Virtual Reality Allows Patients To Be There, Not Here

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Bob Jester at his home in Greenport, with a set of virtual reality goggles. Lori Hawkins photo

Bob Jester is a man of science to his core. He is deliberate, calculated, proud and determined.

And he never, ever takes shortcuts.

But on August 8, 2016, the professional chimney sweep set up his ladder in stone — which he never does — and when he put his foot on the first rung and glanced up, he realized it wouldn’t reach the chimney he was cleaning.

Despite 42 years of experience telling him otherwise, he still climbed up, convinced he would jump from the top rung to the roof. He can recall every detail “just perfectly,” the retired Riverhead High School science teacher said from his home in Greenport.

Including the fall.

“When I went through the air, I can still remember even what went through my mind,” he said. “As I fell, I said, ‘This is gonna be a real bad day.’”

His back hit the slab of concrete and, immediately, he knew he was severely injured — with no feeling below the waist. But unbeknownst to him, he was lying on the ground with 19 broken bones.

“All of a sudden, the pain started to come in. I can’t explain to anybody what the pain was like,” he said. “It was beyond description. All I saw was white light. Everything was white.”

Jester was airlifted to Stony Brook University Hospital, where surgeons worked through the night to stabilize his broken back. A week later, he was transferred to Rusk Rehabilitation Institute in Manhattan, where he stayed for three weeks of physical and occupational therapy — supplemented by morphine and oxycodone, an opioid medication.

“I was concerned I was constantly using more and more opioids, because the pain, it was just unbelievable,” he said. “I started using that more and more, and I found after a while I needed a little bit more, and that was concerning me.”

When Jester returned home to the East End — first to Peconic Landing, where he lived for a month — the father of one of his former students stumbled across a California-based company, appliedVR, using virtual reality for acute pain abatement.

When appliedVR CEO and founder Matthew Stoudt heard Jester’s story, he shipped him a mobile headset, complete with a smartphone, and gave him access to the virtual reality app — three-dimensional worlds that are realistic enough to convince users that they were somewhere else, far away from pain and anxiety.

“When we first started this, we didn’t focus on the chronic pain side, which is where Bob falls into,” Stoudt said. “Where we started off was going into hospitals and deploying this as a new first line of defense for pain management that can help reduce the level of sedation they give, and the level of narcotics they use on patients.

“Now we’re in 200-plus hospitals across the U.S., we have clinical studies demonstrating our ability to reduce that acute pain up to 52 percent, and all of that’s been great,” he continued. “But Bob really is, quite frankly, the genesis of our move in going after chronic pain.”

The first time Jester tried on the virtual reality headset, he was sitting in his living room with his dinner in front of him, watching the “Farm Animals” program — so lifelike that when a cow came up to lick him, he accidentally knocked his entire plate of food all over the room.

A virtual farm. Image courtesy of Applied VR.

“I wanted to document this thing with data. That was the science teacher in me. So I kept a record of how much pain medication I was taking and how often I used the VR,” he said. “Every time I talked to them, I was taking less and less pain medication. I was struggling with it — it was a lot of medication involved — but I was dealing with it a lot better.

“What I was learning to do was take those same feelings I had and concentrate on something in the same way I did with VR,” he continued. “You basically feel immersed in it.”

In the months since, Jester has flown with the Wright brothers, hiked to Machu Picchu and explored the metropolitan hubs of Los Angeles and London. He’s even visited Greenland, he said, all from the comfort of his home.

This is escapism at its finest and, potentially, a realistic assist in modern-day medicine — especially during an era when opioid addiction is on the rise, according to Robert Chaloner, chief administrative officer of Stony Brook Southampton Hospital.

“Virtual reality helps the brain rewire itself, essentially. To an extent, you can refocus the mind away from the pain,” he said. “I think it’s something that needs to be studied more, but I also would say with all of the problems we’re having with the abuse of opioid medications, finding a non-opioid approach to pain relief — any sort of experimentation in that area — would be a good thing to try and come up with these alternatives.

“Opioids are very powerful and very effective, but as we’ve seen in society, can be abused, also,” he continued. “Having alternatives is a very, very good thing for health care and the country as a whole. I think this is a trend worth watching and hopefully promoting. Hospitals can be a little on the conservative side, sometimes, in adopting technologies until they’ve really been tried out in other settings.”

To date, Stony Brook Southampton Hospital has not experimented with virtual reality — practicing guided imagery and meditation instead — but other leading institutions across the country have, including Massachusetts General Hospital and NewYork-Presbyterian Weill Cornell Medical Center.

Slowly, hospitals are moving away from heavily prescribing opioids, a move that was previously “encouraged and very much supported in every way,” according to Dr. Gabriella Kovi, who works in anesthesiology and pain management at Stony Brook Southampton Hospital’s Meeting House Lane Medical practice.

“It was so surprising to me that young folks who have severe injuries — major fractures, major tendon injuries — come and say, ‘I do not want opioids, tell me what else I can have,’” she said. “There is a new generation now knowing that opioids are not the answer. They don’t want narcotics. They are looking for other options, and virtual reality could be one.

“It could be very much incorporated in the future use of treatment for chronic pain,” she continued. “It’s all about education: knowing that VR is available, hearing that somebody already tried it, knowing that opioids are not the only answer for chronic pain treatment. I truly believe there is a time you must use pain medications, but somebody like [Bob Jester] — who has had such a complex and very bad experience, and potentially a chronic pain sufferer — was able to find another tool than just medication, it’s wonderful, and it could be the future.”

Instead of visiting a hospital or psychologist, virtual reality also brings treatment closer to home, Kovi noted, putting care directly into the hands of the sufferer and allowing access at all times of the day. A newer appliedVR meditation program, which monitors Jester’s breathing and heart rate, has even helped him sleep.

“Bob is not gonna ever have a world where he is pain free, but he is gonna have a world where he can actually envision a better life with the pain that he has, and that’s ultimately what this is about,” Stoudt said. “For me, he is the poster child of what people can achieve when they put their mind to it.”

At the time of the interview, Jester was entering his ninth month opioid free, he said — which resonates with a message he would pass onto his former students, year after year, and one they repeat to him when they visit today.

“When I was trying to get the kids to stay off drugs and alcohol, I’d say, ‘All alcohol and drugs do is they relieve pain, but eventually you have to face it.’ I used to tell them this all the time, and so many of them told me this again,” he said. “It’s the dark days, when you have a lot of pain, that really determines who you are. Anybody can be smiling and happy and feel they have a good life and everything’s going well, but it’s the dark days that determine who you are.”

Almost two years since the fall, Jester has limited movement — wheelchair bound, but able to take primitive steps with braces. His upper body is strong, but two rods and 16 bolts down his back hinder strengthening his stomach muscles. He will never be able to bend over to pick up a pen, or pet a dog, he said, but he remains logically optimistic.

“Right now, I have no intention of giving up. Hopefully I’m gonna get some movement back. I hope to someday get back to cleaning chimneys,” he said. “That was my goal. Even if I don’t, I want to at least go back to the people where I had the accident, and just ask them if I can do their chimney one time — just so I can say I never left a job undone.”

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