Matthew R. Kaufman, M.D., FACS, a plastic and reconstructive surgeon at the Institute for Advanced Reconstruction at the Plastic Surgery Center in Shrewsbury, New Jersey, talks about a new procedure to treat a debilitating condition called diaphragm paralysis.
Interview conducted by Ivanhoe Broadcast News in July 2016.
You invented this procedure right?
Dr. Kaufman: I invented the application of standard techniques for this problem. I didn’t invent the methods or the surgical techniques. Because they are applied for various nerve problems though out the body. What’s unique is that we’ve taken a problem for which there was no true solution and applied these standard micro surgical methods and have been able to help patients with a unique problem that previously had not been able to recover function.
What was the impetus for creating that application, is it necessity being the mother of invention for you?
Dr. Kaufman: Yes, we have a unique practice and for many years we’ve had a presence for rare and esoteric nerve injuries. When I joined the practice based upon my unique training and having patients inquire as to whether there was a treatment for this particular problem and the more senior partners thinking that I was the best suited to sort of develop and work on a solution for this problem. There was an unmet need that we were seeing out there primarily from internet inquires. Because doctors didn’t know about anything that they could offer their patients and were telling their patients learn to live with it. When someone is told that, they get on the internet. They found our site and were inquiring as to whether we could help them.
Simply put the procedure and the application here does what?
Dr. Kaufman: The procedure is intended to restore function to a muscle that’s paralyzed. The muscle that we’re talking about is the muscle of breathing okay. The name of the muscle is the diaphragm muscle. Most people don’t know what that is but basically every time you take a breath that muscle is working. It’s the biceps of breathing. If that muscle is not working on one or both sides it’s going to lead to significant breathing impairments. Even though it’s not directly an impact on the lung, the lung has no muscle, the lung moves passively and the diaphragm is what’s doing all of the work. When the muscle is paralyzed the lung cannot function normally and the patient exhibits anywhere from moderate to severe breathing disturbances.
By doing this it enabled what?
Dr. Kaufman: By doing the surgery it restores partial or complete function to the paralyzed muscle and allows someone who has been suffering with this problem which usually means they’re unable to exercise, unable to lead a vibrant active lifestyle. Sometimes if they have a manual labor type job they’re not able to carry out the responsibilities of their job. We’re able to get them back to some reasonable level of function in that capacity or in those capacities.
Any numbers in general that would illustrate how rare or how prevalent, I presume more on the rare side it seems like, this condition is and the number of procedures that are done as a result are.
Dr. Kaufman: We have a hard time figuring out how prevalent or how likely it is that someone will develop this or how many people there are in the United States or in the world with this problem. But what we do know is that we receive roughly anywhere from five to ten inquires per week from around the United States; at least two hundred fifty to three hundred inquiries per year. These are new cases. We also know that certain of the more common causes as a result of surgical procedures such as heart surgery or nerve blocks for shoulder surgery we know that the incidence of this particular injury is about one percent in each of these procedures. There are thousands of these procedures being performed every year. We have to imagine that there are hundreds if not a few thousand new cases every year in the United States that add up and particularly if not being treated. We’ve done in a ten or eleven year period now about three hundred cases, most of those in the last five years since the surgery has been more recognized. We receive as I mentioned about three hundred inquiries per year at least.
When you say that certain other kinds of surgery that often cause this problem why, what’s happening there?
Dr. Kaufman: The surgeries that result in this injury are safe and the injury that occurs is very rare and not typical. For example, with heart surgery or surgery in the chest cavity based upon the location of where the nerves are located in relationship to where the surgeon is working sometimes it’s a result of scar tissue that develops around the nerve just from the surgery. Sometimes it’s an inadvertent occurrence related to having to stretch on the nerves or pull on the nerves to get to the area deep in the chest cavity. In the situation where someone goes in for a nerve block for shoulder surgery again it could be a perfectly normal procedure done perfectly well and because of inflammation in the area result in nerve compression. It’s somewhat similar to carpal tunnel surgery or carpal tunnel syndrome where there may be a cause or there may be no cause but someone may be susceptible to developing scar around the nerve that results in the problem.
How rewarding is it to you to know that you came up with something that’s making such an impact?
Dr. Kaufman: I think it’s extremely rewarding to be able to have a skill set and apply it not just for known problems and problems that we deal with every day but for a problem where the need is there and the treatment has not been fulfilled and you have people that are suffering; that their quality of life and even from a standpoint of risks of infection and breathing problems and breathing infections can be substantial. It’s quite rewarding to be able to offer them a treatment. At the same time you have to be careful with a new treatment because we want to make sure that it is proven, that it works. It’s taken many years to develop the outcomes and to develop the experience to say this definitely works. So yes it’s rewarding but you have to be very careful and not to over use a new treatment as well.
Have you any thought on the irony that you have these two patients, these two women that actually know each other and were playing tennis together and they come up with the same scenario and need to have the same treatment.
Dr. Kaufman: I think it’s very unique that two friends with two rare conditions would both find a surgeon that performs this and probably the only surgeon in the country and they both are here in New Jersey. It’s very ironic in many levels but the main thing is that we were able to help both of them and get them back to a rewarding active lifestyle. We also have patients that find each other on the internet through blogging with similar stories. We have virtual connection as opposed to this situation which is a real life you know connection. The goal is to educate both the population at large about this treatment option and also to educate the medical community. Most of the patients are still finding us by searching on their own. Slowly as the years go on and we’re publishing and trying to get the medical literature out and speaking at national and international conferences we’re getting more information out to the medical community who see these patients first hand and then is able to make a more educated decision about their treatment plan or whether to refer them for treatment.
It’s diaphragm paralysis or partial paralysis?
Dr. Kaufman: The name of the condition is diaphragm paralysis which means weakness or inactivity of the breathing muscle. It can be on one or both sides. For the patients that we’re talking about today it was a unilateral paralysis meaning a paralysis on one side, so they weren’t on a ventilator and they weren’t oxygen dependent but they couldn’t exercise, they couldn’t play tennis, they couldn’t have the energy to do things that they would otherwise do. It was like advancing them in age thirty years in terms of breathing capacity. The name of the surgery is called phrenic nerve reconstruction, phrenic nerve being the nerve that provides the impulse to the diaphragm muscle.
You are the only ones doing this?
Dr. Kaufman: We have the greatest experience by far. There are some other surgeons in the United States and in other parts of the world that I’ve corresponded with who are experts in nerve surgery. They know the techniques and I’ve helped them figure out who to perhaps apply them to. I think there are a few surgeons I know one in Canada and in Europe and a colleague in San Diego who they’ve done a smattering of cases to start to offer this to their patients as well.
You are definitely the only one doing it, you’re doing it the most.
Dr. Kaufman: Yeah, I think with any regularity we are you know the largest center for this problem.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
If you would like more information, please contact:
Heather O’Neill
732-741-0970 Ext. 158
honeill@theplasticsurgerycenternj.com
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