Paralyzed Diaphragm

Posted by giller198 @giller198, Jul 3, 2018

My name is John and I was diagnosed this past January with a paralyzed right diaphragm. Phrenic nerve damage has been ruled out because of the amount of time between my heart valve surgery and when this started. I still cannot figure how this happened, I have a couple of ideas but nothing conclusive. I have seen two pulmonary doctors and both say there is a surgical procedure that can be done but no guarantee that it will work. I would like to know if anyone out there has been diagnosed with a paralyzed diaphragm and if they had it fixed.

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@nla4625

@grump. Thanks for the update! I really hope the plication surgery goes well for you. Where are you having it done?

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Mayo in eau claire

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@jakedduck1

@grumpy
A nerve was cut during one of my cousins heart surgeries (3) does that disqualify him from having this surgery?
Thank you,
Jake

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Does your cousin have a diagnosis of having a paralyzed diaphragm as a result of the nerve being cut or symptoms indicating he does, such as shortness of breath after exertion, breathing problems, lack of stamina, etc. If so, he should see a thoracic surgeon, who can order the needed diagnostic tests, advise him, and perform plication surgery if he is a candidate. Paralyzed diaphragms are pretty rare, and plication surgery is not for the faint of heart. I'm putting it off for as long as I can but will do it when my symptoms are really limiting me. Many who have had it done are experiencing pain weeks and months afterwards and are taking months to recuperate, depending on how the surgeon does the procedure, how physically fit they are at the time of the surgery, etc. My surgeon didn't warn me about those things, which is why I'm grateful to the people on Mayo Connect and the people in the facebook paralyzed diagram group who have shared their actual experiences -- good and bad. I now know what to realistically expect and will be mentally prepared to deal with whatever comes. I hope your cousin is doing well. 3 heart surgeries is a lot to endure. His cardiologist can refer him to a thoracic surgeon, who would most likely know more about paralyzed diaphragms and treatment options than a pulmonologist.

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@nla4625

@grump. I'll be anxious to hear what the surgeon recommends so hope you will let us know. I hope he is a thoracic surgeon experienced in doing plication surgery using video assisted technology (VAT) and robots. It's a minimally invasive way to do chest surgery with less wear and tear on the body. I watched a video about plication surgery using robots on You Tube, and it's pretty amazing. Not being able to breath is awful; and if I were having serious difficulty, I'd have the surgery now after getting a second opinion that it was the right thing to do. If your nerve isn't damaged, you might want to look at a diaphragmic pacemaker as an option to plication surgery and contact Dr. Raymond Onders at University Hospitals Cleveland Medical Center. One of the men in the paralyzed diaphragm facebook group had this done with great success. He said Dr. Onders is the only person in the country doing it. Good luck! Nancy

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@nla4625 @grump If you might be looking for another opinion, there is a surgeon who grafts a nerve to replace the phrenic nerve. I saw another patient mention this so I'm passing along the information as I have no experience with this issue. Here are some links.
https://www.advancedreconstruction.com/phrenic-nerve-program/
https://www.uclahealth.org/Workfiles/clinical_updates/plastic-surgery/14v2-11PhrenicNerve.pdf
https://www.masserypt.com/wp-content/uploads/2018/05/Massery.-Phrenic-Nerve-PT.-Rehab-Surgery-Chap-11.-2017.pdf

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@jenniferhunter

@nla4625 @grump If you might be looking for another opinion, there is a surgeon who grafts a nerve to replace the phrenic nerve. I saw another patient mention this so I'm passing along the information as I have no experience with this issue. Here are some links.
https://www.advancedreconstruction.com/phrenic-nerve-program/
https://www.uclahealth.org/Workfiles/clinical_updates/plastic-surgery/14v2-11PhrenicNerve.pdf
https://www.masserypt.com/wp-content/uploads/2018/05/Massery.-Phrenic-Nerve-PT.-Rehab-Surgery-Chap-11.-2017.pdf

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I have no nerve damage so this is my only option

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@grump

I have no nerve damage so this is my only option

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@grump. If my phrenic nerve was working, I would definitely see if I was a candidate for diaphram pacing before I'd even consider plication surgery. Because my nerve isn't working, I don't have that option....but it sounds as though you might. One of the members of the facebook paralyzed diaphragm group has posted extensively about his really positive experience with diaphragm pacing, and it might be valuable for you to join the group to read about it. I posted information about this on Mayo Connect before with the name of the doctor doing it at University Hospital in Cleveland. You could google him or contact his office if you wanted to pursue it.

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@nla4625

@grump. If my phrenic nerve was working, I would definitely see if I was a candidate for diaphram pacing before I'd even consider plication surgery. Because my nerve isn't working, I don't have that option....but it sounds as though you might. One of the members of the facebook paralyzed diaphragm group has posted extensively about his really positive experience with diaphragm pacing, and it might be valuable for you to join the group to read about it. I posted information about this on Mayo Connect before with the name of the doctor doing it at University Hospital in Cleveland. You could google him or contact his office if you wanted to pursue it.

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Is not an option for me- the diaphragm pacing

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@grump

Is not an option for me- the diaphragm pacing

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Ok -- I really hope you'll be on the road to good health soon. Take care.

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I am having trouble in finding someone that will do a EMG to see if my Phrenic nerve in my area (Springfield Mo). I have been told that I have no more recourse other than just live with my paralyzed left diaphragm. It is a bit frustrating that there is no options for me except trying to figure out where else I can go to get things done.

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@charlier

I am having trouble in finding someone that will do a EMG to see if my Phrenic nerve in my area (Springfield Mo). I have been told that I have no more recourse other than just live with my paralyzed left diaphragm. It is a bit frustrating that there is no options for me except trying to figure out where else I can go to get things done.

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@charlier I don't think you've gotten very good advice from whoever told you there was nothing you could do about your paralyzed diaphragm and you just had to live with it. From my research, there are 4 things you can do: 1) wait and see if the phrenic nerve heals itself and the diaphragm starts working again - as long as 2 or more years, 2) have plication surgery to keep the diaphragm in its proper place so your lung capacity can expand and you will breath better, 3) diaphragm pacing where a pacemaker is attached to your diaphragm and kickstarts your diaphragm into working again, and 4) have a functioning nerve grafted onto your non functioning phrenic nerve. For the test you want to evaluate the condition of your phrenic nerve, you need to get to a major medical center, because it is a difficult test to administer. I'm not familiar with Missouri, so I did a quick search on best hospitals in Missouri and then narrowed it by best hospitals in Missouri dealing with lung/pulmonary issues. All my tests relating to my paralyzed diaphragm were done at a hospital, and my thoracic surgeon has his office there as well, which is why I looked at hospitals. The Barnes-Jewish Hospital in St. Louis was listed as the top hospital in Missouri and is ranked nationally as #21 in the country for lung/pulmonary surgery. Mercy Hospital in St. Louis was ranked as 4th best in MO and as high performing for adult lung/pulmonary issues. I'd recommend finding a thoracic surgeon affiliated with them or in your area. They will know more about paralyzed diaphragms than a primary care physician or pulmonologist would and will be able to help you. If you're willing to travel out of Missouri there are a lot of options, beginning with the Mayo Clinic. It's a pretty rare condition. Good luck! Contacts:
For diaphragm pacing: Dr. Ordners University Hospital, Cleveland.
For nerve grafting: Dr. Kaufman, New Jersey

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@nla4625

@charlier I don't think you've gotten very good advice from whoever told you there was nothing you could do about your paralyzed diaphragm and you just had to live with it. From my research, there are 4 things you can do: 1) wait and see if the phrenic nerve heals itself and the diaphragm starts working again - as long as 2 or more years, 2) have plication surgery to keep the diaphragm in its proper place so your lung capacity can expand and you will breath better, 3) diaphragm pacing where a pacemaker is attached to your diaphragm and kickstarts your diaphragm into working again, and 4) have a functioning nerve grafted onto your non functioning phrenic nerve. For the test you want to evaluate the condition of your phrenic nerve, you need to get to a major medical center, because it is a difficult test to administer. I'm not familiar with Missouri, so I did a quick search on best hospitals in Missouri and then narrowed it by best hospitals in Missouri dealing with lung/pulmonary issues. All my tests relating to my paralyzed diaphragm were done at a hospital, and my thoracic surgeon has his office there as well, which is why I looked at hospitals. The Barnes-Jewish Hospital in St. Louis was listed as the top hospital in Missouri and is ranked nationally as #21 in the country for lung/pulmonary surgery. Mercy Hospital in St. Louis was ranked as 4th best in MO and as high performing for adult lung/pulmonary issues. I'd recommend finding a thoracic surgeon affiliated with them or in your area. They will know more about paralyzed diaphragms than a primary care physician or pulmonologist would and will be able to help you. If you're willing to travel out of Missouri there are a lot of options, beginning with the Mayo Clinic. It's a pretty rare condition. Good luck! Contacts:
For diaphragm pacing: Dr. Ordners University Hospital, Cleveland.
For nerve grafting: Dr. Kaufman, New Jersey

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I went to a Mercy Pulmonologist here in Springfield, he was the one who said the only option was go somewhere else. That was it. My regular doctor said she has no idea on where to go or who to see. I will contact Mercy in St. Louis to see if I can get in there. I just had a Spinal Stimulator implanted for nerve pain and neuropathy. It been an interesting year so far.

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