For much of the past four decades, Casper businessman Mike Reid lived with a left ankle free of pain.
“What I had done is fallen off of a second-story shelf, landed on my ankle and wound up at Wyoming Medical Center,” he said.
Surgery repaired the ankle and for 41 years things went fine.
But about 18 months ago, the 75-year-old felt the old injury start to flame up and he learned he had osteoarthritis. His ankle was “bone-on-bone,” all the cartilage was gone.
“I started having significant pain with it,” he said, adding it was hard to sleep at night.
His orthopedic surgeon told him that the ankle would have to be replaced. But Reid said though he knows that will likely need to happen someday, he is too busy and did not want to take time off for the procedure.
Shots to kill the pain that initially worked for a few months lost their effectiveness.
Conversations with a friend and Casper interventional radiologist Dr. Charles Bowkley led Reid to think about something else — a procedure Bowkley called transarterial musculoskeletal embolization, or TAME.
Bowkley, who has practiced at Casper Medical Imaging for the past 15 years, said he first learned of the procedure at a medical conference in 2023.
A Japanese interventional radiologist, Dr. Yuji Okuno, pioneered the method that uses interventional radiology treatment techniques for cancer treatment and applies them to orthopedic joints, tendons and some soft tissue problems.
“It really has wide-ranging applications, and I personally believe it is going to change how we treat chronic musculoskeletal pain,” Bowkley said.
Although new, Bowkley said the promise for it to help people with chronic pain like Reid is enormous.
Dr. Charles Bowkley discusses the ankle procedure he did on Mike Reid. (Courtesy Dr. Charles Bowkley) 
Casper businessman Mike Reid said since his ankle procedure, it is 95% back to normal. (Dale Killingbeck, Cowboy State Daily) 
Dr. Charles Bowkley tells medical professionals at a conference about the first Wyoming transarterial musculoskeletal embolization on ankle patient. (Dale Killingbeck, Cowboy State Daily)
Minimally Invasive Procedure
The minimally invasive procedure involves the doctor inserting a catheter into an artery and moving it to the site of the pain through the use of radiology imaging.
Once there, an “embolic” substance is inserted that blocks blood flow to tiny chronic inflammatory blood vessels invading a joint or area as a result of trauma or disease. The lack of blood then causes associated sensory nerves created with the bad blood vessels to die off.
Bowkley said after the conference he started doing research and talking with other interventional radiologists across the country about its potential.
The procedure is a “micro” way to treat certain joint and tendon issues such as Reid’s osteoarthritic ankle, tennis elbow, golf elbow, frozen shoulder, osteoarthritis of the knee, bursitis of the hip, certain foot conditions and more.
A federally approved research study of the procedure on the Nation Institutes of Health website confirmed that TAME shows great promise in treating patients with chronic joint pain caused by osteoarthritis.
“TAME represents a promising therapeutic approach providing relief from the burden of joint diseases and substantially enhancing the quality of life,” the authors wrote. “Clinical outcomes emphasize the efficacy and safety of TAME in mitigating pain and improving functional capabilities in patients with chronic pain associated with osteoarthritis.”
Choosing the right candidate for the treatment is important, Bowkley said.
People who may sustain a joint injury or get golf elbow for the first time typically can be treated through physical therapy, stretching, and anti-inflammatory medications such as aspirin, Advil, and other non-steroidal drugs.
But when pain does not go away and conditions become worse, people may be prescribed stronger medications and even opioids to deal with the chronic pain.
The TAME procedure can be a way to avoid or remove all medications, Bowkley said.
“By removing all those pro-inflammatory agents and by removing the microenvironment by using this very small particulate embolization you reduce the need for non-steroidal (medications) and you reduce the need for opioids,” he said. “You can go back about your normal daily life.”
Bowkley said prior to Reid, he had performed the TAME procedure on knee patients. But the ankle presented an issue because there is limited artery access to it and using a substance that would permanently block a blood vessel could create more harm to him.
Many embolic substances manufactured in the U.S. are made of plastic and are permanent. Bowkley wanted to use the same temporary embolic substance made of two antibiotics that the Japanese doctor had used.
Special Substance
He worked with Banner Wyoming Medical Center’s pharmacy department to get approval to purchase the substance and use it in the procedure.
Bowkley said the great thing about the substance is that he can create different sized molecules to fit the blood vessel that he needs to block. He said only a very tiny, diluted amount of the substance was required to get the job done for Reid.
Before doing the procedure a couple of months ago, Bowkley applied an ice pack to the outside of Reid’s ankle which helps with procedure safety and allows the embolic substance to be more effective. It dissolves within 48 hours.
The procedure involved inserting a catheter into an artery in Reid’s groin and moving down to the left ankle where Bowkley then targeted the area above the osteoarthritis and released the embolic substance.
In a recent presentation for medical professionals in Casper, images showed the inflamed area prior to the procedure and the inflammation removed after it.
Reid, who spoke with Cowboy State Daily at his business, characterized the procedure as “easy.”
“I went in at 10 a.m. as an outpatient, went into the procedure room and a hour and a half after that I was back up in a room waiting to be discharged,” he said.
Bowkley said Reid’s procedure represents the first in Wyoming involving an ankle and the use of the temporary embolic. He now has other patients he is working with for knee pain, those with inflammation in their Achilles tendon and others with heel pain caused by inflammation.
When Surgery Isn’t An Option
He said in addition to patients like Reid who don’t want surgery, the procedure may also be appropriate in certain conditions for patients who cannot be candidates for surgery because of obesity, their age, or the fact they are on a blood-thinning medication.
“This is literally the perfect option for them because you don’t need to remove the bone, you don’t need to take out the joint,” he said. “And in a whole lot of patients you can treat the underlying real reason … and get them out of pain.”
Reid said he would recommend people investigate the option. He enjoys being “95% pain free.”
“It’s just amazing,” he said. “Sure, there are days, when you sit a lot, the first couple of movements are a little sketchy, but then it is right back to normal.”
For Bowkley, the procedure represents an untapped side of medicine for interventional radiologists. He is used to putting coils into brains to fix aneurysms or working at treating a tumor on a liver lobe with catheters and radiologic imaging.
“Taking that skill set and just applying it in a slightly different fashion to those inflamed joints was a very easy pivot for me because it’s something I’ve been doing for my whole career,” he said.
Dale Killingbeck can be reached at dale@cowboystatedaily.com.
