CASPER, Wyo. (AP) — Brad Stulberg lay face down on the bed of a CT scanner, flinching slightly as tiny needles pierced the skin behind his knees.
Above him, Dr. Joseph McGinley used an ultrasound machine to aim for the small sections of muscle that had been compressing Stulberg's arteries, causing pain and numbness during the triathlete's races and intense workouts. Then he injected Botox — the stuff that gets rid of wrinkles — into his patient's legs.
Stulberg had once been scheduled to undergo surgery for the ailment. He would have woken groggy from anesthesia, facing weeks of physical therapy and the possible buildup of debilitating scar tissue.
Instead, he found himself in a Casper radiology clinic, alert and talking, as McGinley completed the 45-minute procedure. He stood afterward and casually walked from the office.
The 27-year-old triathlete lives in San Francisco, a city with no shortage of quality medical facilities. Yet he flew 900 miles to see McGinley, the only doctor in the world who uses Botox injections to treat patients like Stulberg.
More than 30 percent of McGinley's patients live outside central Wyoming, with some coming from as far as New York and California. It's a strange role reversal for Casper, a city where residents are used to driving to other states for big city amenities. Instead, elite athletes are making Casper a medical destination, at least for a few, unique procedures.
"There are a lot of gimmicks in medicine," McGinley said. "People are skeptical right away when they hear 'Casper, Wyoming.' But . patients will do their own research and become convinced this is the way to go."
Before developing the Botox procedure, McGinley mostly treated patients from the Casper area. Then in 2011, he met Laura Stamp, a Natrona County High School senior and athlete who endured constant pain while participating in sports.
Stamp suffered from compartment syndrome, which can occur when athletes build up their leg muscles. There's only so much space inside the leg, and as the muscle grows, it begins pressing against the vessels, blocking blood flow. That can cause numbness, pressure and excruciating pain.
The average person can address the issue by quitting the sport. But that's not an option for determined athletes.
The condition can be treated through surgery, but there are drawbacks. It's expensive and forces athletes off their feet for a time. Scar tissue can form, causing additional problems. And for all that, there's no guarantee of success.
McGinley spent a couple of days thinking about Stamp's situation before arriving at a solution. He decided to inject Botox into her leg muscle to prevent it from contracting against the blood vessels.
Stamp's parents wanted her to avoid surgery and were willing to try McGinley's procedure, which didn't require a hospital stay or anesthesia. It worked and soon she was back playing soccer.
— Word of mouth
McGinley stayed quiet for six months to make sure the procedure was successful. Then he spoke with a local television station. The story went national and word of the procedure began to spread.
There was no need for national advertising. Athletes shared the news with other athletes. McGinley also presented his work at conferences, leading to referrals from other physicians.
"It sort of happened," he said. "I was fresh out of training. I had no experience with marketing."
Even now, nearly three years later, McGinley doesn't spend money advertising outside of Wyoming. He relies on his website and word of mouth.
"Patients will contact me," he said.
— New option
That's exactly what happened with Stulberg. For the past two years, he'd experienced leg pain when he raced, or during strenuous training.
Stulberg took an interest in endurance sports about four years ago. He started road biking first, then moved to duathlons — races where athletes run, bike and then run again — before finally competing in triathlons. He completed his first Ironman race last year.
The pain continued to dog him. It felt like someone was inflating a balloon inside his calf until the muscle threatened to pop. Then his foot would go numb.
At first he wrote it off, figuring it was a side effect of pushing his body so hard. But it was hampering his performance.
"It was really slowing me down in races because running with a numb foot, with a calf that feels like it is going to explode, is not comfortable," he said. "It started to worry me a little bit."
Stulberg consulted with a sports physician, who encouraged him to pursue the matter. He was ultimately scheduled for a December surgery.
Then he stumbled upon a Facebook page for popliteal artery entrapment — a condition similar to compartment syndrome, but involving arteries instead of veins. He saw a post about a noninvasive procedure in, of all places, Casper.
"I didn't even know where Casper was," Stulberg said.
Still, he explored the option. Then he gave McGinley a call. Stulberg learned McGinley has performed the procedure in the neighborhood of 50 times, with a success rate of 70 to 90 percent, depending on the ailment. That got his interest. His research showed surgery had a lower success rate, carried risks and the prospect of considerable downtime.
They spoke a second time and Stulberg did more research. He also consulted doctors in California, who agreed he should pursue the Botox treatment.
Stulberg booked a flight to Casper. He arrived on a Wednesday night in December, and the following morning, was performing tests on a treadmill at Wyoming Medical Center.
Stulberg underwent an MRI and then a CT scan. Finally, McGinley was convinced: His patient had considerable artery entrapment in both legs.
A short while later, McGinley began the Botox procedure. He inserted 10 needles into his patient's legs and used a CT scan to make sure they were in the proper place. Then he injected the Botox.
Once it was finished, Stulberg had no trouble standing. He would have to switch to a lighter training regimen for about 10 days and then shut it down for a few more. But after three weeks, he could ramp up his workouts.
Stulberg, who flew home the day after the procedure, will likely return to Casper for additional treatments, but if his recovery mirrors some of McGinley's other patients, the symptoms will eventually disappear completely.
Not that Stulberg minds making the trip.
"I can afford the airfare," he said. "A $500 plane ticket is so worth it versus having your legs cut open or having to quit the sport you love."
Information from: Casper (Wyo.) Star-Tribune, http://www.trib.com