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.
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