United Brachial Plexus Network, Inc.

Researching surgical options to help deal with a paralyzed diaphragm from having damaged my phrenic nerve which decreases my breathing capability significantly in my right lung.

Discovered the Diaphragm Plication procedure which involves opening the side of the chest and basically stitching up the diaphragm into a tight drum like web to give the lung room to expand.

Has anyone had this done or even ever heard of it?

My chest XRays make it clear that my intestines have filled up half of my right lung space, because there isn't a nerve impulse to indicate the muscle to contract and help fill the lung with oxygen. This would give my lung more space, but not necessarily help it "breath" much better. We'll see...

Thanks,
Christopher

Here's a good link about the procedure with VIDEO of it (not for the weak kneed):
http://mmcts.ctsnetjournals.org/cgi/con ... 006.002568

i injured my phrenic nerve on my left side in my accident ~4 months ago. I am normally very active, and although i've been pretty sedentary while i've been healing up, when i have gotten on a bike or hiked around, i haven't noticed a big difference in my breathing. I also gave up 2 intercostal nerves to (hopefully) get my left biceps back... and just yesterday my dr. told me that she had recently been at a conference and heard that some people have given up 4 intercostals and been just fine. sounds scary to me but if she could use the other 2 to give me some hand function, i dunno, could be worth it. i'd be interested to hear your experience with the phrenic/diaphragm breathing issues since you've been dealing with this injury longer than i have. i'm hoping to get back to a lot of the things i used to do, especially the snowboarding.

i will say the one time i do seem short of breath is singing - i played guitar in a punk band up until my accident, and they refused to kick me out, so i traded places with the guy who used to sing (to the detriment of the band - he's no guitar player and i'm no singer) and it's been tough. i am exhausted after every practice, my volume isn't there, yelling hurts like hell, and i have to catch breaths in odd places. i'm hoping that all gets better.

Sounds like your lung capacity is less than normal from the issues you experience with singing, but if you didn't sing before, than that could be from just breaking in the lungs and voice as well. Probably both.

How was it determined that your Phrenic nerve was damaged? Via EMG or XRay? Most doctors miss it. One of my doctors in Los Angeles thought my lung was full of scar tissue from blood solidifying in it from a false read of the XRay (my right lung was ruptured in my wreck).

From having my lung ruptured I lost one Intercostal nerve from the drain tube inserted in the side of my ribs, and they used 4 more to innervate my biceps and a transferred Gracilus muscle from my left thigh (2 Intercostals to each muscle). That leaves me with one Intercostal to help expand my ribs, and it's on the 1st rib, way up by the Collarbone, so it doesn't do much expanding at all.

I only notice issue when bending over, like tying my shoes (my gut feels like it is pushing into my chest/lung area), and when I'm exerting myself; stairs, running, climbing, sex, swimming, etc.

I hate to say this, but the only way I've heard of innervating a hand that actually works, is harvesting a Phrenic nerve all the way down past the pumping heart, from the base of the diaphragm, and then rerouting that nerve all the way as close as possible to the hand. The Mayo is the only place that is practicing this as far as I know. This is with many avulsions with no nerves to use from the arm it's self.

When a nerve is grafted (a segmented piece harvested and reattached to a different area and muscle), the nerve has to regenerate all the way from the area that it was first cut, distally from the spinal cord. So if you're tall like me, and have long arms, a nerve will have to regenerate from your neck or shoulder, all the way back to the hand. That's 2-3+ feet. If a nerve regenerates 1 inch per month, that's 2-3+ years. Muscles can be uninnervated for a maximum of two years, and that i's really pushing it. That's why if you lose hand function you are screwed, unless you try a muscle transfer for grip function.

Hope this helps a little, and please give us updates on how your breathing is working.

Exercise when you're able. The best therapy known in the medical sciences for nerve injuries and Spinal Cord Injuries is to get those neural pathways regenerating from pushing the signals through. It is possible if your Phrenic wasn't completely torn, that it could get some function back. Luckily breathing is a constant impulse, so your diaphragm is getting a constant attempt for nerve signals.

Best of Luck,
Christopher

Hey Brain!
I forgot to say.... keep the music rocking!!

You must have some good buddies if they are hanging on and changing gears to adapt to the situation. Don't let go of that! Please. Keep your heart in the game, I took mine out, and it was a slow and certain death. Use your new found "misery & anger" to pump your voice through the roof! Like anything, the voice is a muscle that needs to be worked (personal experience & history in the dramatic arts). Of course some people just don't have it, but how will you ever know unless you push it & test it. I'm jealous! No wonder why your throat hurts... you're singing punk music! Ha.

Cheers,
Christopher

ps adapting to everything is the key. I used to play stand up bass, now I play trumpet, left handed. I love it!

Man I miss my instruments. I gave my guitar to my cousin (sucked at that anyways ) but I'm just not ready to give up my flute. I suppose I could turn it into a lamp stand or something, but I just can't mutilate a good instrument
Sounds like great band mates........just keep at it. A lot of great bands have begun with the band first, and the playing/singing know-how second anyways, lol.
Good idea with the trumpet. I always wanted to play the french horn, but that brass embouchure just never clicked for me.

Christopher - thanks for the reply. My doc never told me how she identified the torn phrenic, but I spent a lot of time getting xrays and MRIs during the week I was at Stanford so I'll assume it was X-ray. I have a lot of confidence in my Dr. (Catherine Curtin), it's hard to explain but she seems knowledgeable, confident, and she obviously cares a lot about her patients. I also damaged that side lung in my accident, they originally told me it was a small tear but i think they finally decided it was just a contusion. there was a lot of confusion those first couple days, too many doctors coming through and too much morphine.

I feel like I've had a similar sensation of my intestines or whatever pushing up into the space my lungs want to be in, it's hard to say if it's the same thing but i definitely get an ooky feeling when i bend sometimes. based on what you're saying i'm going to think long and hard before I sign off on harvesting 2 more intercostal nerves to try to get my hand working. From the little bit she discussed it with me, it would be a 'new' procedure (she is going to do her first on some other fellow next month) that involves the intercostal, patching into existing nerves, and a free-muscle transfer from the leg. as you point out, the timeline for nerves regenerating all the way down my arm (I'm 6' and have long arms like that phelps kid) pretty much forces the issue on the muscle transfer. I'm just not sure that whatever function I'd get out of my hand would be worth losing more breathing. I like breathing, and as you mention it's helpful for doing other things I like like swimming and having sex. which ps is super awkward now, i don't see that discussed anywhere on these forums, are we trying to keep it PG or is everyone just shy? I myself have no shame... but if anyone wants to vent or has some one-handed sexing tips you can send me a message, i'd sure like to have a frank discussion on the topic.

re: the band, when we started out we were awful and we all agreed we would never kick anyone out for lack of ability. if you were a jerk, we didn't care how talented you were, we didn't want to play music with you. i think it was a good strategy, over the last 4 years or so we have gone through a couple drummers but never had any real drama and we've gotten a lot better. when i wrecked, the first person who visited me was our singer, and he and everyone else in the band continued to visit me as i got better and basically told me that i could quit if i wanted, but whether or not i could play guitar, they weren't going to tell me to go.

of course i will always miss playing. got my first tattoo a couple weeks ago...
http://www.flickr.com/photos/55365281@N03/5135119322/
i've been playing a little harmonica, and thinking about taking up trumpet, i used to play trombone so i've got the mouth part already, just need to learn the scales with keys instead of a slide...