in the hospital recovering from my injuries, I could not even focus
on reading a few sentences in a book, so my mind became more like
mush than anything else. I started working again just 3 months after
my SCI. I work as an analyst, so my mind is critical to my job.
When I did return to my job, it was very hard, but awesome at the same time. I came back to work so I could provide for my family as well as keep myself from falling into a deep depression. The first time I rolled into the office I just talked with my coworkers. We talked about my story and how it has affected me. Then I spoke with my boss about beginning work again. There are a few things I would recommend to people who are returning to work after SCI.
1 . Ask for Help
are willing to help, and they want to help. Coworkers took on my
tasks while I was gone and were happy to keep helping as I worked to
sharpen my mind and get back in the game. I remember when I had to
ask for help for the first time. I had a deadline approaching and
knew I couldn’t hit it. I remember crying when I asked for help
because this was something I was proud of doing, but the team rallied
and helped me complete the task on time. As I work more and more, I
need to ask for help less often.
2 . Take Time to Cry
a long time, every time I would go use the bathroom, I would also
just spend a few minutes crying. What we go through with SCI is not
easy. None of our friends and family get it. Cry about it whenever
you can. The future is different and I often long for my prior life.
Anything can be a trigger. Take that time in the bathroom to cry or
close the office door and let it out. Holding it in doesn’t help.
3. Find a Support Crew at Work
when I came out of the bathroom after crying, a coworker noticed I
had been crying and approached me about it. It felt good to talk to
him. People want to see you be human. By being vulnerable and talking
about things with those you trust, you can enhance your mental
health. All it took for me was a friend at work who was willing to
talk and help me problem-solve. Now when I have an issue at work, I
know there are people I can go talk to and cry in front of while we
work through the problem.
4. Take it Easy
is easy to want to jump right in and go. But working after your
injury gets overwhelming very fast. You might not be able to work
full-time right away. Maybe you can start working only a couple days
a week for part days, like I did. Your 100% might look different than
it did before. Talk to your boss about workload management at the
office. Most bosses just want you to get better, so take the time you
need to ease back into the office—but do it quickly, as your
company needs your help.
5. Have Fun
you can’t find a task to do at work, then make your task to have
fun. Turn an excel spreadsheet into a game or find a way to compete
with someone at a task. You may be slower, but you can blame the
injury and make them feel guilty. Okay don’t do that, but the
important thing is to find the fun in life again. Talk about things
you love and work on important tasks in a fun way. Find something to
laugh at. I started to have “roll up music” when I come into the
office. Before I rolled in, I would select a song and play it loud on
my phone to “make an entrance”. Everyone laughs and loves it. It
starts the day on a good note.
I am still trying to make my mind sharp again. I understand it’s a process and might take a while. Until then, I will keep taking the small steps to be better. One day, I will roll into the office like it’s any other day and when I do, I’ll know I’m back.
By Nicole Ficarra, Communications Coordinator, Avery Biomedical Devices (Commack, NY, www.averybiomedical.com), the global leader in high reliability diaphragm pacemakers.
I would not have predicted the path my life has taken. Car accidents, of course, are unpredictable, and I was in one at age four. I suffered a spinal cord injury; a stretched spine, which left me a quadriplegic, unable to walk or breathe without ventilator support.
At age 11, though accustomed to my life in a wheelchair and using a mechanical ventilator, my life changed due to a diaphragm pacemaker. The device is used to support breathing in individuals who require breathing assistance due to a spinal cord injury or other medical conditions such as Congenital Central Hypoventilation Syndrome, Central Sleep Apnea, central neurological disorders or autoimmune diseases like Multiple Sclerosis, serious bacterial infections, Lyme Disease and Acute Flaccid Myelitis.
At age 11, on a trip to the emergency room with pneumonia, I learned about diaphragm pacers. I resisted having the surgery to implant the diaphragm pacemaker components. My parents, however, having learned its benefits, scheduled the surgery; the best decision they ever made for me. That’s why I believe all individuals with spinal cord injuries should explore whether they would be a good candidate for this device.
a Diaphragm Pacemaker Works
To understand how a diaphragm pacemaker works, you must understand the phrenic nerve and its role in breathing. This nerve originates in the neck at the cervical nerves C3 through C5 and continues down between the lung and heart to the diaphragm. It serves as the neurological pathway between the brain and the diaphragm.
It is composed of motor, sensory and sympathetic nerve fibers, enabling it to send motor information to the diaphragm and receive sensory information back. A diaphragm pacemaker system consists of surgically-implanted components, an external transmitter, and antennas worn on the skin. A battery-powered transmitter sends a series of electrical pulses to the antennas.
These pulses are converted into radio waves and transmitted through intact skin to an implanted receiver. Pulses inside the body are sent to the phrenic nerve via a small electrode implanted close to the nerve, causing the diaphragm to contract. This contraction increases the space around the lung resulting in inhalation. Exhalation occurs when the pulses stop and cause the diaphragm to relax. This repetitive process produces a normal breathing pattern.
Are You a Candidate for a Diaphragm Pacemaker?
Not everyone is a candidate, nor needs ventilator assistance. For instance, patients with an injury or disease at C1, C2, and higher cervical nerve, may have little or no movement of their head and neck, and may be entirely dependent on ventilator assistance for breathing. Those with C3 level injuries, typically do have control of their head and neck, and can sometimes be weaned from ventilator assistance. Those with C4 level injuries are often weaned from ventilator assistance, and those with C5 and lower injuries generally don’t need ventilator assistance.
key criteria are: the individual must have functional lungs and
diaphragm muscle, and an intact or repaired phrenic nerve(s). To
qualify a patient, a neurologist performs a phrenic nerve conduction
study. In the study, the phrenic nerve is stimulated, just as it
would be by a diaphragm pacemaker, and the diaphragm muscle’s
response to the stimulation is recorded. The surgical procedure lasts
two to four hours. To confirm the proper stimulation of the phrenic
nerve and diaphragm functioning, an interoperative evaluation is
conducted to observe the chest wall and palpitation, and measure CO2
changes. For some patients, a fluoroscopy test is performed to
observe the diaphragm’s motion in greater detail. There is usually
a one or two day hospital stay. Some individuals can undergo the
minimally invasive procedure on an outpatient basis.
The Benefits of Diaphragm Pacemakers over Mechanical Ventilators
As awareness of the device’s benefits over mechanical ventilators continues to grow, more physicians are recommending it to their patients. Individuals with diaphragm pacemakers also are communicating the benefits these devices have provident them, such as:
mobility and freedom to pursue different activities;
time performing daily activities;
of routine maintenance and disposable supplies ventilators require;
risk of the infections, pneumonia, collapsed lungs, airway injuries
and diaphragm atrophy associated with ventilators;
stress associated with locating power sources or power outages;
breathing, speech, eating, drinking and hearing;
sleep quality; and
A study published in the peer-reviewed journal, Spinal Cord, also found that diaphragm pacing costs an estimated 90% less than ventilator-related expenses, yielding savings of up to $20,000 annually.
Diaphragm Pacemakers Are Having a Huge Impact
The first commercially distributed diaphragm pacemaker was developed in 1971 by Avery Laboratories, now known as Avery Biomedical Devices (Commack, NY). Today, Avery is recognized as the global leader in diaphragm pacing with its device implanted in over 2,000 people in 40 countries. The Avery device has a consistent record of safety and reliability spanning almost five decades, and full market approval from the U.S. Food and Drug Administration (FDA) and CE Marking privileges under the European Active Implantable Medical Device Directive for adult and pediatric use. Its high reliability and economic value has Medicare and most private and government insurance providers offering reimbursement for the Avery diaphragm pacemaker.
Once implanted with a diaphragm pacemaker, I gained renewed confidence. I earned my Bachelor’s Degree in Advertising, internships with a local legislator and area hospital, and a job as social media coordinator for Avery (whose device I have). Additionally, I serve as a patient ambassador for Avery, encouraging others to learn how a diaphragm pacemaker could help them and attend medical conferences to raise awareness. It’s not all work for me either. I enjoy the same activities as my peers. I recently had an incredible experience at Disney’s D23 Expo and regularly attend concerts featuring artists like Pink, Justin Timberlake, Pink and the Jonas Brothers.
Other quadriplegics also have regained their lives following a spinal cord injury. Arlyne M. said, “I do more things than ‘normal’ people do, and even go golfing and dancing. The pacer has changed my life tremendously from being on a ventilator 24/7, and always worrying about power outages or running out of time on the battery life, it is fabulous. It is very liberating.”
Dalen J. has seen his health improve greatly. He’s had no infections since getting a diaphragm pacemaker and his speech and hearing have improved, improving his social interactions. For former professional cricket player, Jamie H., the device has him back in the sport he loves as a coach. Former diver and gymnast, Keith S., who suffered a spinal cord injury from a trampoline accident, now feels like he is breathing on his own. The diaphragm pacemaker improved his mobility, enabling him to return to work and take overnight trips. Annapolis Naval Academy graduate and Top Gun Instructor, William M., said, “Before my surgery, there was a real sense of having two minutes to live should my ventilator become disconnected. Now, I can relax a little bit knowing that I am able to breathe without having a tube connected and breathe off the vent in my wheelchair.”
Many physicians recognize the value of diaphragm pacemakers for carefully selected patients. Don B. Headley, MD (Phoenix, Arizona), an ENT Surgeon/ Otolaryngologist, currently retired from Dignity Health (San Francisco, California), the fifth largest health system in the nation, noted, “Freedom from being tethered to a mechanical ventilator is the single most important benefit patients with diaphragm paralysis note after being implanted with a diaphragm pacer. It is very humbling to be able to make such a profound change in people’s lives through the implantation of this Avery device. Working with the dedicated members of this organization that enables these patients to have more freedom, and live longer, more fulfilling lives with this device is most satisfying.”
George V. Letsou, M.D., FACS, Professor of Adult Cardiac, Thoracic, and Vascular Surgery at Baylor College of Medicine, The Texas Heart Institute and TIRR (the Institute for Rehabilitation and Research) in Houston, Texas commented that, “Diaphragm pacing can dramatically improve the lives of people dependent on mechanical ventilation. Usually the relatively small operation involves only an overnight hospital stay. As outlined by Ms. Ficarra (in this article), the procedure can free appropriate patients from mechanical ventilation, allowing them to lead fuller and markedly more complete lives.”
In summary, the diaphragm pacemaker can help individuals with spinal cord injuries regain their freedom and pursue the life they wanted. To borrow a quote from Dr. Seuss, “Oh, the places you’ll go!”L