October 29th, 2013
Article originally published in the Asbury Park Press. Original can be found here: MAKING CONNECTIONS: Specialized procedures…
In 2011, Chet Conlon, 63, suffered two episodes of atrial fibrillation and was unable to bring his heart rate back to a normal rhythm through medication.
His cardiologist recommended a procedure known as a cardioversion, in which electricity is used to convert cardiac arrhythmia to a normal rhythm. Conlon required two of these procedures, “but the second one seemed to work,” the retired pharmaceutical R&D specialist said.
However, although the procedure likely saved his life, it triggered some unexpected consequences.
“After the second cardioversion, I had trouble breathing and the doctor noticed an elevation in the right side of my diaphragm,” Conlon said. “Additional tests confirmed that the right side of my diaphragm was nearly paralyzed and the conductivity of my phrenic nerve was impaired.
“My heart had been beating at 140 beats per minute, which could have led to a stroke or worse, so the nerve damage was the lesser of two evils,” Conlon said.
Dr. Matthew Kaufman, a plastic and reconstructive surgeon at The Plastic Surgery Center and The Institute for Advanced Reconstruction in Shrewsbury, said that Conlon’s experience is not a common problem.
But as necessary as the cardioversion was, “because the phrenic nerve is in contact with portions of the heart, it’s possible it was susceptible.”
According to Kaufman, the phrenic nerve connects the brain and spinal cord to the diaphragm muscle, which is responsible for the respiratory force that the lungs rely on to inflate and take in air.
“Damage to the right or left phrenic nerve can be caused by inadvertent trauma to the neck, chest, spine or various parts of the body from an accident, surgery, etc.,” he said.
But while modern treatment for general nerve injuries got its start in World War II, little had been done in the specialized and lesser-seen field of phrenic nerve damage until the past decade.
“We reasoned that, if other peripheral nerves outside of the spinal cord could be repaired, why not the phrenic nerve?” said Kaufman of the expertise he has become recognized for nationally since 2007 using advanced microsurgical techniques.
Kaufman is board certified in both plastic surgery and otolaryngology-head and neck surgery, and was trained at The Mount Sinai Hospital in Manhattan. Kaufman has patients worldwide who have received his phrenic nerve surgery.
After using electrodiagnostics to identify Conlon’s exact “zone of injury” and provide a roadmap of the damage done, Kaufman performed a precise, two-step process to help repair the 5- to 6-centimeter portion of Conlon’s right phrenic nerve that had been affected.
“First, we applied decompression to the nerve to free it up and release it from the scar tissue — or compression — that was tethering it,” he said. “Then we bypassed the blockage in the nerve using a segment of the sural nerve in the leg by the outer ankle, which is considered a standard donor nerve because it can be sacrificed and used without much collateral damage. We connected it to healthy nerve above and below the injured section.”
He continued: “Because nerves regenerate at the slow pace of 1 millimeter a day, a patient has to wait for the body to regenerate new axons through the nerve graft to the muscle,” he explained, a process that can take up to a year or more based on the length of the graft, its distance from the muscle, and the severity of the injury.
Since his three-hour surgery this July, “I’ve noticed improvement on a day-to-day basis in terms of the amount of physical activity I can do without shortness of breath,” said Conlon, who’s assisting his own recovery at home in Hillsborough with twice-daily workouts on a treadmill and regular breathing exercises to build up his diaphragm muscles.
“My heart is in a normal rhythm, my breathing is steadily improving, and I’m just looking forward to getting back to normal so I can enjoy my retirement years with my family,” Conlon said.
October 18th, 2013
Dale Hopkins had a trip planned. After undergoing phrenic nerve surgery with Dr. Matthew Kaufman, Dale Hopkins asked Dr. Matthew Kaufman if the surgeon thought it would be okay for his patient to travel to Russia. “Go for it,” Kaufman responded.
Hopkins was thrilled when he could comfortably walk around and up stairs in Russia without being completely out of breath, as was the case prior to his surgery. He was surely even more thrilled when he witnessed the purpose of his trip: to see his nephew Michael Hopkins of NASA take off with his two Russian counterparts in their Soyuz-TMA-10M capsule, which docked successfully in the International Space Station just six hours later.
The 76-year-old Clarksville, Missouri resident was stopped at a light during Memorial Day 2012, when a chain of cars rear-ended each other, including his vehicle. “A week later I started having trouble breathing,” he said. Hopkins made six visits to the ER, and came down with both bronchitis and pneumonia. That is when a doctor diagnosed him with asthma. The asthma medications didn’t help, and his condition worsened, to the point that breathing was so difficult he had to sleep sitting up in a reclining chair. The retired U.S. Air Force colonel, who works full-time as a flight simulator instructor at an Air Force base, also gives numerous student lectures on flight operations, which he was forced to curtail.
Finally, Hopkins received a diagnosis of a paralyzed diaphragm, and with it, the exact line nearly every patient of Dr. Kaufman hears: “There’s nothing we can do; you’ll just have to learn to live with it.”
The diaphragm muscle is the primary muscle involved in breathing. Contraction of the diaphragm permits expansion of the chest cavity and inhalation of air into the lungs. The phrenic nerve controls function of the diaphragm muscle.
The cause of phrenic nerve damage is sometimes very easy to pinpoint, such as surgery to the neck or chest, or an accident like Dale Hopkins’. Sometimes, however, the cause is unknown.
Hopkins did what many of Dr. Kaufman’s patients do: Google their condition and find Dr. Kaufman on the Internet. Among his nerve surgery expertise, performed at the Institute for Advanced Reconstruction in Shrewsbury, NJ, Dr. Kaufman is the only known surgeon to perform specialized phrenic nerve surgery. He has performed the surgery nearly 100 times, on patients from age 11 to over 70 and from all over the USA and other countries, including Australia, Ireland and Israel.
Dale Hopkins underwent phrenic nerve surgery with Dr. Kaufman on Feburary 26, 2013 at Jersey Shore Medical Center. Subsequently, during his September trip to Russia, Hopkins said he did “a lot of walking, and climbed five flights of stairs. Before the surgery, I don’t think I could have made it.”
Dale Hopkins is back to full time teaching and lecturing. Seeing his nephew launched to the ISS in Russia was a thrill, but then, so was meeting Dr. Kaufman—his hope for a solution to a crippling problem. The first time he saw Dr. Kaufman, he told him, “I can’t tell you how glad I am to be here,” through tears.
April 23rd, 2013
Kurt Matthewson went out for his typical run one morning, and quite suddenly, had trouble breathing. “I couldn’t take a deep breath,” was how he felt. When the problem persisted, he went to his family physician, and then to a specialist, who determined the 48-year-old Madrid, Iowa resident was working on only 50 percent lung capacity.
Tests revealed the left side of his diaphragm was not functioning. The diaphragm muscle is the primary muscle involved in breathing. Contraction of the diaphragm muscle permits expansion of the chest cavity and inhalation of air into the lungs. The cause of phrenic nerve damage is sometimes very easy to pinpoint, such as surgery to the neck or chest, or an accident; however sometimes, as in Matthewson’s case, it can be difficult to discern.
Over the next several years, Matthewson twice traveled to a very famous major medical center. After the first time, he waited for two years, hoping the problem would abate. When he returned to the same center for testing, they found no change in his diaphragm function, and suggested plication, a surgical procedure that pulls the diaphragm down. Matthewson was not inclined to do that surgery, and when he asked the specialist at this renowned institution about nerve grafting, the doctor answered back, “There is no such thing.”
Four years removed from the problem, Matthewson found Dr. Matthew Kaufman on the Internet, for whom phrenic nerve surgery is, in fact, a reality. Among his nerve surgery expertise which he performs at the Institute for Advanced Reconstruction in Shrewsbury, NJ, Dr. Kaufman is the only known surgeon to perform specialized phrenic nerve surgery. He has performed the surgery over 75 times, on patients from age 11 to over 70 and from all over the USA and one from Australia.
In addition to a career as a commercial lender in the banking industry, Kurt Matthewson is a lifelong athlete whose resume includes a career as a collegiate golfer and a period of time in his 40s as an amateur competitive natural body builder.
He traveled to New Jersey in 2012 to undergo surgery with Dr. Kaufman, who as part of his usual procedure, did a nerve transplant with a graft taken from Matthewson’s ankle.
According to Dr. Kaufman, “We are optimistic that Mr. Matthewson will regain substantial diaphragm function after undergoing phrenic nerve surgery and that he will see progressive improvements over the next two to three years as the regenerated nerve leads to gradual muscle recovery.”
Kurt Matthewson’s surgery was six months ago. Reports Matthewson, “Today I’m feeling better. I feel my breathing is improved. I’m going to fight the good fight.” To that end, Matthewson, who is now regularly running, has set himself a goal. Since he believes long distance running is the ultimate test of breathing, his goal is to run a marathon (26.2 miles) on the one year anniversary of his surgery, July 20, 2013. “Hopefully, I’ll be able to celebrate my improvement.”
January 31st, 2013
We recently heard a glowing and gratifying report from the Loitz family (1/13). Tristin’s latest story of phrenic nerve surgery with Dr. Matthew Kaufman at The Institute for Advanced Reconstruction is on our website Pediatric Phrenic Nerve Procedures—Children Find Renewed Life with Groundbreaking Surgery. Below is an excerpt from an email from Tristin’s mom, Tracy.
When we returned home (from surgery) in October, we were told to let Tristin heal for at least 2 months. We did just that; however, it was driving Tristin crazy. He wanted to do everything–run, exercise, play ball, go to gym class with his friends at school and even take out the trash and shovel snow.
Now that the 2 months have gone by with Tristin waiting to lead a normal life after more than 4 years of being sedentary, tired all the time and with a lack of oxygen, he was ready to start a life, a new beginning.
I started working at The Alaska Club (GYM) which has access to cardio, weights, basketball, tennis, rock climbing, swimming, racquetball and group fitness classes. Tristin has been able to exercise and play basketball for long periods of time. We got with a personal trainer at the Alaska Club due to his weight that he had gained from being sedentary for so long. We wanted to be able to track his progress. Since our first visit with the personal trainer 3 weeks ago Tristin has lost 3 pounds, 10 pounds of body fat and gained 3 pounds of muscle.
We have also added a treadmill in our house. He is on it everyday. He started out at 10 minutes a day and now he is up to 30 minutes a day and at an incline.
It is so amazing the improvement Tristin has made not only physically, but mentally as well. His spirits are higher. He has more self-confidence and is interacting a lot more with his friends.
We were so very fortunate to have found Dr. Kaufman and his team. Now Tristin can live a longer and healthier life.
January 11th, 2013
Dr. Matthew Kaufman of The Institute for Advanced Reconstruction is Only Known Surgeon to Treat This Condition
Young people are benefiting from a groundbreaking procedure to solve a medical problem that for the most part rules their lives. Of the nearly 75 phrenic nerve surgeries performed since 2007 by Dr. Matthew Kaufman of The Institute for Advanced Reconstruction, the only known physician to conduct this surgery, several young patients are testimony to the potentially life-changing benefits of this procedure.
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. Injury to the phrenic nerve causes everything from severe shortness of breath to frequent bouts of pneumonia.
Twelve-year-old Tristin Loitz of Fairbanks, Alaska had Klippel-Feil Syndrome, a devastating disease characterized by fusion of any of the cervical vertebrae, potentially causing severe damage to major organs. Tristin was banned from all contact sports—primarily his beloved football– due to two missing discs in his neck. Tristin, with a medical school student’s grasp, describes his ordeal. “Klippel-Feil affects one in 42,000 kids. Doctors went through an MRI looking for bone cancer or scoliosis.” The multiple trips to doctors over the years led Tristin to ask his mother, “Am I going to die?”
It turned out, however, that aside from the missing cervical discs, Tristin’s only remaining problem was the diaphragm paralysis caused by his paralyzed phrenic nerve. After four years of desperation at a variety of doctors as far from their home as Seattle, the family ultimately heard the same line that has become universal with Dr. Kaufman’s phrenic nerve patients. “You’re just going to have to live with it.”
It was difficult enough for 10-year-old Grace Doran of Cherry Hill, New Jersey to endure treatment for lymphoma. But when she attempted to resume the sports she loved, she couldn’t even swim two laps in a row. Pale and out of breath, Grace was devastated. Because her lymphoma was mostly in her chest, including the largest tumor (10 centimeters), physicians believe this caused the destruction of her phrenic nerve, which resulted in diaphragm paralysis and the ensuing chronic shortness of breath, sleep disturbances, and lower energy levels. Like Tristin, Grace and her family were told: Learn to live with it.
Dr. Kaufman, who has operated on patients as young as 10 and as old as 70+ and from around the U.S. and Australia, has a 70-80% percent success rate, which is consistent with other nerve surgeries that have been around for many years.
Both Tristin and Grace found Dr. Kaufman, and underwent phrenic nerve surgery. As a result, their lives have radically improved. Tristin was operated on at Jersey Shore Medical Center in October, 2012. Prior to surgery, he would turn blue from lack of oxygen merely trying to run a few feet. Three months following surgery, he exercises vigorously almost daily, doing 20-30 minutes per session of cardio. He also goes to classes like any other student: repeatedly walking the sets of stairs in his school, which he could not do prior to his surgery. In addition, “He is more high-spirited,” reports his mother, Tracy. “He feels so much better being able to exercise (and play basketball),” she says.
Grace Doran had her surgery in June, 2012. Eight months later, and both a swim and softball season successfully completed, she is up to 5 ½ days of school, no naps, and her sports, and she needs far less medication. Before her surgery, she could barely function for a 3-hour day, and needed significant medication and 12-14 hours per night of sleep.
Children present different physical and psychological responses to surgery and healing. Their inherent resilience and rates of healing make them good candidates for phrenic nerve surgery.
“In our two youngest patients with diaphragm paralysis we have observed and demonstrated tremendous improvements in respiratory function after phrenic nerve surgery. Our publications in the medical literature reporting the successful outcomes of our first several adult patients will soon be superseded by one that is much more comprehensive and includes the results of both our adult and pediatric cases.”
Just a year ago, on her birthday, Grace Doran was in the hospital, yet again. This time, on October 30, 2012, when she turned 12, she got her much-desired gift: a cell phone. Tristin Loitz recently got a gift as well: a home treadmill. Most children dislike exercise for its own sake. Not Tristin. He asks her mother every day to go on that treadmill.