Dear Heather, Hope everyone is well in your  family and at clinic.  Can you please say a big hello to everyone and I have some news that you can pass on for me please. Have just had Lung Function tests today at Austin Hospital and compared with tests done at same place in December of 2010. I have attached these results and I am sure that Dr Kaufman will be happy to see a marked difference in the results. I also have had other improvements. Prior to Surgery I was only able to sleep on my right side ( which was damaged side), I now can sleep on both sides and my back as well. I have also noticed my ability to talk without getting a husky voice due to low air has gone and now I can talk the legs off a table!!!  I have been getting more active as weeks pass and have only had one short stay in Hospital due to Pneumonia and I recovered from that much quicker than I used to. I am starting new program of Rehabilitation and hope to achieve a higher standard of fitness than before. I will keep the updates coming and hope to hear from you soon. I hope you can tell that I was very happy today and pleased with results. PS Also pass on that Dr Kaufman”s scar is very neat and muscle is flattening out as he said it would.

Cheers Don Bird

Dr. Kaufman shares his reaction to Bird’s email:

“All of us at the Institute for Advanced Reconstruction are excited to learn that Don has been experiencing early clinical benefits from the nerve transplant surgery performed in November 2011.  Although we expect this regenerative process to take at least one year, these early signs of improvement increase the chances that he will continue to improve over this time period.  We will be following his progress very closely to completion and are happy that he has already detected some recovery in his respiratory function.”

By Walt Kilcullen: Original article found here

After a stroke, some survivors experience paralysis of one arm along with a clenched fist. If a nerve is injured preventing that nerve from sending signals to a muscle or muscles, the result is paralysis and loss of muscle function. This result is virtually no use of the affected arm and hand, and, in some cases discomfort. When a nearby tendon is not effected, it may be possible to transfer a functional tendon from its original attachment to a new attachment restoring some use to the non-functioning area.

What exactly is hand tendon transfer surgery? Below the elbow, there are between forty and fifty muscles. When a muscle or muscles are neurologically destroyed due to the stroke, they can no longer signal the arm or hand to function. There are three major nerves in the hand: the ulnar nerve, the radial nerve, and the median nerve. When any of these are injured or destroyed, paralysis, loss of feeling, and clenched fist is the result.

How successful is hand tendon surgery? Hand tendon transfer may be successful in restoring some function to the hand or arm. In a 2008 study in the Netherlands (LC Heijnen et. al.) six patients were followed who had hand tendon transfer surgery for clenched fist.

After the surgery, all six could passively open their hands in a resting position, and some flexible movement was gained in each case. There were no complications after nineteen months and all six patients were still able to keep their hands open. There was also permanent improvement in pain reduction and hygiene.

I asked Dr. Andrew Elkwood how much success he has had doing this surgery. Dr. Elkwood practices plastic surgery at the Plastic Surgery Center in Shrewsbury, New Jersey. He is considered an expert in nerve reconstruction surgery for patients who have lost the use of a limb due to nerve damage.

He has also been featured on the T.V. show, “The Doctors.” Dr. Elkwood was reluctant to profile what a good tendon transfer surgical candidate looked like because diagnosis depends on so many factors, such as how many nerves and or muscles are damaged, and to what degree they are damaged. He stated, “I like to examine, evaluate, and then give my assessment as to the expected results of surgery.”

Dr. Elkwood also told me that the hand is more difficult than the arm to restore. After surgery, even if function cannot be restored, at the very least, the patient will be able to open the hand. “No one gains 100% of function but there are some who show great improvement, some who cannot be helped at all, and many who fall in between these two categories.”

Tendon Transfer Surgery for Foot Drop

Seven years ago, Sandy Smethers, a stroke survivor that I was mentoring (and still am), was recommended by a neurologist to consider tendon transfer for her drop foot. We went to Pennsylvania University Hospital in Philadelphia to see Dr. Maryann Keenan, an orthopedic surgeon.

Dr. Keenan recommended tendon transfer surgery and she performed it shortly after our visit. Sandy’s surgery was only partly successful. Her foot was restored to a more normal position, but she still walks with a brace and a considerable limp. Her balance improved and she walks freely without a cane,

Foot drop, or drop foot has many causes and varied symptoms. A stroke survivor who has foot drop as a result of a stroke has difficulty lifting the front of the foot. As a result, the patient may drag the affected foot on the ground making walking difficult. Many patients will trip with a drop foot.

To compensate, one may raise the thigh unusually high, and may swing the affected foot out to the side to avoid lifting the thigh upward. The immediate aid is to wear a brace from the upper calf, down past the ankle extending under the entire foot. This will keep the foot in a normal position.

I was able to reach podiatric foot and ankle surgeon, Dr. Lawrence DiDomenico by telephone. Dr. DiDomenico is a podiatric physician and surgeon at the Ankle and Footcare Center in Youngstown, Ohio. Dr. DiDomenico stated,”withclassic foot drop, the common peroneal nerve is affected and leads to anterior and lateral (front and outside muscles of the leg) muscle group weakness which controls the foot.”

Diagnosis of the cause is imperative as that will determine the course of treatment. Dr.DiDomenico told me that treatment options for foot drop include prescribing a brace, gait training, physical therapy, and tendon transfer surgery.

You, as a patient must discuss these options with your podiatric surgeon or orthopedic surgeon. But once the diagnosis calls for tendon transfer, the tendon transfer surgery is performed with the goal of restoring the function of the foot and ankle to a more normal anatomical alignment so that the patient can walk on the sole of the foot with the heel touching the ground, improving gait and balance when walking in a shoe and without a brace.

Dr. DiDomenico told me that the large majority of tendon transfers for foot drop are done by podiatric surgeons and orthopedic surgeons that have an expertise and interest in foot and ankle surgery. “The surgery involves rerouting the posterior tibial tendon, a tendon that functions well from the back of the leg, and transferring it to the front of the leg and connecting it to the top of the foot. This compensates for the loss of muscle function in the front of the leg as a result of the stroke. Although 100% improvement is not expected, between 40% and 50% is typical.”

The Institute for Advanced Reconstruction’s New Jersey plastic surgeons, Doctors Matthew Kaufman, Andrew Elkwood, Tushar Patel and Russell Ashinoff have had their collective work published in Clinical Neurology and Neurosurgery. The full article, entitled “Diaphragm paralysis caused by transverse cervical artery compression of the phrenic nerve: The Red Cross syndrome” can be found by clicking the front page image above.

Foot drop describes the inability to raise the front part of the foot due to weakness or paralysis of the muscles that lift the foot. As a result, individuals with foot drop drag their toes along the ground or bend their knees to lift their foot higher than usual to avoid the scuffing, which causes what is called a “steppage” gait. Foot drop can be unilateral (affecting one foot) or bilateral (affecting both feet).

Although foot drop has a variety of causes, it can be the result of nerve damage alone, such as in Wisnewski’s case.

Wisnewski, a 45-year-old Beachwood, New Jersey resident, who works as a manager of a group home for the mentally disabled, started off at her primary care physician, who then sent her to an orthopedist. The orthopedist sent her to a neurologist, who gave her a brain scan to rule out any neurological problem. “It’s very frustrating when they can’t tell you what’s wrong,” she says. Finally, the neurologist referred her to Dr. Michael Rose of The Institute for Advanced Reconstruction located in Shrewsbury, New Jersey.

Fortunately for Wisnewski, Dr. Rose is among a handful of plastic surgeons trained in nerve decompression surgery for those suffering from all forms of neuropathy. He felt Wisnewski had suffered nerve damage in the knee caused by her fall. It could either be rectified by a nerve graft, or by the removal of scar tissue around the nerve. The latter, more conservative approach, worked for her.

Wisnewski is one of nearly 20 million Americans who suffer from neuropathy, a chronic condition that results from damage to or compression of the nerves outside the spinal cord and brain, and also referred to as peripheral neuropathy. According to Dr. Rose, traumatic neuropathy is common –and he sees a good deal of in his practice.

Within a week after surgery, Wisnewski had some movement in her foot. “Today,” she reports, “I feel like nothing happened.”

Says Dr. Rose, “I think the best advice is not to automatically accept it when you are told there is nothing that can be done. It took Fran Wisnewski three doctors until she was sent to the proper person. It’s just fortunate that her neurologist was aware of the work I do, and so she was sent to me. Many doctors would simply say: Learn to live with it; there is nothing we can do. It’s hard to believe, but often even very good doctors don’t know what cutting-edge procedures that other specialists are doing. There is simply so much to know, and so much new being discovered all the time.

“In an ideal world, Fran would somehow know to call me directly, but the reality is, most people to their general practitioner first for some direction, It wasn’t a straight line, but she did, in fact, end up at the right place in the end.”

Wisnewski appreciated Dr. Rose’s demeanor and knowledge. “You can tell he knows what he’s talking about. I had immediate confidence in him. He told me the surgery was not 100 percent guarantee, but he still gave me hope.”

Dr. Michael Rose gave Fran Wisnewski more than hope; he gave her a “rescue after a fall.”

Paul Nese with Dr. Michael Rose of the Institute for Advanced Reconstruction

Imagine your body—bones, muscles and skin—collapsing like a building. Now, imagine an actual building doing the deed. That’s what happened to construction worker Paul Nese, when, in October of 2011, he went into a building to oversee a job—a simple task that would be over in 15 minutes from when disaster struck. From 22 feet above him, 60 trusses, weighing 300-500 pounds each, came down, some of them landing directly on top of him.

The results were tibia and fibula (major bones) broken in his right leg, which also tore through his skin, a broken femur, fractured ribs, bone chips in his spine and severe herniated disks in his lower back. The 39-year-old Plainsboro, New Jersey, resident was rushed to the hospital, where he underwent several surgeries, lasting a total of approximately 15 hours.

Among those surgeons treating Nese, at this point at Jersey Shore Medical Center, was Dr. Michael Rose, who repaired the leg in which the bones had torn through muscle and skin. Dr. Rose salvaged what he could of the damaged muscle and did a skin graft from Nese’s thigh to his lower leg.

After undergoing some months of rehab, and additional surgery for what became the need for a full titanium hip replacement, Nese realized he had yet further damage. “When bones tore through my leg, they also tore tendons and caused nerve damage.” This caused Nese to experience foot drop as a result of the traumatic nerve damage, and also a severe case of traumatic neuropathy. “It was so painful from the calf to the tip of my toes. You know that painful tingling you experience when coming in from the cold? That’s what I had, only 24 hours a day.”

“This type of neuropathy is often overlooked in the aftermath of a life-changing injury when there are more pressing issues to which to attend. That being said, Paul (and others like him, who come into contact with me and our practice) was fortunate that I am familiar with and skilled at treating traumatic nerve injuries,” said Dr. Rose.

In all of Paul Nese’s misfortune, he had a stroke of good luck: a connection to Dr. Rose, who is among a handful of plastic surgeons trained in nerve decompression surgery for those suffering from all forms of neuropathy.

Nese is one of nearly 20 million Americans who suffer from neuropathy, a chronic condition that results from damage to or compression of the nerves outside the spinal cord and brain, and also referred to as peripheral neuropathy.

However, cases like Nese’s are more complicated because medical experts have to deal with the other injuries and make timing decisions for surgery for neuropathy. That being said, Dr. Rose points out that although one has to wait for other injuries to improve before working on the nerves, for the best surgical result for neuropathy, “the sooner the better in most cases.”

On Februrary 17, 2012, Nese underwent surgery with Dr. Rose, who did a tendon transfer on his toes, allowing his right big toe–that was completely hanging limp–to be connected and work with the rest of his toes. Dr. Rose also repaired the nerve in his ankle and on top of his foot.

Relief was immediate. “I experienced a huge result. It is so much better than it was,” says Nese. Of his overall recovery, Nese reports, “I’m able to sleep more comfortably, and not on constant pain killers. I’m looking forward to more future progress.”

In his 22 years working construction, Paul Nese had never had an accident prior to an event that so radically altered his life. But for those like Nese, who experience such life-altering events, medical experts such as Dr. Michael Rose can return part of the normalcy that was taken away.

By Melissa Dribben, Inquirer Staff Writer

The equipment that could add years to Kevin Neary’s life came in a flat gray box the size of a frozen taco dinner.

His father, Joe, pulled the device out of a backpack and placed it on the desk in a nondescript medical office park in Egg Harbor Township, N.J.

“Let’s do this,” said Neary’s surgeon, Matthew Kaufman.

“I’m ready,” said Neary.

click to read newspaper article

Three weeks ago, Kaufman operated on Neary in a South Jersey hospital, expecting to perform a delicate and rare procedure with about a 50-50 chance of success. He was going to salvage one of Neary’s healthy nerves, the one that allows him to shrug his shoulders, and transplant it to replace the phrenic nerve. If that worked, it would have taken six to 10 months before Neary could try using a pacemaker to fire up his diaphragm and breathe without the ventilator for minutes, perhaps hours, maybe even 24/7, if they were very, very lucky.

But once the surgery was under way, Kaufman discovered that Neary didn’t need a transplant after all. His phrenic nerve was intact and functioning. It had been merely caught in a clutch of scar tissue and shoved out of place. Kaufman cleaned out the biological muck, both freeing the nerve and giving Neary more mobility in his neck, then sent him home to heal.

Kaufman also was able to extract the bullet from Neary’s neck and gave it to him to take home. (The bullet, about 3/4 of an inch long and weighing less than an ounce, will be handed over to the Philadelphia District Attorney’s Office this week.)

As soon as the scars healed to pink and brown dashes above his collarbone and along his rib cage, Neary was anxious to try out his new equipment.

He, his father, and one of his nurses had been up before dawn Wednesday, preparing for the 90-minute drive from Upper Chichester.

“Not many health-care professionals are comfortable with this pacemaker,” said Kaufman, an elegant man in a dove-gray suit. He is 39, tall and thin, with the poise and posture of a ballet dancer.

“The only thing we want to do is turn it on and see if he’s getting responses. We don’t expect miracles today. This is like Week One of a four-week training for a marathon.”

Neary laughed. “I do a lot of walking and running in my spare time!”

Neary’s father reached into the backpack for a 9-volt battery to plug into the gray box, which would emit signals to the internal transmitters. Then he tore off strips of athletic tape to attach the antennae – two rubbery-looking circles – to his son’s chest.

Then Kaufman’s assistant called Kenneth Aron, the vice president of sales and marketing for Avery Biomedical Devices, the company that manufacturers the phrenic nerve stimulator.

The device was first approved by the FDA in 1986, Aron said. In 2003, actor Christopher Reeve, who had been paralyzed in a horse-riding accident, was part of a trial testing a system similar to the one Neary received.

A few dozen patients have been breathing with these pacemakers for 20 years, Aron said. Fewer than 100 a year are implanted.

From his office in Long Island, Aron would be guiding Kaufman through the test run. He had planned to monitor, by telephone, how well the device was working, but the connection was not clear enough. Kaufman, instead, would report Neary’s oxygen levels and heart rate and adjust the power of the electrical impulse accordingly.

“You’re going to have to walk me through this,” said Kaufman. Normally, the test run is handled by a pulmonologist or respiratory therapist, but there had been scheduling difficulties and Neary was impatient, so Kaufman agreed to get him started. There was no risk, he said, because if the device didn’t work, he would immediately put Neary back on the ventilator.

“How do we want the settings?” Kaufman asked Aron.

“My starting point would be 1.8 to 2.4 . . . look for maximum diaphragm contraction.”

“OK,” Kaufman said, talking over static on the phone line. “Are we on Mars yet? On the transmitter, the lever is switched to B. . . . Is that correct?”

Neary listened carefully, trying to follow.

“Hello?” Kaufman asked. The telephone connection was lost.

While the assistant redialed, Neary complimented Kaufman. “I like your shirt and tie,” he said, offering to send him something from his own collection. Before the shooting, he had started his own business, recruiting health-care staff, and had been an impeccable dresser. Now his injuries made sweatpants and hoodies more practical.

With Aron back on the line, Kaufman flipped a few switches.

“OK. Take the vent off,” he told the nurse.

“Nice!” said Neary. “I hate the vent.”

The room fell silent. Everyone stared at Neary’s chest. The machine beeped. His rib cage jerked suddenly. Then again. “He’s getting some movement,” Kaufman said.

For the first time since he was shot, Neary was breathing independently.

His dad began to cry and left the room to regain composure.

“Apollo has landed!” said Kaufman. “He’s cranking.”

“It feels weird,” Neary said, mouthing the words. It will take months for him to learn how to speak with the reversed flow of air. And over time, as his breathing muscles regain strength, the contractions will grow smoother.

After 14 minutes, Neary’s oxygen levels were still at 98 percent, but Kaufman didn’t want to push him too fast, too far. “Why don’t we switch him back to the vent?”

Neary shook his head, “No!”

“All right. We’ll go to 15.”

Reattached to the ventilator a minute later, Neary thanked Kaufman. “Good job, doc.”

“You’re on your way, my friend.”

...will be replaced by this small unit

The new pacemaker installed by Dr. Kaufman means that this large device on the back of Kevin Nealy's wheelchair....

Definition

A stroke is the sudden death of brain cells in a localized area due to inadequate blood flow.

Description

A stroke occurs when blood flow is interrupted to part of the brain. Without blood to supply oxygen and nutrients and to remove waste products, brain cells quickly begin to die. Depending on the region of the brain affected, a stroke may cause paralysis, speech impairment, loss of memory and reasoning ability, coma, or death. A stroke also is sometimes called a brain attack or a cerebrovascular accident (CVA).

Some important stroke statistics include:

• More than one-half million people in the United States experience a new or recurrent stroke each year
• Stroke is the third leading cause of death in the United States and the leading cause of disability
• Stroke kills about 160,000 Americans each year, or almost one out of three stroke victims
• Three million Americans are currently permanently disabled from stroke
• In the United States, stroke costs about $30 billion per year in direct costs and loss of productivity
• Two-thirds of strokes occur in people over age 65 but they can occur at any age
• Strokes affect men more often than women, although women are more likely to die from a stroke
• Strokes affect blacks more often than whites, and are more likely to be fatal among blacks

Paralysis

Paralysis is one of the most common disabilities resulting from stroke. The paralysis is usually on the side of the body opposite the side of the brain damaged by stroke, and may affect the face, an arm, a leg, or the entire side of the body. This one-sided paralysis is called hemiplegia if it involves complete inability to move or hemiparesis if it is less than total weakness. Stroke patients with hemiparesis or hemiplegia may have difficulty with everyday activities such as walking or grasping objects. Some stroke patients have problems with swallowing, called dysphagia, due to damage to the part of the brain that controls the muscles for swallowing. Damage to a lower part of the brain, the cerebellum, can affect the body’s ability to coordinate movement, a disability called ataxia, leading to problems with body posture, walking, and balance.

The specialists of The Institute for Advanced Reconstruction deal with some of the results of stroke. According to Dr. Andrew Elkwood, “Whereas we cannot cure stroke, we can sometimes help treat some of the results. We can sometimes mitigate the paralysis and help patients with increased function. It is possible to lessen some of the spasticity caused by stroke. Ultimately, the goal is to cure and prevent strokes; nonetheless, surgeons at The Institute for Advanced Reconstruction can help limit its devastating effects.”

Relevant procedures deal the results of most major types of stroke. These include:

Right-Hemisphere Stroke

A stroke in the right hemisphere often causes paralysis in the left side of the body. This is known as left hemiplegia.

Left-Hemisphere Stroke

The left hemisphere of the brain controls the movement of the right side of the body. It also controls speech and language abilities for most people. A left-hemisphere stroke often causes paralysis of the right side of the body. This is known as right hemiplegia.

Brain Stem Stroke

Strokes that occur in the brain stem are especially devastating. The brain stem also controls abilities such as eye movements, hearing, speech and swallowing.

Innovative Stroke Treatments at the Institute for Advanced Reconstruction

At the Institute for Advanced Reconstruction, the world famous surgeons have pioneered treatments to help reverse arm paralysis in some stroke patients. In fact, the Institute was the first and only center in the nation and probably in the world to successfully perform nerve reconstructive surgery in a stroke patient.

For more on this procedure, and on The Institute for Advanced Reconstruction, log on to www.advancedreconstruction.com

Caretakers are a critical part of plastic and reconstructive surgical care. However, even a thorough search of the Internet fails to account for the advice needed to optimally do this job. At the Plastic Surgery Center and The Institute for Advanced Reconstruction, we pride ourselves on fully informing both patients and their caretakers, thus providing knowledge and compassion on every aspect of patient care. It is yet another of the cutting-edge aspects of our practice.

Congratulations! You have the privilege of being the caretaker for a friend, family member or other person undergoing a cosmetic or reconstructive plastic surgery procedure. If you see this as an honor, you will enjoy being useful, and a positive force for your patient’s well-being, and ultimately, contribute to her* healing.

While it is important to undertake this task, depending on the procedure and your personal circumstances, evaluate whether you should be the sole caretaker.  In some cases, you may be better served by a professional caretaker (such as a nurse experienced in cosmetic surgery), or by having other back-up help. However, in most cases, simply following protocol, coupled with common sense, makes you perfectly qualified. Be assured that the appropriate steps are taken by your patient’s medical provider to make sure your patient is well cared for, and is safe before being released.

Your task is both a physical and psychological one. You want to take care of your patient’s basic needs, and support her emotionally with a competent, calm presence and positive attitude. Anyone can dispense a pill, but encouragement, an upbeat attitude and TLC can also be the best medicine for recovery.

That being said, and as you approach the procedure, if you are a friend or loved one, your concern for the patient is obvious. It is natural to be nervous for an impending procedure, and especially on the day of the surgery; remember that the doctor, nurses and staff at The Plastic Surgery Center and Institute for Advanced Reconstruction hear and see this all the time. It’s okay for your patient to express any anxiety (encourage it if necessary), and to let the staff use their expertise to reassure her. That can be amazingly calming. If you, too, are nervous, express that out of earshot of your patient, and allow the staff to comfort you as well. Additionally, post-surgery can also result in anxiety for your patient, for a variety of reasons. Understand that this is a natural part of the process, consult our staff if necessary, and just be a good listener. Remain upbeat.

As for practical matters: Prior to surgery, arrange all instructions and have on hand emergency telephone numbers and the number of a 24-hour pharmacy in case of need. At least one day before the procedure, review all paperwork for your patient, and pack it together with supplies. If you are new to the hospital or surgical facility, don’t simply print out directions or plug them into your GPS, but study them to ensure you have complete familiarity and avoid wasted time or anxiety by getting lost. Arrange to be freed up for any transportation, and for as long as necessary, for follow-up appointments and other needs, as some procedures require a longer break for a patient before she can resume driving.

The more competent and prepared you are, the more potential stress you take off the patient, and the more calm and confidence you inspire.

Here are a few other tips to ensure success in your role as caregiver:

Engage with the Staff - Get to know your patient’s doctor, nurses and support staff. Not only does it help to gather tips and inform yourself, a “kind word” is also appreciated by those working to serve you.

Make Yourself an Integral Part of the Process - If your patient is comfortable with it, go into all relevant pre- and post-procedure appointments so you will understand as much as possible. Ask any questions that will apply to the process. Post-surgery, carefully review with the medical staff how and when to change bandages or dressings, and deal with surgical drains if applicable.

Four Ears are Better Than Two - Listen to all instructions, and ask for any extra information not on the printed list. Write everything down—particularly since some of the most useful tips may come in conversation with the doctor, nurses and other expert staff. Take notes so you can remember everything and be well prepared. This takes a lot of the burden off your patient having to remember the details.

On Procedure Day, Be Prepared—for Your Patient and for Yourself - It is usually a long day(s), so have your supplies packed ahead of time. While you are of course focused on your patient, don’t forget yourself. Get a good night’s sleep prior to the procedure; bring water and snacks, and something easy to read (a novel or magazines) to pass the time. During your wait, take a walk or go for coffee or a meal, since it helps to break up the time and keep you fresh.

For post-procedure, pack extra clothing for warmth, have a large bottle(s) of water, with cups for easy drinking, as patients are instructed to hydrate well, and can get a head start on the way home (especially if it is a long drive).

Be Prepared for the Unforeseen - Next to doctor and staff, your patient relies on you—particularly in the crucial follow-up immediately following a procedure. Your understanding of the necessary post-operative care, and any signs that would alert you to telephone the doctor, allow you to confidently do your job.

Be Present, but Don’t Cling - You should not hesitate to be close and helpful, especially in the first 24 to 48 hours following surgery. Sleep nearby (in the same room if possible) and escort your patient to the bathroom or when she begins to walk around, since due to medications and being sedentary, some lightheadedness can be expected. Encourage your patient to get up and move as she is able, as walking helps facilitate recovery.

Help Your Patient Maintain a Healthy Recovery - Make sure she takes all medications–stay especially on top of pain medication as needed–and remind her to move her legs and or simply contract leg muscles frequently, to prevent the risk of clotting following anesthesia. Provide plenty of water, and make sure to include protein in every meal. Remember that your task can be tiring as well (such as being up in the middle of the night with your patient), and to continue to take care of yourself as well.

Provide a Patient Testimony - Encourage and assist your patient to write a testimonial, forms for which are provided by the practice; or, ask the staff how you can be most helpful. This is the best way of saying “Thank You” to your doctor, his/her staff and their practice for the service you have received.

While your patient may experience discomfort or moodiness, and at times you may feel stressed, hang in there. You are a vital part of your patient’s recovery. It is very satisfying to be a part of her care, and rest assured that she is grateful. Many of us can testify to the pleasure of hearing our patient express her thanks.

*The use of third person female, her, is used here to simplify the article. Men as well as women undergo these procedures at The Plastic Surgery Center and The Institute for Advanced Reconstruction

Read all about it, and see our video, on the practice website, http://www.advancedreconstruction.com/migraine-headaches/.

That’s what 29-year-old Kevin Neary told the Philadelphia Inquirer in a March 26^th article. But it has been an incredibly hard journey to reach that remarkable conclusion. After being shot in a robbery last November nearby his residence in Philadelphia, Neary remains completely paralyzed. Since then, his journey has gone from desperation and darkness, to hope and determination.

On March 27^th, Neary underwent surgery with Dr. Matthew Kaufman of The Institute for Advanced Reconstruction and the Center for the Treatment of Paralysis at Jersey Shore Medical Center, in an effort to salvage Neary’s phrenic nerve and install a pacemaker to hopefully make his diaphragm work.

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.

The Inquirer legitimately characterized this difficult procedure as having only a “moderate” chance of success. Then again, Dr. Kaufman’s phrenic nerve patients, who come from around the country and the world, hear that kind of discouraging news from other doctors all the time. That’s why they seek him out.

Fate dealt Kevin Neary a devastating blow, but fate also landed him in the hands of Dr. Kaufman, who is the only known surgeon to perform nerve transplantation to reverse phrenic nerve damage.

“Kevin’s procedure went much better than anticipated.  We went into the surgery anticipating severe nerve damage and were elated when both phrenic nerves responded to external stimulation.  The prospect of him successfully weaning from the ventilator is excellent.  We will be initiating this process in two weeks and are hopeful that he will be breathing independently in the weeks and months to come.” – Dr. Kaufman

In the Inquirer article, Neary concluded, “If I can get off the ventilator for six hours, that’s a work day, or enough time to enjoy a Phillies game,” Neary said. “Work is a big part of who I am. It’s work and baseball for me.”

At the hands of Dr. Matthew Kaufman, Neary may, in fact, see the World Series hopeful Phillies repeat their 2008 title.

Neary underwent surgery with Dr. Matthew Kaufman of The Institute for Advanced Reconstruction and the Center for the Treatment of Paralysis at Jersey Shore Medical Center, in an effort to salvage Neary’s phrenic nerve

You can view the articles by clicking on the pictures below.

Click Here to Listen to Dr. Rose

(Lansford, PA–March 1, 2012) Carrie Marrero, Robert Marrero’s wife, says her husband “always loved football.” And she did too. Rob was expressing that love playing in a semi-pro game in Pennsylvania when the unthinkable happened. He took a hit that would forever change his life, and the life of his family.

Carrie, the mother of the couple’s two children, a boy age 11 and a girl age 2, explains: I was sitting in the car with the kids to avoid the rain. One of Rob’s teammates tapped on my window. “Rob is down and he’s asking for you. He can’t feel his legs.”

Initially, Carrie, who knows her football from growing up watching the sport, says, “I thought it was just a stinger, common in football; you get hit and go numb for a few minutes. Rob had that before.” This time, she knew it was different, “I could tell by the look on his face.”

Still, she held out hope, until she made it to the hospital where Rob was in the ICU. That’s when she was told her husband had a broken neck in three places, and that he was paralyzed from the neck down.

That was on May 7, 2011, and since that day, “There is nothing about life that hasn’t changed,” she summarizes.

According to the Spinal Cord Injury Information Pages, approximately 11,000 new spinal cord injuries occur each year, and 52 percent of them are considered paraplegic, like Rob. Among the 250,000 Americans with spinal cord injuries, 82 percent of them are male, and the average age of a spinal cord injured person is 31. That’s exactly Rob Marrero’s age.

It was an event in the ICU that eventually led Carrie to find Dr. Matthew Kaufman of The Institute for Advanced Reconstruction. The medical staff was adamantly trying to get Rob to cough, to keep his lungs clear. They told him if he couldn’t cough, they would have to put him on a ventilator and that if they did, “we don’t know if we can get you off.” Unfortunately, his attempts were not sufficient.

It was during rehabilitation in Philadelphia that Rob’s phrenic nerve was tested, and the results were not good. “Our hearts were broken,” says Carrie, who cried yet another river of tears. As in so many cases with Dr. Kaufman’s patients, the Marrero’s were told there was nothing that could be done.

Says Carrie, “Because I love my husband terribly and didn’t accept that diagnosis, if there was anything that could be done, I was going to find it. I researched my butt off.”

Nine months after his accident, on March 16th, Dr. Kaufman will operate on Rob phrenic nerve at the Center for Treatment of Paralysis & Reconstructive Nerve Surgery at the Jersey Shore University Medical Center, with the goal to make him eventually breathe independently of the respirator.

The couple, from Lansford, Pennsylvania, met 13 years ago. Rob, who had grown up in foster care, and Carrie, who has only her mother living nearby, are pretty much on their own. They have gotten minimal help, but are grateful to Rob’s employer prior to the accident, Gordon Food Service in Pottsville, PA, who moved them into a new, one floor home in only two hours.

Carrie, Rob’s full-time caretaker, was well-trained by the rehab facility, and is a diligent researcher. “I wanted to learn everything I could,” she says.

But how does a parent ever learn how to make a son, who is struggling with the feeling his dad has been taken from him, understand the kind of thing that has happened to his father?

The Institute for Advanced Reconstruction’s New Jersey reconstructive surgeon Dr. Andrew Elkwood was featured on a recent episode of daytime television talk show “The Doctors”.  In his appearance, Dr. Elkwood spoke about his revolutionary BARS hernia treatment.  If you missed Dr. Elkwood’s segment on “The Doctors”, visit their site and view the “Complacency and Hernia” segment from their recent video library!

Directed by Daniel Junge and Pakistani filmmaker Sharmeen Obaid-Chinoy, “Saving Face” follows several survivors, and narrates the tale of their fight for justice, and a Pakistani plastic surgeon who has returned to his homeland to help them restore their faces and their lives.

In 2010, at least 8,000 acid attacks, forced marriages and other forms of violence against women were reported, according to The Aurat Foundation, a local nonprofit. Because the group relied mostly on media reports, the figure is likely undercounted.

As surgeons at The Institute for Advanced Reconstruction, we are often faced with performing life-saving surgery, particularly using microsurgery techniques. This includes deformations following illness or accidents.

We applaud the recognition of those plastic surgeons who heal, and whose ranks we are proud to be a part of.

In my experience with cases of diaphragm paralysis (caused by injury to the phrenic nerve) there are unfortunately many people unable to find and receive treatment. This is due to the relative rarity of the condition, and the lack of comfort on the part of many pulmonary and neurology specialists. Furthermore, there is often a mis-diagnosis of their condition, or even worse, a belief that diaphragm paralysis does not cause severe dysfunction and therefore does not require treatment.

Under these circumstances many people take matters into their own hands, and begin searching the Internet. We often see patients who have done extensive research into their condition, and generally have more knowledge than most of the physicians they have seen previously.

This blog post from a former patient elaborates on the problem of phrenic nerve injury, and illustrates the need to get the word out on this topic. While I am gratified at being titled the “one surgeon in the world who could help me” by the blog’s author, Steve Crozier, what I appreciate even more is any effort to let people know that there is possibly light at the end of a tunnel for those who suffer from diaphragm paralysis.

Read the article here:

Matthew R, Kaufman MD, FACS

To listen to Dr. Rose’s live interview on March 12, please visit: http://w4wn.com/

There will be a rebroadcast of his segment on Saturday, March 17 at 1:00 p.m.

*Women 4 Women network is the world’s number one Internet radio station for women.*

That’s when her primary care doctor told her, “I think I know someone who can help you.” That someone was New Jersey plastic surgeon Dr. Russell Ashinoff of The Institute for Advanced Reconstruction in Shrewsbury, NJ.

Lockhart described her first meeting with Ashinoff, “He spoke to me for a few minutes, and asked to see the infection. Most doctors would just pull off the cover and look, but he took care to place a blanket over me.” His kindness immediately impressed her.

Following her recovery from the infection, she went to the offices of The Plastic Surgery Center, where Dr. Ashinoff explained to Lockhart, her mother and sister, the operation that would remove the excess skin of her lower stomach and repair her abdominal hernia. This skin, which hung to her knees, was the site of recurrent infections and severely restricted her ability to move around.

On September, 27, 2011, Helen Lockhart had her post-bariatric surgery. The surgery was designed to take off the excess skin and fat from her lower abdomen. The weight Dr. Ashinoff took off, coupled with what she has lost through subsequent diet and exercise, accounts for 86 total pounds.

According to Dr. Ashinoff, “When a patient has a large amount of skin and fat of the lower abdomen, it is really a vicious cycle. It prevents her from exercising and leads to more weight gain. This procedure allows us to break this cycle and give patients their lives back. Helen is an amazing woman who always puts others first. The first thing Helen asked me when she woke up was, “How are you feeling Dr. Ashinoff?” Her great attitude really helped the recovery process.”

Following the surgery, she spent nearly three months Laurelton Village Rehabilitation Center in Brick, New Jersey, where they offer all types of physical therapy. Her experience led her to plan on returning to volunteer to assist with other patients. “They called me the cheerleader of the floor, since I was always encouraging other patients.”

Currently, Lockhart walks outside a half-hour daily, supplemented with a build-up of more walking time on her indoor treadmill—all which she has been able to do as a result of her surgery. “I can walk better, breathe better. I can do everything better,” she testifies.

“The surgery was a lot to do, but I’m glad I did it, and I’d do it again. I’m very happy,” says Lockhart.

As for Dr. Ashinoff, Helen Lockhart reserves the highest praise, “He’s the most kind and compassionate man ever.”

“There are days when my headache is so horrible, my vision is impaired, everything is blurry, I feel nauseous like I am going to throw up, and nothing seems to matter. It becomes a waiting game and I don’t know how long it is going to last,” says Schulpheiz, 46, of Middletown, New Jersey. 

Schulpheiz began experiencing headaches within the last ten years when other medical issues arose. At first she accepted the headaches as part of her condition and began taking ibuprofen almost daily. Years went by before her neurologist diagnosed her with cluster migraines–a neurological disease that entails a massive amount of pain to the head.

The headaches interfered with her daily life. According to Schulpheiz, a previous executive, work wasn’t even an option. She began postponing deadlines and appointments. She moved from Manhattan to New Jersey, where she currently resides, with a great support system of friends and family.

In 2006, Schulpheiz was treated for migraines with Botox® in New York. At the time, the procedure was controversial (pre FDA approval), and after two treatments she stopped and began oral medication. Initially, the oral medication proved to be very helpful, but after two years of taking it she started to experience adverse side effects. 

Schulpheiz claims, “If you looked at me you could see that I was in pain. I had such a headache that I would look mad because my face was so scrunched up.” Her neurologist finally recommended Botox injections with New Jersey plastic surgeon Dr. Matthew Kaufman.  This time she was confident. She received her first Botox injection in April of 2010 and then again in July. Following a break in treatments due to problems with her insurance company, she has resumed the Botox injections.

Many ponder, says Schulpheiz, why put Botox into your system? According to Schulpheiz, “Other medications have basically all had the side effects. Dr. Kaufman injected me exactly where the pain is and it goes right to the area that needs treatment, versus the oral medicine, that travels throughout my body and gets into my bloodstream.” She even described how she felt immediate relaxation to her “scrunched up” face following the Botox injections.

Dr. Kaufman assures Faith that if she received relief after minor treatment, one day she could have more a more permanent improvement. “I know I have other medical issues but if I can have relief in one area of my life, why not?” 

According to Dr. Kaufman, “Faith has been suffering with migraines for many years and had trouble finding a successful treatment.  She has responded extremely well to Botox therapy, and it has allowed her to regain a more normal and functional life.  We anticipate continuing Botox therapy for the next few months, and will consider offering her the nerve decompression surgery that we sometimes perform in patients who have responded well to Botox therapy. The surgery is essentially the “surgical equivalent” of what Botox does on a temporary basis.  Therefore, the surgery has the potential to provide a more permanent reduction, or possibly even elimination, of migraine headaches.  Of course, not everyone will benefit from migraine surgery, so it is important to speak with a surgeon who is skilled and experienced in this surgical technique.”

For more information on migraine relief, log onto The Institute for Advanced Reconstruction’s Migraine Headache Treatment page.

Dr. Matthew Kaufman with migraine patient Cheri Weiss

Migraine headache patient finds relief with cutting-edge BOTOX® treatment with Dr. Matthew Kaufman of The Institute for Advanced Reconstruction

Cheri Weiss endured headaches throughout her life, to the point where she would carry ibrupofen every day during high school.  She began experiencing migraine headaches and occipital neuralgia — a medical condition characterized by intense, chronic headaches — at 21 years old, in the second year of her Physician’s Assistant program.  She knew about aneurysms and assumed the worst:  “I took five ibruprofen and went back to bed, assuming I was going to die.”

Weiss survived the ordeal, but realized she was in a new and escalating battle with her headaches. She continued to suffer through the migraines and occipital headaches for over a decade.  Despite the support from her family and friends, they simply couldn’t fully grasp what she was going through, Weiss says:  “Unless you feel that kind of pain, it’s really hard to completely understand.” This from someone who truly understands, especially since she also works in a pain management practice.

Misdiagnosed with tension headaches, Weiss was unaware of a family history of migraines stemming from the women on her father’s side of the family; a common phenomena,  women suffer from migraines nearly three times more than men.  At the peak of her crisis, Weiss was suffering from an average of 23-25 occipital headaches and migraines per month.  Despite the crippling effects of the headaches, which can often cause dizziness, nausea, light sensitivity, and more, the nature of Weiss’s job meant that she could not afford to miss work.

After being diagnosed with migraines and occipital neuralgia, she began treatments with a typical migraine drug.  She then switched to an anti-caesural drug typically used to treat migraines, but suffered from adverse side effects despite seeing moderate results in pain relief.  Experimenting with acupuncture proved useful as well, but when her migraines became an almost daily occurrence in June of 2010, she sought out alternate treatments.

With her knowledge from years of work in the medical field, Weiss knew what she wanted.  After receiving a few occipital nerve block treatments from a pain management physician, she decided to try Botox® to provide a more extended relief.  “Botox works well, is safe, and isn’t something you have to take all the time, like medicine,” says Weiss.  She specifically chose Dr. Matthew Kaufman of the Institute for Advanced Reconstruction because of her work with him in the ER, and because of his expertise in plastic surgery, specializing in head and neck.  “Because I worked in the profession, I knew what I was looking for.”

Says Dr. Kaufman, ” We have been treating many migraine sufferers with BOTOX® for the last 6 years and have observed how well it can reduce or, in some cases, eliminate severe headaches.  For individuals who cannot tolerate the side effects of more traditional medicines, or who have experienced severe headaches despite therapy, BOTOX® should be a consideration.  Prior to treating any patient with BOTOX®, I ask that they consult with a neurologist, or headache specialist, to undergo a comprehensive headache evaluation.”

To the Editor:

I am in full agreement that as a means to guarantee against interference by pharmaceutical companies in doctors’ judgment, the federal government has an obligation to regulate certain marketing practices by drug and device manufacturers.

Let’s please apply the same standard to those who are imposing these regulations and document all the ways in which these same manufacturers are allowed to influence our elected representatives in their decision-making process through lobbying.

The hypocrisy here is unreal.

JONATHAN M. WEISWASSER
Shrewsbury, N.J., Jan. 17, 2012

The writer is a vascular surgeon.

I was reviewing migraine statistics on the Internet and was amazed to read that there are over 300 million people worldwide classified as migraneurs – people suffering from migraine headaches.  In the Unites States alone, migraines impact 12% of the population, or roughly 4 million people.  That is a tremendous number of people suffering through their daily lives with intolerable headaches.  People with chronic migraines are dealing with headaches more than 14 days out of every month.  I could imagine how a migraine, added to all of life’s other daily challenges, makes it virtually impossible to function at work and at home.

Despite the availability of excellent medical therapies to treat migraines, many individuals just cannot seem to find sufficient relief, even with these medications.  Other people may experience some improvement, but cannot tolerate the side effects of the medications.

Botox® therapy for migraine headaches has been around for several years and has more recently become approved by the U.S. Food and Drug Administration (FDA) as a migraine treatment.  The FDA promotes the use of Botox® as an effective way to prevent migraine headaches.

When I began treating migraine sufferers with Botox® six years ago, there was a great deal of skepticism regarding its true benefits.  Naysayers speculated that patients were coming in to get their wrinkles eliminated under the guise of a migraine treatment.  It did not take long for these sentiments to change when migrainepatients in my practice, and others being treated around the country, were noticing often dramatic relief from these periodic injections.

Fast forward six years later – now we promote Botox® as a very effective treatment for many patients.  Those patients that benefit from injections report they now can get through their day, being productive at work, taking care of family duties, and even resuming an exercise regimen, things that were not possible prior.

Botox® therapy for migraines is best performed every three months as a series of injections into suspected migraine “trigger points”.  I find that patients notice the most significant improvements over successive treatments and that is why I do not deter patients from getting follow-up injections even if the first or second sessions do not result in much change.  The injections are relatively painless and can be performed with minimal concern for pronounced bruising or swelling.

Obviously, not every migraine sufferer will benefit from this form of therapy, however it may be worth investigating Botox® therapy for migraines if you, or someone you know is suffering the chronic effects of this common, debilitating condition.

Matthew R. Kaufman, MD FACS

Clinical Neurology and Neurosurgery is devoted to publishing papers and reports on the clinical aspects of neurology and neurosurgery. It is an international forum for papers of high scientific standard that are of interest to Neurologists and Neurosurgeons world-wide. Professor Peter Paul De Deyn, Scientific Director of the Institute Born-Bunge at the University of Antwerp, Belgium, is the Editor-in-Chief.

Dr. Kaufman has continued to expand his unique expertise in the area of phrenic nerve surgery. Recently, he has also been published in the CHEST journal and presented a paper at October, 2011 CHEST seminar in Hawaii.