Wednesday, January 17, 2007

Surgery Gives Quadriplegic Ability to Breathe on His Own

Bob Blair bears an uncanny facial resemblance to Christopher Reeve and on top of that, he, like Reeve, was paralysed in a horse-riding accident.

But the similarities don't end there as Blair has now had an experimental operation ? just like Reeve did in 2003 ? which will also rid of him of mechanical ventilation for the first time since his injury four years ago.

That's where the coincidences with the late actor end, as Blair, an Alberta farmer, is the first patient to have the procedure in Canada, at Vancouver General Hospital.
The surgery was developed by Dr. Raymond Onders and engineers at a Case Western Reserve University spinoff company called Synapse Biomedical Inc.

VGH is the only Canadian hospital to participate in a clinical trial in which surgeons implant electrodes that stimulate the phrenic nerves in the diaphragm to make it contract and relax so that breathing in and out in paralysed individuals is not dependent on respirator tubing and machinery.
The technology means such patients can breathe through their nose instead of getting air through a hole in their throats.

A 29-year old Vancouver man named Daniel Leblanc had the surgery done in Cleveland last year.
Leblanc still has the tracheostomy in his throat so that if he ever needs backup mechanical breathing support, the tubing can be quickly attached. He became a quadriplegic just over two years ago in a dirt biking accident.

"I can smell again and taste. It's changed my life in a good way. I feel more free and a little more natural," said Leblanc, noting that he also likes the fact that he doesn't have to hear the ventilator's constant humming noise anymore.
During a joint interview Monday, Blair and Leblanc spoke of the quality of life improvements the technology brings.

Blair said he feels fortunate he's had the opportunity to meet another high level quadriplegic (with a severe high cervical area spinal cord injury) who has already undergone the process. Blair had the electrodes implanted a week ago and he is now in what is called the conditioning period, the interim time in which he undergoes exercises to retrain the diaphragm before the mechanical tubes are disconnected in a few weeks and the external pack paces his breathing full time.
Doctors in Cleveland have now implanted the electrodes into 46 patients in the past five years, (with only one reported failure) and are getting closer to final Food and Drug Administration approval.

Dr. John Yee, a VGH thoracic specialist, went to Cleveland to learn the technique, and accompanied Leblanc when he went there for the surgery.

Yee said the clinical trial is an example of "how advances in the basic science of muscle physiology can be combined with biomedical engineering and minimally invasive surgery to bring practical solutions" to improve patient's lives.

Blair said one of the things he's looking forward to the most when he banishes his mechanical ventilator is breathing "the fresh country air where I live" in through his nose for the first time since his accident.

"Also, my voice will be much clearer and I will be able to speak stronger," said the 61-year old.

Dr. Jeremy Road, a VGH respirologist, is principal investigator of the Canadian trial. Road said there are patients from across Canada being considered for inclusion in the trial.

Patients must meet certain criteria, including having a diaphragm which still has preserved nerves so that the electrodes can stimulate them. Health Canada has granted permission for 10 surgeries in the clinical trial at VGH and spinal cord injury patients who are ventilator dependent from across Canada will be considered for inclusion.

By Pamela Fayerman
Vancouver Sun