Jon Bratsch: When I was a kid, I would hear a Harley coming. I would run outside and look, always. I've always been kind of a rebel, you know.
Kris Bratsch: So he knows so many people, and they know him. Jon Bratsch? He never gets sick. He's always at work. But, you know, that was always the deal. He always took care of everybody. It was always, Dad, can you come fix it? Dad can fix everything. And then for a long time, he could not.
I had that feeling from day 1. Something is not right. And we've got to keep moving until we figure it out.
Jon Bratsch: I wasn't getting better, and I wasn't getting better. Finally, the doctor said to my wife, I think the best place for him would be Rochester, if he survives the trip.
John Chen, M.D., Ph.D.: We first heard about Jon as this mystery patient. Essentially comatose, quadriplegic, completely paralyzed. So we've got our ICU physicians there just keeping him alive. We didn't know what it was, so we had a brain biopsy. So we had neurosurgery involved. His hormone levels were off, so we had endocrinology involved. But when we started to realize it was more an autoimmune inflammatory condition, that's when we pulled in our neuroimmunologists like Dr. Flanagan, Dr. Pittock, Dr. McKeon, all these experts in Neuroimmunology.
Eoin Flanagan, M.B., B.Ch.: When I met with Mr. Bratsch, I met his wife, and at the time he was very unwell. He was not able to follow any commands. He was on a breathing machine. He was also very weak in his arms and legs and clearly severely confused.
Jon Bratsch: I was pretty sure I was going to die, and I had accepted it. Then every day I'd be like, well, I got one more day, you know. And I went into a coma for eight days.
Dr. Flanagan: We had been given information that his MRI had shown changes that suggested some disease in the white matter. It looked suspicious for some demyelinating disease. But we still weren't sure of the exact cause. So we sent off for an antibody test that we had developed on a research basis in our lab. This is an antibody to myelin oligodendrocyte glycoprotein, or MOG, which is a protein on the surface of oligodendrocytes. Oligodendrocytes are cells within the brain that make our myelin, which is the insulation for our nerves. When those cells get damaged, the insulation goes away and patients have neurologic symptoms.
Dr. Chen: We've got this sample sitting in the lab and we go, gosh, this looks like MOGAD, a brand new disease that's really not well recognized. But we've been seeing patients with a similar phenotype, collecting data, seeing if they all fit a similar phenotype. Drawing blood and trying to perfect an assay against these MOG antibodies.
Dr. Flanagan: Really, when that came back, that gave us the answer. We knew what Mr. Bratsch had and we knew how to treat it.
Dr. Chen: We treated him very aggressively with steroids and we just started slowly tapering down the prednisone and eventually we switched over to mycophenolate.
Dr. Flanagan: With this treatment, he started to improve. This was a very important disease to diagnose because it can affect your thinking and your vision. As a mechanic, it's so important for him to have his dexterity back, to have his vision pristine. And it was partly the aggressive treatment that we were able to do, knowing what we were dealing with and getting him on the right treatment. So we were able to preserve all those functions so he could return to work as a mechanic and to ride his motorcycle without any concerns or without the need for any help.
That just shows you the power of this field of autoimmune neurology where we can really reverse conditions and get people back to the best of their life, back to fully functional.
Dr. Chen: I think anytime a patient is a mystery, it does keep us up at night. But we're not in this alone. Any of our complex patients always have at least two or three other providers thinking about the patient from a different angle.
Dr. Flanagan: The Mayo Clinic is a center of expertise. We want to help patients. We want to see patients like Mr. Bratsch who we can really help.
Dr. Chen: I think that's really what makes Mayo Clinic strong. It's a clinic model where we're all under the same roof, and we really do put the needs of the patient first.
Kris Bratsch: Courtney and I sat outside and cried when he pulled out of the garage with it. It was very emotional because we thought we'd never see him on it again.
Jon Bratsch: I started it up. It felt good. And after that, we just started riding. I've been riding ever since.