Brooke Hopkins got a new way to breathe Monday, when doctors at University Hospital implanted a device that will rhythmically stimulate his diaphragm.
The retired University of Utah English professor, paralyzed in November 2008 after a bike accident, was the first patient to have the surgery in the Beehive State.
And the results delighted doctors.
"It's slick," exulted Daniel Vargo, the U. surgeon who implanted the diaphragmatic pacemaker. "You just fire it up and it works."
This has been a long time coming for Hopkins, who has been working strenuously for more than a year to build up his ability to breathe off a respirator. When he first arrived at South Davis Community Hospital in March 2009, the
spinal cord patient could barely breathe for 15 or 20 minutes on his own. Mustering all his physical and mental energy, Hopkins pushed himself for longer periods each week. He started to visualize his diaphragm and what inhaling and exhaling looked like.
During his first breathing breakthrough last April, Hopkins began to feel that "his breathing was not only stronger, but that every breath had become a joy," he wrote on a joint blog with his wife, nationally recognized ethicist Peggy Battin. "For the first time in his life he experienced what he had always been looking for in Buddhist meditation but had never actually found: the full life of breath."
He continued improving -- to one hour, two, three. By this year, he could sometimes spend up to seven hours a day off the respirator.
But, inevitably, there were setbacks.
From December through February, Hopkins suffered several infections that kept him bed-bound and inert. He grew frustrated and occasionally despaired that he never would be able to breathe on his own.
Before him always, though, loomed the prospect of the diaphragm pacer. No doctor in Utah was yet trained to implant it, and it wasn't certain that insurance would cover it. But it did hold out hope.
About the time of his68th birthdaylast month, all the approvals and preparations were in place.
Raymond Onders, the Cleveland surgeon who pioneered the device,agreed to come to the Beehive State to oversee the first implantation, and the insurance company approved it.
Finally, the elusive dream Hopkins barely had hoped would materialize became reality.
At 9:30 a.m., he arrived at the U. from the Bountiful rehab facility, upbeat and excited.
"It's great to be here and doing something new," he said, while being prepped for surgery.
With Battin's help, he showed off some of his latest improvements -- separately lifting his left and right hand, a feat he couldn't do six months ago but which took every muscle to accomplish. The return of some sensation to his arms and legs has buoyed Hopkins, too.
"Optimism is central to his care," Battin said. "And I am feeling extraordinarily optimistic."
So were the doctors.
After the hour-and-a-half operation, Onders grinned at his patient and said, "You've got a great-looking diaphragm."
And, he added, nodding at Vargo, "you've got a great team of doctors here."
These were clearly moments of triumph for the amiable surgeon from Cleveland.
Onders helped launch the pacer, implanting the second one ever produced in Christopher "Superman" Reeve, who was paralyzed in a horseback riding accident, in 2003. Reeve died a year later of infection, but not because of the device's failure.
Four years ago, Roy resident Braden Howe flew to Cleveland to get his own diaphragm pacer as part of a clinical trial. Howe was in a bike-auto accident as a 13-year-old in 1996 and was on a respirator until the surgery. With the pacer, he was able to go off the ventilator for about 10 hours a day and completed his undergraduate business degree from Weber State University in Ogden.
In 2008, the Food and Drug Administration approved the diaphragm pacer -- manufactured by Synapse Biomedical Inc. in Oberlin, Ohio -- and, since then, Onders has implanted it in about 350 patients worldwide. Now 25 leading medical centers have the go-ahead to offer this treatment.
Onders believes this tool could transform the care for those who suffer spinal cord injuries. He has begun to put it in patients within a week of their accident, avoiding any long-term respirator dependence. It may have other uses in the future, particularly to aid patients suffering from ALS (commonly known as Lou Gehrig's disease) when their lungs stop working.
"It is healthier, safer and more natural than the ventilator," Onders said. "The irony is, a ventilator keeps you alive, but it damages your lungs in the process."
The cost savings -- around $13,000 a month -- are impressive, too.
"It should free you up quite a bit," he said, alluding to the hope that the device will allow Hopkins to breathe on his own. The team will further weak the device's programming today and train a team of South Davis' respiratory therapists.
This is karma, Mike Battin told his stepdad. "It's payback for working at a goal for a very, very long time."
Next stop for Hopkins? Returning to his Avenues home -- possibly within weeks -- to craft a new life from the remnants of the old.
"I told the respiratory therapist I seem to be getting better and better at this breathing control, talking through the speaking valve with a deep, resonant voice. And today I read a page and a half-long paragraph from Proust's Swann's Way. I'm going to miss all this breathing work, frankly. Contrast this with the blogs from last year at this time, when 20 minutes was a triumph, and having an ecstatic experience during five minutes of a 20-minute period was immense, but only the beginning. I really felt wistful yesterday, a very strong feeling. ... We start over again with something artificial, something that will control my breathing, that will produce regulated breaths, the timing not under my own control. Of course, this is a giant advance over being on a full ventilator, but just the same, it makes me nostalgic for what I imagine will seem like the good old days (as awful as the early trach-masking was). I've been waiting for this implant for at least seven months and am extremely eager to have it, but just the same with a tinge of regret.
Source: www.brookeandpeggy.blogspot.com on April 8