United Brachial Plexus Network, Inc.

Brandon,
I couldn't agree more. Who is going to have more motivation to create a cure for an injured person more than that injured person, or someone that loves that person. No one knows what it's like but the person troubled by it...

If I could get back to my original level of spirit (be depression free) that I had pre-injury and get some real control over my pain I would be more than willing to take the bull by the horns and go back to school to obtain a medical degree and happily spend my hours productively trying to bring the science & medicine that would help heal us all, to us all, faster. Unfortunately I'm still climbing out of the hole on this thing. So I don't trust myself fully yet. But I'm finally completely drug free and am the closest I've been to my old self in almost three damn long years (BPI on 12/15/2002) and am still figuring out what changes I need to rebuild my future.

I don't like placing responsibility on any one else's shoulders to heal me but myself. But that doesn't mean I will except the notion that some self righteous bureaucrat/politician wants to keep the doors closed to an operating room that might hold the cure to what ails me! I believe in moving forward responsibly & sensibly, but how does one decide what is responsible & sensible for another when they have never been in the other's shoes.

You are absolutely right that we are not powerless, that is the beauty of this forum. It gives us all power thru sharing knowledge and experience. Hell at first I hated the idea of returning to this site, because to me it meant I hadn't picked up the pieces and moved on. I even wrote Punchy Sue (Susan) a letter telling her to watch out and not get sucked in (sorry Susan). But now I realize it is actually helping me pick up the pieces much faster than I ever could have alone. It is constantly a source of inspiration to do more and research more. Every time I read someone newly injured on here looking for advice, I swear my heart drops thru my pants, and all I want to do is help give them back the life they, their friends, & families, once knew and must now terribly miss.

I know I'm going off target here a little, but I hate injustice & suffering, especially when it happens to people and they aren't aware of how and why it's even happening to them. One of my driving goals is to learn more about the resolve to this injury. To do what no other doctor or specialist can, to gather as much purposeful & practical information & science that each medical field has to offer that might bring a cure to this injury, and keep on pushing it into the hands of those that could put it all to use and implement it.

One of the natures of this beast is that all these great and learned specialist are all completely separated by their specialties. The communication between Neurosurgeons, Stem Cell Biologists, Neuronal-Researchers, and Orthopedic Surgeons is extremely limited to annual meetings and the like. I hope to change that, soon. It seems to be the best thing I know that gives me a sense of control over my life again. It ain't over till it's over!

Chris

Susan,
I never thought of that, using your own eggs for your own 'embryonic' stem cells! That's about as straight forward and as smart as it gets!!! I guess I haven't been thinking 'out of the box' since I'm ovary and egg dependent, if I want 'embryonic' stems cells to help me heal. Maybe I'll get a sex change so I can fix my arm, that's not too desperate is it? The sick thing is that if it'd work, I'd probably do it... I'm getting a little tired of sleeping with myself night after night, a little change up might be just what the doctor ordered.

I hope you're hanging in there, been med free for one and a half weeks now and it's great and sucks both at the same time. More pain, but more brains (and heart). Which is much better than before, because before it just sucked all the time.

Be well,
Chris

This may be a bit longer than anyone feels like reading...
but, it hints at one of the greatest obstacles that faces Surgeons and Researchers and finally the patient.... not enough collaboration & communication!

BRIEF: this article discusses the "newness" of nerve transfers, and it's history since.... 1912!!!!!!!!

our medicine in practice almost older than the first automobile!




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CREATING NEW FUNCTION-RESTORING NERVE CONNECTIONS
(adapted from December 2005 “Paraplegia News” article)

As reported in the prestigious Journal of the American Medical Association (JAMA), U.S. scientists have for the first time rerouted nerves from above the spinal cord injury (SCI) site to restore some function in paralyzed areas. Specifically, Drs. Charles Frazier and Charles Mills, University of Pennsylvania, successfully rerouted nerves to restore bladder function in a 27-year-old man who had sustained a lumbar-level (L2) injury after a gas tank exploded near him.

Although the patient had regained some function since injury, his bladder remained paralyzed, and he had “absolute incontinence.” Eight months after injury, he underwent a surgery in which a functional L1 nerve above the injury site “was divided extradurally at its exit from the spinal canal and brought within the dural sac” and then sutured end-to-end to sacral-level S3 and S4-nerve roots. Eight months later, the patient had regained some bladder control.

In previous PN articles, I discussed the creation of function-restoring neuronal connections such as the aforementioned. I just assumed such procedures were at the cutting-edge of twenty-first century science. Amazingly, the surgery described above was carried out in 1912!

When I came across the article (JAMA 59, 1912), I realized with dismay that function-restoring surgeries in some form have been available for nearly a century - but relegated to the therapeutic dustbin until recently. Given such glacial progress, it is understandable why many people with SCI are frustrated with science’s slow pace in producing real-world therapies.

This article will briefly review the slow emergence of these procedures since this 1912 publication.

Another rerouting surgery was carried out in 1951 by Dr. L. W. Freeman, Indiana University (J Neurosurg 18, 1961). In this case, Freeman connected intercostal nerves (those leading from the spinal cord around each rib to the sternum) to sacral nerve roots below the injury site in a 33-year-old prisoner who sustained a thoracic (T8-9) injury from police gunshot five months earlier. Retaining their central spinal-cord connections, intercostal nerves were freed, routed through the spinal canal, and connected to sacral nerve roots or implanted into the conus medullaris (i.e., the spinal cord’s conical tip). Although the patient believed that new leg and bladder phenomena ware attributed to the surgery, he died four months later. Post-mortem analyses indicated the continuity of intercostal nerve axons into both the sacral roots and spinal cord.

Based on Freeman’s work, Dr. Hiroyasu Makino et al (Japan) also routed intercostal nerves to paralyzed areas in eight patients with paraplegia sustained at least a year before surgery (Neurol Mediochir (Tokyo) 6, 1964). In four, one pair of intercostal nerves was inserted in the conus medullaris and another pair connected to L4 nerve roots. In the other four, two pairs of intercostal nerves were connected to L3 and L4-nerve roots. Because results were reported relatively soon after the surgeries, only one patient at that early stage had demonstrated significant improvement, including some ambulatory ability.

Reported in 1980, Drs. Carl-Axel Carlsson and Torsten Sundin (Sweden) connected thoracic T12-nerve roots to the S2 and S3-nerve roots in two men, age 23 and 43, with L1-injuries with injuries from accidents 10 and 14 days earlier (Spine 5(1), 1980). About a year later, both had regained some bladder function, and one regained erectile ability.

More recently, Dr. Shaocheng Zhang (China) has rerouted peripheral nerves to restore function in hundreds of patients (PN, April 2002). Restored function depended upon the specific areas that the target nerves serve (e.g., leg muscles, bladder or bowel, etc). Zhang often rerouted vascularized intercostal nerves, and if not long enough to reach the target site, intervening sural-nerve segments (from the calf) were attached. In one of Zhang’s studies using this procedure, 18 of 23 subjects regained some ambulatory function and were able to walk with crutches or other assistive technology (Surgical Technology International XI, 2003). Another study demonstrated that an intercostal-sural nerve bridge restored some bladder-and-bowel function in the majority of 30 subjects.

Dr. Giorgio Brunelli (Italy) has restored function by redirecting the wrist’s ulnar nerve and connecting it to nerves that control leg function. After this procedure, a patient with a complete spinal-cord transection could stand and walk short distances. In another procedure carried out in a woman with a complete thoracic transection, the peroneal nerve (to the leg) was used as a bridge directly from the spinal cord above the injury site to the nerves of the gluteus and quadriceps muscles. After two years, she was able to walk 30-40 meters with a walker (PN, August 2004).

Dr. Marc Tadie and colleagues (France) have rerouted lumbar nerve roots from below the injury site to the spinal cord above the injury site, creating a functional neuronal pathway from brain to paralysis-affected leg muscles. This rerouting was done in a man who sustained a complete T9-injury at age 52 three years earlier in an auto accident (J Neurotrauma 19(2), 2002). Specifically, three 6-cm-long nerve segments from the patient were implanted on each side of the cord at the T7-8 level immediately above the injury site. The opposite ends were sutured to L2-4 nerve roots, which had been detached from the point where they exit the cord. Eight months after surgery, the patient was able to initiate some contraction of adductor and quadriceps leg muscles, activity which was electrophysiologically confirmed.

Finally, Dr. A Livshits et al (Russia and Israel) connected intercostal nerves above the injury site to nerve roots below the injury site in 11 patients with complete L1-injuries (Spinal Cord 42(4), 2004). Specifically, intercostal nerves were transferred through a vertebral canal created under deep spinal muscles and then connected end-to-end to S2-3 nerve roots. Some bladder function was restored in all patients.
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CONCLUSION
Although I usually see much promise and potential on the SCI horizon, I was dismayed to learn that function-restoring, nerve-rerouting surgeries have existed in some form for nearly a century. I have personally observed such surgeries and the dramatic improvements accruing from them. Overall, I strongly believe that such procedures can restore significant life-enhancing function in many with SCI.

Given its key role in developing new therapies, I’m troubled that the National Institutes of Health (NIH) with its nearly $30-billion research budget seemingly can not duplicate century-old results while a growing number of foreign scientists are able to do so. As a former senior NIH official, I believe this is partially the result of NIH’s approach to funding the most scientifically meritorious of laissez-faire submitted grant applications. Although the process sounds good, it is based on a questionable assumption that funding the best science automatically translates into the greatest potential for spinning off new therapies. In fact, the result is usually that the development of real-world therapies becomes secondary to scientific agendas.

Although I’m in awe watching surgeons connect nerves that I can barely see, this nerve-rerouting approach represents theoretically a simple concept. Perhaps, this is an example of NIH overly emphasizing sophisticated science agendas at the expense of non-glamorous, but much more promising, surgical approaches.


http://www.healingtherapies.info/

About the Author: Laurance Johnston obtained his doctorate in biochemistry and molecular biology from Northwestern University (Evanston, IL). He became a regulatory scientist at the U.S. Food and Drug Administration and later Director, Division of Scientific Review, National Institute of Child Health and Human Development, National Institutes of Health (NIH). After leaving NIH, he assumed the directorship of the Spinal Cord Research and Education Foundations, Paralyzed Veterans of America (PVA).

Supported by PVA, Dr. Johnston currently researches and writes about various alternative, complementary, or innovative therapies that expand the healing spectrum of people with spinal cord injury. He has been invited to speak at national and international meetings and is listed in Who's Who in America.

I have to put in my opinion here. I am a huge supporter of stem cell research. I am not against the US. The government and medical/science community does do a few things that kind of make you wonder. I believe that if all the cures for diseases and stem-cell research were available, the gov't and pharmacuetical companies would lose too much money. Can you imagine how much money goes to therapy, surgery and meds. ALOT These people that have the authority to make a difference in the lives of so many, but they don't want to take the chance of not making the millions per year that they make. We can't pray in school, we can have religious things in public buildings... but these same people say that stem-cell research is wrong. I tell people all the time, if stem-cells were used, my son would be fine.
Just my 2 cents.

Marlyn