August 11th, 2015
I am so blessed to have had the phrenic nerve surgery that Dr. Kaufman had performed on Friday, March 13th!
I have so much more energy and feel so much better! I sleep better as well. I have so much more energy during the day. No more yawning all day long for me, feeling like I would never make it through the work day, not being mentally sharp. I used to be so exhausted. I would not sleep well at all either. I would actually recline in my car during my lunch hour many days just to make it through the day. I rarely would cook dinner when I got home. I would just put a load of laundry in and not have the energy most days to fold it. That would be the extent of my energy. My husband did all of the cleaning and grocery shopping.
Now I am very active. I sleep very well and very sound so I feel rested in the morning. I am walking two miles per day outdoors or two miles on our elliptical machine, going to work, cooking dinner, cleaning and also helping my daughter a couple of nights a week with our first grandson born June 13th. I do our laundry and my daughter’s laundry as well to help her out. I go shopping and enjoy myself more! I have the energy and can breathe better to be intimate with my husband again which was so difficult for us when I wasn’t well. I feel like I am living again! Doing every day activities is so much easier and feeling great is such a blessing! And I have lost about 10 lbs. because I have more energy to cook so I can eat healthier and exercise! I feel so much healthier. I have also seen an improvement in my HDL, LDL, triglycerides, cholesterol and blood pressure. My resting heart rate is about 70! I have been focusing on cardio and plan to start weight training in mid-August. I never could begin to think of doing anything extra other than going to work. Now I am actually working to get in shape so I am much stronger and leaner. I would love to go back to school and take up a new hobby. I could never begin to think beyond just getting through my workday before the surgery.
My husband and I are on vacation in St. Petersburg, Florida. I would have not been able to be in the heat and humidity before. We have walked along the beach, been on the beach for about 6 hours today, walked quite a bit, visited the botanical gardens – getting a lot of exercise and being very active!
I did well on the flight from BWI to Atlanta and the flight from Atlanta to Tampa. However, coming back home I had trouble breathing on the flight from Tampa to Atlanta. It seems I only have trouble now with breathing when the air quality isn’t good or there are fumes in the air. I made it through the one-hour flight doing my pursed lip breathing and trying not to get anxious. I didn’t feel really great for about an hour or so but was much better once I had to board the flight from Atlanta to BWI. That flight was fine as the air quality was much better. (I think if I could have a small canister of oxygen to breath during those times of being in planes or in subways would be beneficial so I have access to healthier air that will not be such a strain on me. Or maybe I will not have a problem in the future as I get stronger.)
I make sure I get my rest and I am able to enjoy myself and be active all day! I could have never dreamed of taking this trip before the phrenic nerve surgery! Our son had earned a free trip at work for his job last year and had wanted me to go with him to Florida but I couldn’t go with him because of my health. I would never have been able to survive the heat and humidity and flights and being active prior to my phrenic nerve surgery this year. The heat and humidity made me feel like I was suffocating, like someone was holding a pillow over my head. I never had the energy to walk very far or to be outside in the heat and humidity for very long. I would wake up many nights suddenly feeling like I could not breathe. Then there were those anxiety attacks from waking up feeling like I couldn’t breathe or anxiety over going certain places or being outside or driving in traffic because of exhaust fumes or visiting someone’s home with candles lit and perfume smells or feeling like I just didn’t have the energy. My family doctor at one point prescribed anxiety medicine for a short time because I couldn’t seem to control this anxiety about not being able to breathe well. I would avoid going places and would not go anywhere without my husband other than to work. My pulmonologist encouraged me to go through pulmonary rehab and that helped me significantly control my anxiety and know my limitations so I wouldn’t do more than my body could handle. I don’t miss that at all! That seemed to be everyone’s answer – don’t do more than you should. ‘But I still have so much life to live’ was all I could think – I don’t want to slow down and just exist! I didn’t want to accept that I would be like this the rest of my life.
My breathing problem happened as a result of an epicardial cyst that was removed that was causing severe painful spasms in my chest for over 21/2 years; It took the doctor’s 21/2 years to find that the cyst was causing the spasms. There were several times my husband took me to the ER because we thought I was having a heart attack – that is how painful it would be. But no one seemed to know what was causing the spasms. My diastolic would go really high as well as my systolic. Finally an MRI and CT revealed the cyst. After the thoracic surgery to remove the epicardial cyst I had difficulty breathing well. I would wake up during the night suddenly feeling like I was suffocating. Many times I thought I was going to die because no one knew what was wrong with me or how to help me when I had these spasms. My husband would just try to talk to me and calm me down and hold me. We made several visits to the ER and was admitted twice but nothing was found. I was told by one pulmonologist that I was “just afraid to push myself” after the surgery, that I had to stop being afraid. It is difficult to not feel afraid when you can’t breathe as well as you had your entire life! I was told to get a personal trainer and work out to get stronger. Well I did exercise and had to be hospitalized for two days because my blood pressure soared from doing planks and exercises that my body just couldn’t handle. My personal trainer encouraged me to get yet another opinion about my health because he said something just didn’t seem right to him-seemed like my lungs weren’t working correctly. My gastro doctor also did tests and could tell that my esophagus wasn’t working the way it should to push food down into my stomach but also didn’t know what was causing the problem. My pulmonologist said he could only offer plication of the diaphragm but that would only make more room in my chest. To me it didn’t seem like it was worth going through the surgery because there was a good chance it would not make me feel much better. No one seemed to know what was wrong with me, or at least wouldn’t admit the thoracic surgery to remove the cyst could have caused this problem.
I almost gave up. I researched and researched for about two years. Then one day I saw Dr. Kaufman’s article but thought I may not be a candidate. After all, I was ‘functioning’. I went to see my pulmonologist again with the article about Dr. Kaufman’s procedure. He had not heard of Dr. Kaufman or the procedure and said he would look into it. In the meantime, I had several tests performed for my lung and heart functions. My pulmonologist looked into the procedure and referred me to a thoracic surgeon at Hershey Medical. This surgeon did not perform this procedure in the article but had offered to contact Dr. Kaufman with my test results to see if I was a candidate. After a short time, I received a call from Heather stating that I was a candidate! I was so thrilled! Dr. Kaufman conferenced with me on the phone, we set a date for the consultation and surgery. Everything was explained to my husband and me in detail. We decided to go forward with the surgery. It was the best decision for me! And I feel oh so much better after such a considerably short time of a little over four months!
I can’t thank Dr. Kaufman enough for helping me and giving me a second chance at living a fuller life! His staff – Dr. Bauer, Barbara, Ellen, Gina and Heather – has been so supportive and helpful during these past months as well! Daniel at Avery, the pacemaker company, is also very helpful and supportive.
I look forward to my one-year checkup with Dr. Kaufman so he can see how much better I am and how he has helped me so much! I have also given two doctors that were testing me prior to my phrenic nerve surgery the information about the phrenic nerve procedure so they can help their patients.
Jean Marie McCann
July 1st, 2015
Patient to Undergo Phrenic Nerve Procedure with Dr. Matthew Kaufman
Revital Haik already had an uphill battle with her health. Two years ago, she endured not one, but two operations for thyroid cancer. The surgeries were only three months apart.
Hoping for relief, the 41-year-old native Israeli awoke from her second surgery with an entirely different sensation. She reported “serious breathing difficulties”.
“At first I thought it had something to do with the anesthesia, because slowly the distress subsided. But I was still left with a breathing difficulty that I didn’t previously have. My ability to speak was impacted and quite weakened. It is hard to speak fluidly because I get such a small amount of air into my lungs.”
According to Haik, her doctors told her it was “just emotional stress”, essentially ignoring her complaints. Her troubles increased, however, and she eventually contracted pneumonia, a consequence of what would prove to be a result of a damaged phrenic nerve.
Haik eventually found her way to Professor Mordechai Kramer at Rabin Medical Center at Beilinson Hospital. Kramer is a renowned expert in all areas of pulmonary care, and the head of the Pulmonary Institute, the largest and most advanced in Israel. As he had in the past with previous patients, he referred Haik to Dr. Matthew Kaufman of The Institute for Advanced Reconstruction in Shrewsbury, NJ.
Unfortunately, Haik’s story was not uncommon for Dr. Kaufman who continually sees patients with paralyzed diaphragms resulting from surgeries, injuries or accidents. Subsequently, these patients have dangerous, life-altering symptoms and their medical professionals often tell them that they “just have to live with it”. Yet Dr. Kaufman offers an alternative. He is the only known surgeon to perform specialized phrenic nerve surgery.
The phrenic nerve controls function of the diaphragm muscle, the primary muscle involved in breathing. 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.
However, 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 allow surgeons to restore function to previously paralyzed muscle groups.
To date, Dr. Kaufman has performed this specialized procedure over 200 times since 2007 at Jersey Shore University Medical Center in New Jersey and at the University of California at Los Angeles (UCLA) Medical Center. Well versed on the matter, he has also published various academic articles on phrenic nerve surgery.
For his unique expertise and experience, Dr. Kaufman is sought after by patients of all ages from around the world including Australia, Canada, and Israel. Haik is among these patients.
A mother of six children (including 6-year-old twins) and an administrator in the Borsa (Israeli stock exchange), Haik relates, “It was hard to come to the decision to be operated on. After all, it’s my third neck surgery after a difficult period with cancer… But after a year and a half, I decided, especially as the mother of little children: I’m too young to live like an old person.”
Her decision, however, was not made without contemplation. Haik consulted with her personal rabbi and Rabbi Avraham Firer, chairman and founder of Ezra LeMarpeh, a non-profit organization in Israel that provides significant medical assistance.
While Dr. Kaufman cannot be sure of the extent of the problem until the surgery, he is guardedly optimistic. “I have dealt with this problem before [phrenic nerve damage due to thyroid surgery] and most of the patients have done extremely well. Preliminary test results lead us to believe that Revital has a high likelihood of a favorable outcome.”
Haik will arrive in New Jersey at the end of June for her surgery with Dr. Kaufman. Her sister, also a mother of young children, will be escorting her. Says Haik, “Our husbands are staying home with the children, along with our dedicated mother.”
May 27th, 2015
Drs. Matthew Kaufman, Andrew Elkwood and Michael Rose were published in The Annals of Thoracic Surgery in a study entitled Functional Restoration of Diaphragmatic Paralysis: An Evaluation of Phrenic Nerve Reconstruction. The study examines the efficacy of surgical intervention with the goal of restoring function to the phrenic nerve.
To quote the Invited Commentary section following the study:
The article from Kaufman and colleagues provides the strongest evidence to date in favor of a sea-change in how one might approach patients with diaphragmatic paralysis.
May 21st, 2015
Drs. Matthew Kaufman and Andrew Elkwood were published in the Journal of Reconstructive Microsurgery in a study entitled Diaphragmatic Reinnervation in Ventilator-Dependent Patients with Cervical Spinal Cord Injury and Concomitant Phrenic Nerve Lesions Using Simultaneous Nerve Transfers and Implantable Neurostimulators. The study examines the outcomes of ventilator-dependent patients patients who underwent simultaneous microsurgical nerve transfers and the implantation of diaphragmatic pacemakers.
The content of the study is perhaps best summarized in a recent patient story of Andrew Brown, who suffered a spinal cord injury that forced him to rely on mechanical ventilation for respiratory function. After undergoing the simultaneous nerve transfer and diaphragmatic pacemaker implantation procedure, Brown has reduced his ventilator requirements and Dr. Kaufman hopes to see him eventually breathe on his own.
May 11th, 2015
In August 2012, Andrew Brown was on his way home from seeing his young son in the hospital for a surgical procedure when his life was forever changed. Brown was involved in an automobile accident, leaving him paralyzed from the neck down.
Subsequently, he had enormous difficulty breathing, often requiring mechanical ventilation, which put him in the hospital every month last year. In fact, in January 2014, his mother Gloria reports, “The doctor didn’t expect him to live.”
Paralysis can impact the transmission of nerve impulses that control breathing as a consequence of damage to the spinal cord and phrenic nerves. The phrenic nerves control function of the diaphragm muscle – the primary muscle involved in breathing.
On December 5, 2014, Brown underwent surgery with Dr. Matthew Kaufman and Dr. Andrew Elkwood, both of The Institute for Advanced Reconstruction in Shrewsbury, NJ, and Dr. Adam Shiroff, Chief of Trauma Surgery, at Jersey Shore University Medical Center in Neptune, NJ. Dr. Kaufman, the only known surgeon to perform surgery on the phrenic nerve, completed a phrenic nerve graft while installing a diaphragm pacemaker with Dr. Shiroff. Dr. Elkwood, one of few experts worldwide doing certain specialized microsurgery procedures, did tendon transfers to Brown’s right arm, which is permanently bent at a 45-degree angle.
About three months later, Brown could feel a change. “We are thrilled that he has already reduced his ventilator requirements substantially. As the phrenic nerve regenerates over a period of one year and the diaphragm muscle strengthens, we would not be surprised if he is eventually able to breathe completely on his own,” states Dr. Kaufman. In addition, Dr. Elkwood’s procedure has resulted in movement in Brown’s right thumb.
There was a time when Andrew Brown couldn’t even sit up in his wheelchair and had to spend most of his time reclining. Today, the 34-year-old Lacy Springs, Alabama, resident breathes freely with the aid of his pacemaker and spends so much time powering his wheelchair that the battery runs out.
“This was life-changing surgery,” states Andrew Brown. “But I’m still hoping for further improvement.” His goal is to regain the use of his arm and to breathe without the pacemaker.
An article by Drs. Kaufman, Elkwood and others titled “Diaphragmatic Reinnervation in Ventilator-Dependent Patients with Cervical Spinal Cord Injury…” was published in April 2015 in the Journal of Reconstructive Microsurgery. Among those studied, it was concluded that “Recovery of diaphragm electromyographic activity was demonstrated in 13 of 14 (93%) patients.” Andrew Brown has also benefited from these advanced surgical techniques.
Dr. Kaufman will be presenting on the Evaluation Of Current And Future Surgical Treatment Options for Diaphragmatic Paralysis and Ventilator Dependency in High Cervical Tetraplegia at the May 14-16, 2015 ISCOS ASIA meeting in Montreal, the largest international scientific gathering of experts in the treatment of spinal cord injury.