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Chicago-area flautist disregards common outcome of bowhunter syndrome

Naperville flautist Janice Frank has a rare gift for woodwind instruments. She has been playing since the age of seven, has her master’s degree in music, and is the current secretary and past president of the Chicago Flute Club. But when Frank was diagnosed with an even more rare fainting condition a few years ago, she was on the verge of giving up her instrument.

“I should have stopped playing,” says Frank. “A lifelong, pleasant job that is simply part of my nature and that I should have stopped. I’m just reaching [up to] My cupboard to get a box of cereal would make me feel like I might pass out.” The feeling occurred every time she turned her head to the side, up or down.

Fortunately, Frank still plays the flute today and was recently preparing for their next concert – a collection of popular film scores.

The result is nothing short of miraculous, thanks to an impressive intervention by Matthew Potts, MD, a neurosurgeon with Northwestern Medicine.

But in between the first beginning Because of the symptoms and surgery at Northwestern, Frank faced a stressful ordeal that illustrates the difficulty of dealing with bowhunter syndrome – a rare disease that most medical experts don’t know how to diagnose or treat.

“It took months of not knowing what the hell was going on,” Frank says. “Did I have cancer or a brain tumor? I just didn’t know.”

A radiology interventionist had diagnosed Frank with bowhunter syndrome, but there was nothing he could do about it. Potts could. He successfully performed minimally invasive surgery on her, preserving her ability to play music.

In Bow Hunter syndrome, one of the vertebral arteries is narrowed or pinched, preventing proper blood flow to the brain. The most common cause of this is a bone spur on the cervical vertebrae, which leads to the artery being pinched when the affected person moves their head.

Potts says the position that causes symptoms is similar to the way bowhunters turn their heads when using bows and arrows; This is where bowhunter syndrome gets its colorful name.

In severe cases, turning your head can even lead to a stroke, says Potts.

I thought that if I turned my head in my sleep I might pass out and never wake up.

Nevertheless, for Frank it is essential to turn your head when playing the flute. Musicians can develop all sorts of problems due to their fast, repetitive movements. One of the most common diseases is carpal tunnel in the wrist. Flutists are no exception, as they have to hold the instrument unevenly on their bodies.

Frank says she first noticed that when she was out with friends and turned around to listen to them talking, she felt like she was going to pass out. Over time the feeling worsened and Frank had to constantly hold her head forward.

As Frank’s condition worsened, she increasingly spent rehearsals fighting the feeling that she might faint. One evening during a rehearsal, Frank said she kept track of the number of times she almost fainted and found that there were 64 times in just over two hours.

“It scared me to sleep at night,” says Frank. “I thought if I turned my head in my sleep I might pass out and never wake up.”

Before he found Potts, Frank spent She got stuck with medical experts for six months until someone figured out where her artery was pinched. In her case, the cause was not a spinal spur but possibly bone spur tissue.

But even after Frank received the bowhunter’s diagnosis from a radiology interventionalist, most doctors were unwilling or unable to recommend a treatment option.

“They didn’t want to touch it,” she says.

A clinic recommended fusing Frank’s neck bones, which would have relieved symptoms but would have resulted in Frank never being able to turn his head or play the flute again.

There are a number of reasons why diagnosing and treating bowhunters isn’t easy, even for medical experts, Potts says. The disease is very rare; There are many causes of dizziness that may have nothing to do with blood vessels. And it’s often a long journey, from primary care to imaging to a specialist, to determine whether or not there is actually vascular compression.

Additionally, Potts says, most surgeons only recommend procedures they feel comfortable with.

What Potts discovered that other experts missed is that Frank’s vertebral artery on the other side of her neck was closed due to a buildup of cholesterol (atherosclerosis). He knew he could reopen it to get it working again.

Doctors who had previously determined that the artery was no longer functional concluded that it was congenitally blocked from birth, Frank says.

Potts was able to use a special coronary artery stent—a flexible tube—to open Frank’s second vertebral artery. While plaque and cholesterol deposits can affect any artery, they are more common in the arteries of the heart than in the brain. In addition, doctors are often reluctant to perform such an operation because it can be fatal if something goes wrong.

In Frank’s case, the process worked. “Almost immediately she was able to turn her head and had no symptoms,” Potts says.

Earlier this year, Frank thanked Potts and his team for their work by playing flute and piccolo for their clinic.

While Frank’s ordeal had a happy ending, she wonders how many musicians have had to give up their careers or stop playing music because of similar problems that went undiagnosed.

“I do believe that this could happen to other flute players without them knowing what it is,” says Frank. “Maybe we should even call it ‘flutist syndrome.’ There are more flutists than (professional) bowhunters.”

But overall, Frank’s story gives hope that those who suffer from bowhunter syndrome, including musicians, can be successfully treated without affecting their quality of life.

“That’s why so many of us go into medicine: to help people,” says Potts. “It was really nice to be able to give her a living back.”

Frank says she is grateful for her recovery. “I played my instruments. I’m happy.” The only new thing in her life after the operation is an aspirin once a day – and her annual check-ups with Potts.

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Photo above: Janice Frank (pictured left) plays the flute with her sister Joyce

Originally published Fall 2024/Winter 2025 Printing problem.