Tag Archives: Spinal cord injury

Diaphragm Pacemakers – Breathing New Life into Quadriplegics

By Nicole Ficarra, Communications Coordinator, Avery Biomedical Devices (Commack, NY, www.averybiomedical.com), the global leader in high reliability diaphragm pacemakers.

A Diaphragm Pacemaker from Avery Biomedical

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.

How a Diaphragm Pacemaker Works

Avery Spirit Transmitter; full system with plastic case.

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.

The 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:

  • Greater mobility and freedom to pursue different activities;
  • Easier time performing daily activities;
  • Elimination of routine maintenance and disposable supplies ventilators require;
  • Less risk of the infections, pneumonia, collapsed lungs, airway injuries and diaphragm atrophy associated with ventilators;
  • No stress associated with locating power sources or power outages;
  • Improved breathing, speech, eating, drinking and hearing;
  • Better sleep quality; and
  • Reduced hospital re-admissions.

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.

Nicole Ficarra at Disney World.

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

Learn more about the Avery Diaphragm Pacing System

Ally Grizzard: “Learning Your Purpose Through Tragedy”

Guest Blog Written by Ally Grizzard

My whole life I’ve always believed everyone has a purpose. Sometimes you may not know your purpose until something tragic happens or you’re in a situation that you never imagined you would be in, but you eventually learn what your purpose is. I never knew my purpose until God forced me to see it.

On January 31st, 2015, at only 19 years old, I was driving my 10-week-old puppy Lilly to the vet for her shots when a hay truck that was carrying stolen hay was coming at me head-on in my lane. I swerved to miss him, and it caused me to flip end over end for 75 yards. I was ejected and thrown 50 feet from my car and landed flat on my back on the ground. I remember the feeling of landing flat on my back out of the air like it was yesterday. I remember my first thought being “Lilly!” and I tried to get up, but I couldn’t move. I couldn’t feel. I couldn’t do anything.

A few seconds later I remember hearing someone scream “say something, say something!” and all I said was, “Help.” I remember him running over to me and saying, “I have help on the way, it’s going to be okay!” I don’t remember anything after that. I was put into an ambulance and taken to a local church where a helicopter could land and I was life-flighted to Grady Memorial Hospital in Atlanta. I died that day. I took my last breath when first responders put me in that helicopter. EMTs did chest compressions the whole way there trying to keep blood flowing to my lungs.

When I arrived in Atlanta, I still had no pulse and no blood pressure. I was rushed straight into the OR into immediate surgery so they could open me up and bring me back. My spleen had ruptured, causing all of my organs to bleed internally. They were able to remove it and stop the bleeding. At the time, I wasn’t stable enough for any other surgeries, so they still weren’t able to see what other injuries I had. No one knew if I would make it through the night.

By God’s grace, I did. I stayed on the ventilator along with having 5 breathing tubes in ICU and 2 days later, I was stable enough for X-Rays and CT scans to look for other injuries. They found that my entire spine was shattered into pieces, my spinal cord was severed, I had a C2 hangman bone fracture in my neck and collapsed lungs. The next day, I went into an 8-hour back surgery where they reconstructed my entire spine with rods and screws and were also able to see that my spinal cord injury was at level T12, which leaves me paralyzed from the waist down.

After my back surgery, I was able to wake up. I was still on the ventilator, so I couldn’t talk. I didn’t understand much of what had happened and what was going on. I couldn’t sit up, but I could use my hands, so I could write. I laid there every day writing notes to my mom and family members, my boyfriend at the time, and my friends. Although I couldn’t see what I was writing and a lot of times they couldn’t make out what I was writing, I made it work. That was my way of communicating.

I knew I couldn’t feel my legs, but at the time I didn’t know why. I was told by my surgeons that I would never walk again, but I still just didn’t know or understand much of anything. I stayed in ICU for the next 2 weeks and  was transferred to the Shepherd Center, a world-renowned rehabilitation center for brain and spinal cord injury patients. I spent my first 3 weeks at Shepherd in ICU and I finally had my lung surgery and was able to come off of the ventilator and breathing tubes. After I healed from the surgery, I was moved to a regular room and was able to begin very intense physical, occupational, and recreational therapy. I spent a total of 7 ½ months at the Shepherd Center, healing and learning to live again from a wheelchair with only the use of my upper body. It was the absolute hardest thing I’ve ever gone through in my life, but I’m completely independent today because of it.

At 19, you don’t really think something like waking up and finding out you will be paralyzed for the rest of your life could happen to you, until it does. And when it does, it seems to teach you a few things about life. It seems to give you a different perspective: a better perspective. At least, it did for me. You learn who you are, what you’re made of. YOU LEARN YOUR PURPOSE. It’s been almost 5 years now since the accident and time seems to pass by faster with each year that goes by. January 31st is just another day for me now and Lilly is alive and well, too. She is my best friend. The bond we share could never be broken.

That boyfriend I had at the time, he’s now my husband. The most amazing husband I could ever ask for. Those family members, we’re all closer than ever before. I couldn’t be more thankful. And me- I’m a speaker, blogger, and a social media influencer. I live life every single day from my wheelchair and with only the use of my upper body. I drive. I visit Shepherd often and give back to other patients who are in the same situation that I was in, and I teach OT and PT students how to teach a future paralyzed patient of theirs to live life and get dressed from a wheelchair. I do everything that any able-bodied person would do on a daily basis, just in a different way.

I’m still in physical therapy to this day, only 1 day a week for my overall health and range of motion. I also proved my surgeons wrong and I walked down the aisle to my husband in my leg braces, all with the help of my physical therapist training me for 3 whole years. This turned out to be another difficult task, but I think every girl dreams of walking down the aisle to her husband from the time she’s a child. It was something I had pictured in my head from the time I was a little girl and I didn’t want that picture to be played out differently just because of my accident. So, I chased my dream. I conquered my goal and I hope I prove to every girl out there that they, too, can still have that special moment on their big day if they put in the work and never give up on their dreams.

I live trying to inspire others with my story because I feel that’s my purpose. I feel God gave me my story for a reason and I should use it for the good. Almost 5 years ago, I never would’ve imagined I would be where I am today. The mountains, the valleys, the trials, the setbacks, the comebacks- there’s a certain beauty in all of them. They made me who I am. They tend to continually dig up the soil in me and let me see what I’m made of and there’s just something about that part where you find out who you are, when you find out why God gave you this specific battle. I think that’s the whole purpose of the journey- to find out who you are and what you’re made of. To find your why. To share God’s love. To shine light in darkness. To lean on him. To share how he’s made beauty out of ashes.

I’ve learned he won’t protect you from every trial in life, but he will bless you with the strength, wisdom, and grace to get through it. I’ve learned I wouldn’t still be here if there wasn’t more in store for me. I wouldn’t still be here if the journey was over. I’ve learned to keep my eyes fixed on the one who kept me breathing and keep my heart tied to the one who continually strengthens me to keep going. It doesn’t matter what you’ve done or what you’ve lost, in him you’ll find a reason to keep going that you won’t find anywhere else. Lilly and I celebrate our survival and the life that we still get to live day in and day out. I’m grateful for where we’re at, and excited about where we’re going. My wish for everyone I come in contact with and everyone that comes across my story is that you never stop living your life to the fullest no matter what you may be going through. Always follow your heart and dreams, and never give up!

-Ally Grizzard

You can connect with Ally on Instagram (@allygrizzard) or in the LIKEtoKNOW.it app (@allygrizzard).