September 3rd, 2014
Gal Cohen*, who was used to a regular, brisk swim, found that following a surgical procedure for an unrelated issue, he was so short of breath he could barely manage. He couldn’t sleep on his left side and used bedroom fans to provide what he felt was missing oxygen. In general, says the Tel Aviv resident, “I felt like I was suffocating even with mild exertion.”
Subsequent tests determined he had reduced lung function and a chest radiograph (type of x-ray) showed an elevated right diaphragm, evidence of his abnormal lung function and breathing problems.
The surgeon who operated on him told him that the surgery went well and that no nerve was mistakenly cut, and that nerve regeneration would on its own lead to recovery; however, two years later the problem was still not resolved. That’s when Cohen found reconstructive plastic surgeon Dr. Matthew Kaufman via the Internet.
Dr. Kaufman continually sees patients like Gal Cohen, who have a paralyzed diaphragm as a result of surgery, injury or accident. Subsequently, they have life-altering symptoms. Much of the time, these patients are told by other medical professionals that they “just have to live with it.” But the condition can cause severe problems, such as dangerous, repeated bouts of pneumonia. Dr. Kaufman offers an alternative. He is the only known surgeon to perform specialized phrenic nerve surgery. Dr. Kaufman, a specialist in Otolaryngology (head and neck surgery) has patients of all ages who have had phrenic nerve surgery and have come from around the U.S. and the world, including, Australia, Canada, and Israel.
Dr. Kaufman has performed this procedure, which he does at Jersey Shore University Medical Center in New Jersey and at the University of California at Los Angeles (UCLA) Medical Center, over 150 times since 2007. He has also published various academic articles on phrenic nerve surgery.
The phrenic nerve controls function of the diaphragm muscle – the primary muscle involved in breathing. Contraction of the diaphragm muscle permits expansion of the chest cavity and inhalation of air into the lungs. Until now, treatment options for phrenic nerve injury have been limited to either nonsurgical therapy or diaphragm plication, neither of which attempts to restore normal function to the paralyzed diaphragm.
Advances in nerve decompression and transplant have enabled Dr. Kaufman to reverse diaphragm paralysis. The techniques he utilizes are derived from the procedures commonly used to treat arm or leg paralysis, which have allowed surgeons to restore function to previously paralyzed muscle groups.
In July 2014, a year following surgery with Dr. Kaufman, Gal Cohen reported that his
quality of life had improved significantly. He sleeps normally and has done away with his bedroom fans. “I have my energy back and no longer feel limited. I am capable of functioning without heart palpitations and shortness of breath,” he says. Furthermore, a chest fluoroscopy (an x-ray that evaluates diaphragm movement), performed a year after surgery, revealed movement on both sides.
Dr. Kaufman states, “We have been very pleased with the progress of diaphragm recovery in this patient who traveled a long way (from Israel) to entrust us with his care. He suffered a rather severe injury to his phrenic nerve that would have otherwise left him with a permanent breathing deficit. Advanced microsurgical nerve techniques have been utilized for his specific injury leading to tremendous improvements. We expect further recovery over the next one to two years commensurate with ongoing muscle reactivation.”
Gal Cohen, now a 48-year-old Ph.D. in genetics, says that since the surgery, “I can swim one kilometer (0.62 mile) in 25 minutes or less without difficulty. I actually feel almost the same as before the diaphragm injury. I’m so glad I found Dr. Kaufman.”
*Not the patient’s real name
May 20th, 2014
On March 27th, 2012, Kevin Neary underwent surgery with Dr. Matthew Kaufman in an effort to salvage his phrenic nerve and install a pacemaker to get his diaphragm working. The 29-year-old graduate of the University of Pennsylvania had been on a ventilator since Nov. 15, when he was shot during an attempted robbery in Northern Liberties and left quadriplegic. Doctors thought that the damage from the bullet, which was still lodged in his neck, had impaired the phrenic nerve, which triggers the diaphragm and allows the lungs to draw in air. He was hopeful that this procedure would get him off the ventilator for six hours per day.
In a recent video that Kevin sent in shows that he is almost 100% off the ventilator and breathing on his own.
May 13th, 2014
Nick Andrade was a 17-year-old competitive swimmer when he took a vacation trip to his Brazil, where he has relatives. It was there that Nick dove into shallow water and suffered a spinal cord injury, leaving him paralyzed from the neck down and on a ventilator.
Eventually, when he was told he would never be able to breathe on his own, forever connected to a ventilator, Nick did not want to go on; he had lost all hope. Ultimately, he was referred to Dr. Matthew Kaufman of The Institute for Advanced Reconstruction by Dr. Wise Young, director of the W.M. Keck Center for Collaborative Neuroscience and a professor at Rutgers University, New Jersey. In July 2013 Nick underwent specialized surgery with Dr. Kaufman, including nerve grafting and implantation of a breathing pacemaker device. Today, the now 19-year-old Charlotte, North Carolina resident is starting to breath on his own, and is weaning off the use of the ventilator. Dr. Kaufman has been performing these surgeries on spinal cord injured patients in both New Jersey and at the University of California Los Angeles for the past seven years. Currently, as Nick progresses, his physicians are in close contact with Dr. Kaufman and his team.
Breathing pacemakers provide respiratory function superior to mechanical ventilators since the inhaled air is drawn into the lungs by the diaphragm under negative pressure, rather than being forced into the chest under positive pressure. This is physiologically more accurate and comfortable for the patient.
Pacing patients are also at much lower risk of upper airway infections including ventilator-associated pneumonia (VAP). Breathing pacemakers are small, and do not require the bulky tubing and batteries of mechanical ventilators, so the patient’s mobility is greatly enhanced. Breathing pacemakers can be implanted using a variety of minimally-invasive surgical approaches.
Nick Andrade’s progress is the source of great personal joy for him and his family. According to the homepage of his website www.teamnickandrade.com, “Due in large part to the generosity & support of the community, Nicholas has made great strides in weaning off the ventilator. Now Nicholas is able to breathe for up to 3 hours on his own and we are hopeful that he will be off the ventilator before the summer.”
Making news, a new February, 2014 study published in the Journal of Trauma Acute Care Surgery finds that diaphragm pacing (DP) stimulation in spinal cord-injured patients is successful not only in weaning patients from mechanical ventilators but also in bridging patients to independent respiration, where they could breathe on their own without the aid of a ventilator or stimulation.
Dr. Matthew Kaufman has published numerous articles on this topic in the medical literature, and been a presenter at several national and international medical conferences, including more recently in Hawaii and in Vienna, Austria. On, Saturday, May 17th, Dr. Kaufman will present at the 40th annual American Spinal Injury Association (ASIA) 2014 Annual Scientific Meeting in San Antonio, Texas. His topic will be “Successful Reversal of Ventilator Dependency in Cervical Spinal Cord Injury and Stroke With Combined Upper Motor Neuron and Phrenic Nerve Lesions Using Simultaneous Nerve Transfers and Diaphragmatic Pacemakers.”
December 3rd, 2013
Includes first known published protocol for medical management of patients with diaphragm paralysis.
November 6th, 2013
November 4, 2013 – Neptune, NJ – On Friday, November 8, 2013, The Center for Treatment of Paralysis and Reconstructive Nerve Surgery at Jersey Shore University Medical Center in Neptune, NJ will host Switzerland’s Andres Gohritz, M.D. and Veith Moser, M.D. of Vienna, Austria to observe several techniques in phrenic nerve and nerve decompression surgery. Drs. Gohritz and Moser will be present during a diaphragm pacemaker implant procedure on a young child. The pediatric patient suffered a spinal cord injury during a motor vehicle accident in 2009 and was left ventilator dependent.
Specialists at the Center are among a few select surgeons in the country that perform the procedure to implant a diaphragm pacemaker, allowing some patients with spinal cord injury to breathe independently, without the need for long term ventilator support. Matthew Kaufman, M.D., who specializes in treatments for swallowing disorders after stroke, diaphragm paralysis, and spinal cord injuries, will perform this unique procedure. The visiting doctors will observe this procedure and other surgeries performed by the Center’s nerve specialists: Michael Rose, M.D., Andrew Elkwood, M.D., Matthew Kaufman, M.D., Tushar R. Patel, M.D., and Russell Ashinoff, M.D.
The Center for Treatment of Paralysis & Reconstructive Nerve Surgery at Jersey Shore University Medical Center provides some of the most advanced surgical treatment of paralysis and nerve injuries in the world today.
Andres Gohritz, M.D., is a reconstructive hand surgeon at University Hospital in Basel and the Swiss Paraplegic Center in Nottwil – Europe’s leading center for paraplegia, spinal cord injuries and diseases. Dr. Gohritz’s main clinical interests are peripheral nerve surgery and functional restoration in paraplegia, nerve paralysis, and spasticity.
Veith Moser, M.D., is the chief consultant for plastic, hand and reconstructive surgery and an active professor at the University Hospital in Zurich. He also is a consultant for plastic and nerve surgery at the Vienna Trauma Hospital in Austria.
Jersey Shore University Medical Center, a member of the Meridian Health family, is a not-for-profit teaching hospital and home to K. Hovnanian Children’s Hospital – the first children’s hospital in Monmouth and Ocean counties. Jersey Shore is the regional provider of cardiac surgery, a program which has been ranked among the best in the Northeast, and is home to the only trauma center and stroke rescue center in the region. Jersey Shore specializes in cardiovascular care, orthopedics and rehabilitation, cancer care, neuroscience, nerve surgery and women’s specialty services. Through the hospital’s clinical research program, and its affiliation with Rutgers Robert Wood Johnson Medical School, Jersey Shore serves as an academic center dedicated to advancing medical knowledge, training future physicians and providing the community with access to promising medical breakthroughs. For more information about Jersey Shore University Medical Center call 1-800-DOCTORS, or visit www.JerseyShoreUniversityMedicalCenter.com.