The Cancer Center at Northeast Georgia Medical Center (NGMC) is offering a new clinical trial for patients with previously untreated Stage IV pancreatic cancer. All patients enrolled in this clinical trial will receive the standard chemotherapy used to treat pancreatic cancer and some will receive chemotherapy in combination with a novel monoclonal antibody called bavituximab. NGMC is one of five sites in Georgia participating in the study.
“In prior clinical studies for other cancers, bavituximab in combination with chemotherapy has demonstrated promising tumor response and survival for cancer patients when compared to separate studies using chemotherapy alone,” says Andrew W. Pippas, MD, an oncologist at the John B. Amos Cancer Center and Principal Investigator of the clinical trial for the five trial sites in Georgia.
This clinical trial is provided through the Georgia Center for Oncology Research (Georgia CORE). Georgia CORE, which was established as a catalyst to increase availability of and access to clinical trials, is one of only a handful of research alliances and centers across the nation offering this trial.
Pancreatic cancer is among the deadliest cancers in the United States with a five-year relative survival rate of just six percent. As part of an effort to double the survival rate for the disease by 2020, the Pancreatic Cancer Action Network is calling attention to the need for increased participation in clinical trials. Clinical trials are vital to making progress and developing new treatments for any disease. In particular for pancreatic cancer, the lack of treatment options currently available for patients make clinical trials an extremely important part of the research process as scientists seek new, better treatment options that will ultimately increase survival.
“Clinical trials are especially important for pancreatic cancer because so few effective treatment options exist, which is reflected in the dire statistics for this disease. Through participation in clinical trials, patients have access to cutting edge research and are taking an active role in advancing pancreatic cancer research. Clinical trials pave the way to therapeutic breakthroughs,” said Julie Fleshman, president and CEO of the Pancreatic Cancer Action Network.
To learn more about this clinical trial at the Cancer Center at NGMC, call 770-219-8820 or visit Cancer Trials.
Interventional pulmonologists at Emory University Hospital are now offering Bronchial Thermoplasty, a new procedure that shrinks excessive airway smooth muscle (ASM) that lines the bronchial airways using controlled thermal heat. Removing some of the airway smooth muscle decreases the ability of the airways to constrict, leading to a reduction in the amount and severity of asthma attacks.
Patients with severe persistent asthma experience frequent symptoms such as coughing, wheezing, shortness of breath, chest tightness, mucus production and severe asthma attacks, leading to a diminished quality of life. These symptoms account for a substantial portion lost work days, frequent physician office visits, emergency room visits, extended hospitalizations, and missed school or other daily activities.
“Many symptoms of asthma are thought to be due to the contraction of airway smooth muscle, leading to a constriction or narrowing of the bronchial air path. Increased airway smooth-muscle mass is a characteristic feature of asthma, particularly in persons with severe asthma,” says Rabih Bechara, MD, director of interventional pulmonology and assistant professor of medicine, Emory School of Medicine. “Bronchial thermoplasty is a novel intervention where thermal heat energy is delivered to the airway wall during a series of bronchoscopies, resulting in a prolonged reduction of airway smooth-muscle mass.”
Bronchial thermoplasty is performed under anesthetic in three outpatient procedure visits, each scheduled approximately three weeks apart. The first procedure treats the airways of the right lower lobe, the second treats the airways of the left lower lobe and the third and final procedure treats the airways in both upper lobes.
During the minimally-invasive procedure, a thin, flexible instrument called a bronchoscope is inserted into the airway. The bronchoscope is a long flexible tube that has a camera on one end, and also allows the physician to see inside the lungs without an incision. Once inserted, the thermal heat energy is delivered to the airway smooth muscle, shrinking it, and, in effect, further opening the airway for improved breathing function.
The procedure is FDA-approved and, although still a relatively new procedure, it has proven successful for patients suffering from severe asthma. Currently, however, the procedure is not yet covered by Medicare or through most major insurance providers – although physicians expect that will change as success of the procedure continues to show a reduction in hospitalizations and other ongoing care related to severe asthmatic symptoms
“Thermoplasty has proven to decrease asthma exacerbation rates and lower rescue inhaler use. We have seen a much improved quality of life in the patients we have treated,” says David Berkowitz, MD, assistant professor of medicine at Emory. “The procedures are done on an outpatient basis. Most patients experience very minor discomfort and can quickly return to work or other normal activities within a day. The overall reduction in breathing discomfort, lost work or school days, and general disruption of normal life activities has been evident in most of the patients we treat.”
Piedmont Heart Institute Physicians are currently accepting patients for the Medtronic CoreValve U.S. Clinical Trial. Piedmont Hospital is one of 40 hospitals across the United States to participate in the trial to evaluate a revolutionary non-surgical, less-invasive procedure as a treatment alternative to open-heart surgery for patients with severe aortic stenosis.
Patients who have severe aortic stenosis as well as a predicted high risk of requiring aortic valve surgery may be eligible to participate in the clinical trial. For more information about the CoreValve trial and eligibility, visit clinicaltrials.gov and search for the CoreValve trial.
“With an estimated 5 percent of those over the age of 65 experiencing some form of aortic stenosis, there is significant need for new treatment options that do not involve invasive surgery,” said Piedmont principal investigator Vivek Rajagopal, M.D., an interventional cardiologist with Piedmont Heart Institute Physicians. “As the population ages, the need for this procedure will continue to grow.”
According to an abstract published in the European Heart Journal in 2003, worldwide, approximately 300,000 people have been diagnosed with this condition (100,000 in the United States), and approximately one-third of these patients are deemed high risk for open-heart surgery, the only therapy with significant clinical effect that is currently available in the United States.
For trial participants randomly selected to receive the CoreValve System, physicians channel a catheter (thin tube) with a porcine, prosthetic valve through a small opening in the patient’s femoral artery to reach the heart. The physician guides the CoreValve System to the aortic valve, where it self-expands to replace the diseased aortic valve; the procedure is completed without open-heart surgery or surgical removal of the native valve.
In the United States, the CoreValve System will not be commercially available until the successful completion of this clinical trial and approval by the U.S. Food and Drug Administration (FDA). The CoreValve System received CE (Conformité Européenne) Mark in Europe in 2007.
For more information or to be considered as a participant in the trial, contact the Piedmont Heart Institute at 404-605-5003 or email phri@piedmont.org.
Transplant and reconstructive surgeons from Emory University Hospital successfully performed a rare complete hand transplant on 21-year-old.
The 19-hour surgery took place on Saturday, March 12 and involved multiple teams of surgeons, anesthesiologists, nurses, and operating room support staff. Two teams – one dedicated to the patient – and the other to the donor arm – successfully completed the surgery at approximately midnight.
The intricate surgery involved the connection of numerous structures including bones, tendons, nerves, vessels and finally the skin. The patient was placed in a protective splint for 48 hours and is now wearing a high-tech brace that supports the limb while she begins the long process to gain function of her new hand.
Following the surgery, Lu began rehabilitation at Emory. At the news conference she said she understands that it will never be a normal hand, but not having a left hand since she was an infant, “I expect it to help in simple everyday activities.” She went onto say “right now I am filled with emotions and I don’t think that there is really anything that can describe how I feel, other than just happiness, hopefulness and of course thankfulness.”
“This is an exciting time for our patient, her family, and the reconstructive community in general. Ms. Lu is doing very well. She is referring to her transplant as ‘my hand,’” says Linda Cendales, MD, Assistant Professor of Surgery at Emory University School of Medicine.
The Emory University-Veterans Affairs Vascularized Composite Allograft (VCA) Program was created in late 2007 with the recruitment of Dr. Cendales who has worked to develop one of the nation’s premier centers for reconstructive transplantation. This case is among the small number of hand transplants that have been successfully performed in the U.S. and puts Emory among only four centers to have successfully performed the procedure. The first hand transplant in the U.S. took place in Louisville at the center where Dr. Cendales trained, and where in 1999, she was on the team that performed the nation’s first hand transplant.
The program at Emory and the Atlanta Veterans Affairs Medical Center was spurred by a grant from the Department of Defense administered through the Navy Bureau of Medicine and Surgery’s Medical Development Program with the strong backing of U.S. Senator Saxby Chambliss (R-Ga.).
“This represents a great success for Emory and for medicine,” says Sen. Chambliss. “The procedure they have demonstrated will benefit many people including members of our military who have suffered from injuries in Iraq, Afghanistan and elsewhere. I am proud and grateful for the dedicated leadership, physicians, and researchers at Emory who made this extraordinary breakthrough possible.”
The first hand transplant in the world was performed in 1964 in Ecuador, before the development of modern immunosuppressive medications. The recipient, a sailor, had to have the transplanted hand amputated two weeks after surgery because of tissue rejection. The next hand transplant was performed in France in 1998 and endured more than two years before the recipient stopped taking immunosuppressive medication and asked to have the hand removed.
The Louisville team’s first hand transplant is currently the longest surviving hand transplant in the world. Dr. Cendales was also involved in the team’s second hand transplant in 2001.
Surgeons have already tackled many of hand transplantation’s technical challenges, Dr. Cendales says. Issues involved in reattaching a severed limb, such as dealing with crushed bone or mangled connective tissue can make “replantation” more technically demanding than an organ transplant, she says. But vascularized composite transplantation continues to advance by leaps and bounds, with recent reports from around the world of transplants including faces, trachea, and larynx.
Saint Joseph’s Hospital was selected to participate in Medtronics CoreValve U.S. Clinical Trial. The CoreValve could provide a new therapy for patients with aortic stenosis who are considered inoperable.
As a participating site in this nationwide clinical trial, Saint Joseph’s cardiologists and cardiac surgeons will be evaluating a new, non-surgical alternative to open-heart surgery for patients with severe aortic stenosis (abnormal narrowing of the aortic valve) who are at high risk for surgery or cannot have surgery. During the catheterization, cardiologists will replace a patient’s failing aortic valve with the prosthetic CoreValve which uses self-expandable technology to deploy inside the diseased aortic valve, effectively eliminating the need for open-heart surgery or surgical removal of the native valve. Once the CoreValve is in place, it takes over the native valve’s function, ensuring that oxygen-rich blood flows into the aorta and circulates throughout the body.
Approximately 100,000 people in the U.S. suffer from sever aortic stenosis and one-third are considered inoperable; currently, surgical replacement is the only therapy with significant clinical effect that is available in the United States.
The Medtronic CoreValve U.S. Clinical Trial will enroll a total of more than 1,300 of these patients through 40 U.S. clinical sites. For more information about participating in this clinical trial, contact Rita Campbell, RN, CCRC at 678-843-5578.
For more information about the Medtronic CoreValve U.S. Clinical Trial, visit aorticstenosistrial.com.
A new clinical trial underway for patients with atrial fibrillation — using an implantable device — may eliminate the need for a common blood-thinning medication, according to researchers at Emory University Hospital Midtown.
Atrial fibrillation (commonly called A-fib) is a heart condition in which the upper chambers of the heart beat too fast, causing an irregular heartbeat and ineffective pumping action. This condition can cause blood to stagnate or pool and form clots in the left atrial appendage (LAA). If a clot forms in this area, it can increase the chances of having a stroke.
Many patients with A-fib are prescribed blood-thinning medications, such as warfarin (brand name Coumadin), to prevent blood from clotting. This medication is effective in reducing the risk of stroke, but may cause side effects such as bleeding. Blood-thinning drugs can also be affected by other factors, such as diet and other medications, and require frequent blood draws to monitor dosage levels.
The trial, called PREVAIL (Prospective Randomized EVAluation of the Watchman LAA Closure Device In Patients with Atrial Fibrillation Versus Long Term Warfarin Therapy), involves implanting via catheter a small, umbrella-shaped mesh device, called the Watchman closure device, into the heart chamber to prevent stroke. This is a confirmatory study (and the third study testing the implant), which will also look at safety and efficacy of the device.
“We have had good success with this device in A-fib patients in two previous studies,” says David De Lurgio, MD, associate professor of medicine in the Division of Cardiology, Emory University School of Medicine and principal investigator of this clinical trial. “We implant this device into the left atrial appendage of the heart, closing it off. This prevents blood clots from escaping and entering the blood stream, which could lead to a stroke.”
De Lurgio and his colleagues have had five years of experience with this technology thus far. Emory Healthcare is the only health system in Georgia providing access to this device though participation in this clinical trial.
Patients are randomly selected by computer to either receive the Watchman device or remain on Coumadin without the device (control group).
In those selected to receive the device, physicians will implant the small device following a trans-esophageal echocardiogram, which images the LAA for any blood clots. After implantation, these patients will remain on Coumadin for 45 days, then the heart will be re-imaged. If the heart tissue has healed, participants will be taken off Coumadin and placed on aspirin therapy and possibly clopidogrel (Plavix), an anti-platelet medication.
Researchers will then follow study patients with and without the device for five years, monitoring those who have come off of Coumadin very closely. If the FDA approves the device at the end of this clinical trial, those patients in the control group will then have the option to receive the device.
“If approved by the FDA at the end of our five year study, this device will give A-fib patients an alternative treatment option to using Coumadin,” says De Lurgio. Angel Leon, MD, professor of medicine, and Mikhael El Chami, MD, assistant professor of medicine, both in the Division of Cardiology at Emory, are also involved in this study.
Teenagers who consume a lot of added sugars in soft drinks and foods may have poor cholesterol profiles — which may possibly lead to heart disease in adulthood, according to first-of-its-kind research reported in Circulation: Journal of the American Heart Association.
“Added sugars” are any caloric sweeteners added to foods or beverages by the manufacturer during processing or the consumer.
The National Health and Nutrition Examination Survey (NHANES) of 2,157 teenagers (ages 12 to 18) found the average daily consumption of added sugars was 119 grams (28.3 tsp or 476 calories), accounting for 21.4 percent of their total energy.
The American Heart Association recently recommended a specific upper limit for added sugars intake, based on the number of calories an individual needs throughout the day, according to their energy expenditure, sex and age. For example, an appropriate amount for an individual with an energy requirement of 1,800 calories per day (an average teenage girl aged 14-18 might be in this calorie range) would be no more than 100 calories from added sugars. An individual with a requirement of 2200 calories per day should eat or drink no more than 150 calories from added sugars.
Teens consuming the highest levels of added sugars had lower levels of high density lipoprotein levels (HDL), the good cholesterol, and higher levels of triglycerides and low density lipoproteins (LDL), the bad cholesterol.
“This is the first study to assess the association of added sugars and the indicators of heart disease risk in adolescents,” said Jean Welsh, M.P.H., Ph.D., R.N., study author and post-doctoral fellow at Emory University in Atlanta, Ga. “The higher consumers of added sugar have more unfavorable cholesterol levels. The concern is long-term exposure would place them at risk for heart disease later in adulthood.”
Teenagers with the highest levels of added sugar consumption at more than 30 percent of total energy had 49.5 milligrams/deciliter (mg/dL) compared to 54 mg/dL of HDL levels in those with the lowest levels of added sugar consumption — a 9 percent difference.
Previous studies indicate that the largest contributors of added sugars to the diet are sugary beverages such as sodas, fruit drinks, coffees and teas, Welsh said.
“Adolescents are eating 20 percent of their daily calories in sugars that provide few if any other nutrients,” she said. “Sweet things have lost their status as treats.”
The study included dietary recall from one 24-hour period that researchers merged with sugar content data from the U.S. Department of Agriculture My Pyramid Equivalents Databases. Researchers estimated cardiovascular risk by added sugar consumption of less than 10 percent up to more than 30 percent of daily total energy. Two days of dietary data were used among a subsample of 646 adolescents and the key findings remained consistent:
Those with higher intake of added sugar had higher LDL levels of 94.3 mg/dL compared to 86.7 in those with the lowest levels, a 9 percent difference.
Triglyceride levels in those with the highest consumption were 79 mg/dL compared to 71.7 mg/dL among the lowest, a 10 percent difference.
Overweight or obese adolescents with the highest level of added sugar consumption had increased signs of insulin resistance.
“While Americans appear to be working hard to lower their intake of saturated fats, there is not the same awareness when it comes to added sugars,” Welsh said. “The intake of added sugars is positively associated with known cardiovascular risk factors. Added sugars play a significant role in the U.S. diet, contributing substantially to energy intake without contributing important nutrients to the diet.”
Adolescents and adults should “use the labels of the drinks and food they consume to become familiar with the amount of sugar in them,” Welsh said. “Replacing sugar laden drinks with water is one way to substantially reduce sugar and calorie intake.”
Physicians also need to ask adolescents about their sugars intake and guide them to better choices, she said.
Because the researchers used cross-sectional data, they don’t know if added sugars intake caused the differing cholesterol levels, only that they are linked. They also assessed the diet using one 24-hour recall of intake, which may not reflect on a person’s usual intake.
Long-term studies are needed to fully understand the effect that added sugars consumption in adolescence has on cardiovascular disease risk in adulthood, Welsh said.
Co-authors: are Andrea Sharma, Ph.D., M.P.H.; Solveig A.Cunningham, Ph.D.; and Miriam B. Vos, M.D., M.S.P.H. Author disclosures are on the manuscript.
A hormone produced by fat cells could be a tool for diagnosing and treating liver cancer, scientists at Emory University School of Medicine have shown.
Fat cells secrete a variety of hormones, some of which can have tumor growth-stimulating effects. However, scientists have dubbed adiponectin a “guardian angel” hormone because it appears to protect against the effects of obesity on metabolism and cardiovascular health.
The results, scheduled for publication in the November issue of the journal Hepatology, suggest that treatments that mimic or enhance adiponectin’s effects could enhance survival for obese individuals with liver cancer.
“Our study presents important clinical implications since hepatocellular carcinoma has the highest increased risk associated with obesity compared to other cancers such as prostate, kidney, colon, and stomach,” says senior author Neeraj Saxena, PhD, assistant professor of medicine (digestive diseases) at Emory University School of Medicine.
The first author of the paper is Dipali Sharma, PhD, assistant professor of hematology and medical oncology at Emory University School of Medicine and Winship Cancer Institute.
Hepatocellular carcinoma is one of the most common tumor types worldwide, but is relatively rare in the United States. The rate is increasing because of hepatitis C and obesity. Obesity is associated with increased risk and progression of a number of cancers including colon, prostate, breast, and liver cancers. Obese people have about a 1.5-fold increase in their risk of all types of cancer, but for liver cancer, obesity increases the risk 4.5-fold.
Obese populations tend to have higher circulating levels of the hormone leptin, but they may be resistant to some of its appetite-controlling effects. Weight loss tends to increase adiponectin, and low levels of adiponectin are found in patients with aggressive tumors.
One of the main roles of adiponectin is to counteract the effects of leptin. Adiponectin also regulates glucose levels and the breakdown of fatty acids. The levels of adiponectin can partially predict tumor growth, size and disease-free survival in human liver cancers, the authors found. In addition, they found that exposing liver cancer cells to adiponectin can reduce their ability to proliferate and invade other tissues, both in cell culture and in animal models.
“Taken together our results suggest an attractive molecular strategy: employing adiponectin analogues for potential therapy of metastatic hepatocellular carcinoma,” Saxena says.
Previous research by Sharma and Saxena has shown that adiponectin can also inhibit migration and invasion by breast cancer cells. (LINK)
Anti-diabetic drugs known as thiazolidinediones can increase adiponectin’s activity, but they have side effects on the heart that has led to their restriction by the FDA. The effects of injecting high levels of the hormone directly are unknown and need to be tested. Scientists are investigating other ways to increase a patient’s adiponectin, as wells as mutant forms of the leptin protein that may block leptin’s effects on cancer cells. Some natural compounds, such as those found in green tea, may be able to mimic the effects of adiponectin.
The research was supported by the National Cancer Institute and the National Institute of Diabetes and Digestive and Kidney Diseases.
Reference: D. Sharma et al. Adiponectin antagonizes the oncogenic actions of leptin in hepatocellular carcinogenesis. Page #’s. Hepatology (Nov 2010).
Only 45 percent of the 354 million annual visits for acute care in the United States are made to patients’ personal physicians, as Americans increasingly make busy emergency departments, specialists or outpatient care departments their first point of contact for treatment of new health problems or a flare up of a chronic condition like asthma or diabetes.
The findings, which appear in the September edition of Health Affairs, do not bode well for the nation’s already busy and frequently undermanned emergency rooms. While fewer than five percent of doctors across the U.S. are emergency physicians, they handle more than 28 percent of all acute care encounters – and more than half of acute care visits by the under-and uninsured.
According to co-authors including Steven Pitts, MD, associate professor of medicine in the Emory School of Medicine and a staff physician at Emory University Hospital Midtown, and Arthur Kellermann, MD, the Paul O’Neill Alcoa Chair in Policy Analysis at the RAND Corporation and previous associate dean for health policy at Emory University, health reform provisions in the Patient Protection and Affordable Care Act that advance patient-centered medical homes and accountable care organizations are intended to improve access to acute care. However, the challenge for reform, according to study authors, will be to succeed in the complex acute care landscape that already exists.
“Timely access to care is important, especially for those who are acutely ill. First-contact care has been a central tenet of primary care. But over the past few decades, the focus of primary care has shifted as a result of a growing elderly population, the growing burden of chronic disease and the challenge of coordinating care across multiple physicians,” says Pitts. “Low rates of reimbursement have accelerated this trend by forcing many primary care physicians to pack their daily schedules with 15-minute office visits – leaving little time for patients with acute health problems.”
The study, which took place between 2001 and 2004, shows that Americans made an average of 1.09 billion outpatient visits per year to physicians, averaging 321 visits per 1,000 people each month. Slightly more than a third of all encounters, or 354 million per year, were for acute care — treatment of new problems or a flare-up of a chronic health condition.
Twenty-two percent of acute care visits were managed by general/family practitioners, 10 percent by general internists and 13 percent by general pediatricians. Many involved treatment of minor upper respiratory problems, such as cough and sore throat. Office-based specialists handled 20 percent of acute care visits, generally for conditions in their respective areas of expertise (e.g., skin, eye and orthopedic problems). Twenty-eight percent of acute care visits were managed by hospital emergency departments, typically for more complex and potentially dangerous conditions such as stomach and abdominal pain, chest pain and fever.
“One of the biggest barriers to providing acute care in primary care practice is that many primary care doctors have packed schedules. This makes ”same day” scheduling, much less treatment of walk-in patients, extremely difficult,” says Kellermann.
“Busy schedules also discourage primary care physicians from taking the time they need to treat patients with complex, undifferentiated complaints. It is faster and simpler to refer them to a specialist or the nearest emergency department. Ensuring timely access to primary care is a desirable goal, because it increases a person’s odds of finding a “medical home”. Unfortunately, for many years now, primary care in the U.S. has been in decline,” Kellermann says. “Patients have adapted by seeking care elsewhere when they get sick.”
Our data indicate that more than half of acute visits today involve a doctor other than the patient’s personal physician. Dr. Pitts adds, “More than a quarter of all acute care visits, including virtually all weekend and “after hours” encounters, occur in hospital emergency departments. Heavy use of emergency departments for problems that a primary care provider could treat, if their patients could get in to see them, is not desirable from a societal perspective,” says Pitts. “Too often, emergency care is disconnected from patients’ ongoing health care needs.”
“Hospital emergency departments are vital, particularly when your life is on the line.” Kellermann says. “Americans know that when they can’t get care elsewhere, the ER is the one place in our nation’s healthcare system where the doctor is always “in”. Strengthening primary care is a major goal of healthcare reform. If successful, it will be a win for everybody.”
In addition to Pitts and Kellermann, other study authors included Emily R. Carrier, a senior health researcher at the Center for Studying Health System Change in Washington, D.C., and Eugene C. Rich, a senior fellow at Mathematica Policy Research, also in Washington, D.C.
In June, thoracic surgeon Saeid Khansarinia, M.D., implanted a diaphragm pacing system using a minimally invasive thoracic surgery technique, as opposed to an abdominal procedure due to the patient’s specific needs. The modified surgical method will make it possible for Lynn Wheeler of Fayetteville, Ga., to breathe more naturally using an implanted diaphragm pacer instead of a ventilator.
Diaphragm pacing first gained national attention in 2003, when Raymond Onders, M.D., of University Hospitals Case Medical Center implanted a diaphragm pacing system in actor Christopher Reeve via an abdominal surgery. The device eventually enabled Reeve to breathe without the use of a ventilator.
Dr. Khansarinia is one of the latest additions to Piedmont Heart Institute Physicians as part of its expanding cardiothoracic surgery services. He is one of only 18 surgeons performing this procedure through the abdomen and the only surgeon who has performed this operation through the chest. Specializing in thoracic surgery, Dr. Khansarinia is a graduate of St. Louis University and completed his residency at the University of Florida Health Science Center. He is board certified in both general and thoracic surgery.
Functioning in a way similar to heart pacemakers, small electrodes are placed on the diaphragm where they stimulate the muscle to contract, pulling in air through the lungs. The patient carries a small external device that allows them more mobility than the larger machines and breathing tube necessary with a ventilator.
Wheeler, now 63 years old, was left paralyzed after a car accident five years ago and has required the assistance of a breathing tube. However, abdominal surgery was not an option for her. Unfortunately, due to multiple previous surgeries on her abdomen and the nature of her injuries, access to the diaphragm through the chest was the only option for this kind of procedure.
Determined to find a way to help his patient achieve a better quality of life, Dr. Khansarinia and his team in collaboration with Dr. Onders, developed a method to implant a diaphragm pacer through the chest.
As Wheeler’s diaphragm learns to contract and relax again over the next few months, she will be able to rest at home while the diaphragm pacing device works along with the ventilator. Eventually patients with diaphragm pacers are weaned off their ventilators as the diaphragm strengthens and breathing occurs more normally.
“Mrs. Wheeler is doing well. Currently she is off the ventilator and breathing with the pacer over four hours per day,” Dr. Khansarinia said. “She is very happy with her outcome and within a few months to a year, we hope she will be able to breathe without the need of a ventilator.”
For patients with quadriplegia, a diaphragm pacing system can mean a greatly improved quality of life. Communication becomes easier as speech is no longer hindered with the operation of a breathing tube. Sense of taste and smell will also improve for many patients. The risk of infection and pneumonia is significantly decreased for patients who are not dependent on a ventilator.
“What we’ve found is that the sooner we can approach patients with quadriplegia and implant the device, the quicker they recover to a more normal breathing state,” Dr. Khansarinia said. “With older patients and with patients that have been on a ventilator for a longer period of time, it will take a little longer for their diaphragm to relearn its original function with the assistance of a diaphragm pacing system.”
“This procedure has a lasting effect patients’ quality of life,” Dr. Khansirania said. “Their sense of smell and taste often return as air is no longer being forced into the lungs and can now flow freely through the nose and mouth. Most importantly, it gives them an improved sense of self and freedom as their speech pattern returns and they are able to communicate more naturally.”
