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Many individuals who have pectus excavatum or pectus carinatum surgery to correct chest wall deformities do so in adolescence before they’re fully grown. Yet, there’s a number of adults who did not pursue surgical correction who are now experiencing unexpected side effects in adulthood. This was the case for 25-year-old Brooke Britton, a registered nurse and aspiring travel blogger.  

“I started to have pain and a stabbing sensation where the bones in my chest were pushing on my organs. The problem had been bothering aesthetically for some time and for how easily I would become fatigued. I was really uncomfortable, and I began to wonder if the pectus excavatum was structurally getting deeper as I was getting older,” says Brooke. “As a nurse, I knew that my pectus excavatum was causing my chest to push up against my heart and lungs. With the Covid pandemic, this condition would put me at high risk for complications if I did contract corona virus. This situation really pushed me to think more about surgery and addressing the problem once and for all.” 

Addressing a Life-Long Condition 

Brooke’s pectus excavatum was a structural defect from birth. Her parents didn’t notice it at first, and it didn’t become pronounced until around her first birthday. When diagnosed, the experts they talked with at the time said she had a mild case that wouldn’t affect her respiratory or cardiovascular system in adulthood. The family decided not to pursue surgical correction when she was younger, and Brooke didn’t experience any specific problems until her college years.  

As Brooke got older, that slowly began to change when she started experiencing other symptoms related to her physical fitness – her heart rate would go through the roof when she exercised, and she got out of breath much more quickly than family and friends doing the same activities.  She decided to learn more about the surgery to correct the problem and connected with Dr. Lisa Smith, founder of the Pectacular! Chest Wall Reconstruction Program at University Surgical Associates and Erlanger. 

“Dr. Smith really has the whole process of education, preparation, surgery and recovery down to a science. She has her own dedicated team including anesthesiologists and nurse anesthetists, ICU rooms, and a medication regimen fine-tuned to effectively manage post-operative pain,” says Brooke. “Pectacular! was a unique program – unlike anything that I’ve been exposed to while being a nurse. I closely followed her instructions, and it works.” 

Preparation and Support are Key 

Following the plan, Brooke participated in pre-habilitation for two months prior to surgery. Working with specialized physical therapists, she focused on strengthening muscles specifically needed during recovery, including her chest, shoulders and upper back. This would also come in handy after surgery because it also significantly impacts a person’s posture and center of gravity. 

After pre-hab and pre-testing that provided information about the depth of the deformity (called the Haller index) and checked to see how effectively her heart was functioning, Brooke was ready for surgery. She’s quick to share that she doesn’t remember much about the procedure or the days immediately following. She does know that the medication plan ensured she could manage the pain and enabled her to get up and move – spurring on her recovery. 

“I was completely dependent on my family for the first month after surgery – I couldn’t move myself from a lying to a sitting position on my own without potentially disturbing the bars set inside. You also have to learn to maneuver your body because you can’t twist or bend your torso at all,” Brooke shares. “My husband, Brad, and my whole family were an amazing support system who came together to take great care of me. There’s no way you can go through this process without help and support.” 

Full recovery from pectus excavatum surgery typically takes about six months, meaning you have no physical restrictions. Many people are up and moving more normally at three months, and you can begin doing things like carrying a backpack, non-contact sports and gradually increase weight lifting. 

Brooke returned to work at about four months, taking a position that was less physically demanding. Even though the procedure was painful and required a lengthy recovery, Brooke believes it was the right decision – and worth the disruption and discomfort to live a more active and pain-free life. 

“If you’re experiencing pain or feel like there’s a structural issue that’s affecting your ability to live and work or do things you enjoy, I would encourage you to do it now. I have more stamina when I exercise, and I can breathe more deeply than I ever have before,” says Brook. “Dr. Smith has mastered this procedure and knows what she’s doing to help get you through it. It was probably one of the hardest things I’ve done, but knowing what I know now, I would choose this path again.” 

Learn More about Pectacular!

The Chest Wall Reconstruction Program offered by University Surgical Associates and Children’s Hospital at Erlanger is a multidisciplinary program designed to address the needs of individuals who were born with pectus excavatum and pectus carinatum. Because the decision to seek treatment is complex and often involves the whole family, the program was developed to address those very specific needs, provide support, and connect you with others who have walked the road you are considering. 

To schedule a consultation with Dr. Lisa Smith, call 423.267.0466. 

Posted by University Surgical | Topic: Your USA Story

Surgeon Spotlight

August 16th, 2021

University Surgical Associates WElcomes New Vascular SUrgeon 

Ehsan Benrashid, MD, vascular surgeon with USA Vascular, earned his medical degree from the University of Virginia School of Medicine in Charlottesville, VA. He completed a g junior and senior general surgery residency at Duke University Department of Surgery, Durham, NC, where he also served as Chief Resident. During this time, he also completed a surgical research fellowship. After residency training, Dr. Benrashid went on to pursue a vascular and endovascular surgery fellowship from Washington University/Barnes-Jewish Hospital in St. Louis, MO. Dr. Benrashid joined University Surgical Associates in August 2021. 

Dr. Ehsan Benrashid always liked the idea of patient care. Growing up in an immigrant community, he believed from a young age that being a physician was a respected calling. With a desire for stability and to establish himself in a solid career, Dr. Benrashid was further drawn to medicine because of his desire to make a positive impact on people’s lives. While he initially planned to be a neurologist and researched muscular dystrophy, Lou Gehrig’s Disease and other neurological conditions prior to his medical training, vascular surgery was ultimately where he found his passion. 

 “As a medical student, I had a lot of positive experiences with the vascular care team at UVA – the ability to help people by preventing a stroke or correcting a ruptured aneurysm really drew me in. The comprehensive nature of vascular surgery and the ability to be your patients’ physician for the long term was also really exciting to me,” says Dr. Benrashid. “My next inclination toward vascular surgery was due to the impact of several mentors who were experienced vascular surgeons. Even though some were later in their careers, they remained current with the latest endovascular techniques and technologies – and continued to do life and limb-saving work.” 

Vascular and endovascular surgery is one field of medicine that is constantly evolving. With new minimally invasive techniques continuing to improve, what once meant a major open surgery can oftentimes be corrected through catheter-based systems that do not require large surgical incisions. In his work at USA, Dr. Benrashid will focus on a few key areas including cerebrovascular disease, carotid disease and stenting, transcarotid artery revascularization (TCAR), thoracic outlet syndrome (TOS), and the treatment of complex abdominal and thoracic aneurysm through both open and endovascular means. 

“Many people with vascular conditions have complex medical histories – and decisions about their care aren’t always straightforward. But I enjoy the challenge of helping families navigate these difficult medical decisions, and also giving them information that helps them understand their disease process,” he shares. “With a greater understanding of how to incorporate healthy habits and practices into their normal lives, my goal is to help save lives and limbs and help my patients feel better in the long term.” 

Dr. Benrashid notes that his two main goals in coming to Chattanooga and joining University Surgical Associates are to have a positive impact on the community and to raise awareness about the severity and consequences of vascular disease. He’s also excited to work alongside his colleagues at USA, UT and Erlanger to continue to expand the reach of services and offer comprehensive vascular care.  

“The way we treat dangerous vascular conditions continues to evolve and improve – and that means we can bring life- and limb-saving care to more people in southeast Tennessee, Northeast Alabama and even into the western North Carolina,” says Dr. Benrashid. “I intend to lend my efforts to raise awareness about treatment and prevention and find my place in the broader medical community to impact as many lives as I can.” 

For more information or to schedule an appointment with Dr. Benrashid, please call 423.267.0466. 

Learn more about this complex colorectal disorder that affects approximately 1 in 5,000 live births from USA pediatric surgeon, Jeremy Fisher, MD. 

Hirschsprung Disease is a complex colorectal disorder affecting approximately 1 in 5,000 live births. It’s a defect that is typically identified in the early days of a child’s life, if they’re unable to pass meconium in the first 24 to 48 hours after birth. Meconium is a newborn’s first poop that is made of protein, fats, and intestinal secretions like bile. Children who do not pass stool as expected may be suspected of having Hirschsprung Disease. 

“Simply put, Hirschsprung Disease can cause difficulty passing stool. Children affected by this condition often develop constipation or partial or total obstruction of the bowels, leading to discomfort and pain,” says Jeremy Fisher, MD, pediatric surgeon with University Surgical Associates. “The condition involves missing nerve cells in the muscle in part of all of the large intestine. These cells are called ganglion cells, and their job is to allow the rectum to relax. Without them, the muscles in the bowel are constantly contracting and lose their ability to move stool through the intestine and out of the body.”  

Suspicion of Hirschsprung disease is first explored with a contrast enema, which is an x-ray study using a water-soluble contrast agent to capture images of the colon and rectum. If an abnormality or suggestion of disease is found, a biopsy of the lining of the rectum is performed to confirm the diagnosis.  

“Hirschsprung Disease exists on a spectrum – some have a small area affected. The lower rectum is involved for everyone with the condition, and it can move as high as the colon and small intestine,” Dr. Fisher says. 

Who is Affected? 

There are no racial or ethnic backgrounds that make developing Hirschsprung Disease more likely. Anyone can be born with this birth defect, although it is four times more common in males than females. While typically diagnosed at birth, the condition is sometimes found later – where a small area of the rectum is involved and becomes more noticeable as the child gets older and experiences issues with constipation. Because constipation is a such a common childhood ailment, it can take a while to identify the root cause of symptoms.  

In addition to the main symptoms of constipation and bowel obstruction, children who are diagnosed later are also at risk for Hirschsprung enterocolitis, an inflammatory condition and infection of the colon that causes fever, abdominal distention, diarrhea, and sepsis.   

“The only treatment for Hirschsprung Disease is surgery, where the section of the rectum or colon that isn’t functioning properly is removed. When found at the newborn stage, many children will have this procedure before they leave the hospital,” says Dr. Fisher. “The number one goal is to remove the affected area and put things back together so the child can poop normally. Although a temporary stoma is sometimes necessary, the vast majority are ultimately able to go to the bathroom through the anus.” 

Typical recovery for this surgery is a few days in the hospital, usually less than a week depending on other factors. Before discharge home, a child’s bowels must be functioning as expected. Parents are also educated about how to look out for enterocolitis or infection that can develop in the digestive tract after surgery. While in the past surgeons have believed that surgical repair corrected Hirschsprung Disease completely, it’s now understood that many children with the condition may have ongoing issues with bowel function including incontinence and constipation. 

Dr. Fisher notes that Hirschsprung Disease is complex and multifaceted and can negatively impact a person’s quality of life. Because these issues often continue into adolescence and adulthood, routine monitoring or being followed by a specialist is critical to ensure they don’t develop or continue to struggle with the physical and psychosocial issues related to the disease.   

“Pediatric surgeons are trained to treat this disease and it is an essential pediatric surgical condition. However I do believe that more experience and a greater volume of cases means a higher level of expertise – leading to better outcomes,” says Dr. Fisher. “The experience I gained during my fellowship and training under one of the leading experts in the disease means I’m well equipped not only to perform the initial surgery if needed, but to provide a nuanced assessment and advanced care for individuals who are still struggling with long term symptoms.” 

If you or your child is struggling with lingering symptoms of Hirschsprung Disease, compassionate and effective care is available. To schedule a consultation with Dr. Fisher, call University Surgical Associates at 423.267.0466.  

Posted by University Surgical | Topic: Ask a Doc

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