for diagnosing Hansen’s Disease gives new hope to the people around the world who suffer from leprosy.

The Bible often referred to people with leprosy as “unclean” and placed them “outside the camp.” In medieval Spain, victims of leprosy were declared legally dead and their property dispersed. In Norway, Hansen’s Disease patients had cowbells placed around their necks to warn others of their coming. Mohammed advised his followers to flee lepers as one would a lion. Drs. Wheat, Stryjewska and Cartwright are excited about the opportunity to diagnose this reversible but dreaded disease earlier and faster across the globe, and to give those millions of people suffering with undiagnosed leprosy a fighting chance for a cure against this historically dreaded illness.