First Mayo patient with diaphragm pacemaker
Determined Mom breathes on her own
In October 2010, Sheila Lehnen's life changed in one misstep. She was headed down her basement stairs to turn on the yard lights for her two sons who were working late. And she fell.
Her husband heard the fall and found Lehnen at the bottom of the steps — unconscious and not breathing. He called 911 and began performing CPR.
The emergency response team worked on Lehnen on the way to the hospital. She was stabilized in the emergency room, but found to have fractures in her C2 - C4 vertebrae. The next evening Lehnen had a major cardiac arrest.
Dependent on ventilator to breathe
Again, she was stabilized, but surgeons confirmed that she had no movement from the neck down. Also paralyzed was her diaphragm, the muscle that contracts to pull air into the lungs.
Lehnen became dependent on a mechanical ventilator for breathing. She received a tracheostomy, a surgically created opening through the front of her neck into her windpipe (trachea). This opening created a passageway into her windpipe for the use of a ventilator machine.
Not surprisingly, the ventilator and her confinement to a wheelchair severely curtailed her activities. "I went a whole year without seeing any of my sons' activities," Lehnen says. "I missed basketball tournaments, show choir, the marching band."
In November 2010, she was moved for spinal cord rehabilitation at Saint Marys Hospital in Rochester, Minn. "These are patients who often have highly complex needs, and it takes a real integrated team of specialists to help them through, from the surgery to the point when they can go to the next stage of care," says Ronald K. Reeves, M.D., Mayo Clinic Physical Medicine and Rehabilitation physician.
Outpouring of support
Despite the trauma to the family, Lehnen's husband, Joe, and her sons Zachery, 15, and Matthew, 14, were heartened by the support from the Altoona, Wis., community where Lehnen had been school board member. The Altoona girls' high school basketball team and their coaches even came to clean the Lehnen home.
Still, there were lonely times. Joe Lehnen recalls the first Thanksgiving with his boys and without their mother. "The men and I attempted a Thanksgiving meal together. I had pizza as a backup plan in case things didn't go as planned."
First Mayo patient to receive breathing pacemaker
Five months after her accident, Lehnen saw hope. In March 2011, she became the first Mayo Clinic patient to receive a diaphragm pacemaker.
Cardiac pacemakers regulate abnormal heart rhythms. Lehnen's breathing pacemaker stimulates her diaphragm to contract and relax, enabling her to breathe on her own. She was the first person in Minnesota to receive this newly approved device.
The device itself is a small external battery-powered stimulator that fits inside a fanny pack that Lehnen wears on her waist. It has wires, or leads, that are implanted in Lehnen's torso and send electric impulses to her diaphragm. These impulses induce diaphragm contraction and inhalation, which fill the upper and lower parts of Lehnen's lungs.
"An electrical signal tells Sheila's diaphragm to contract at predictable rate, say about 16-times a minute," says Dr. Reeves, explaining how Lehnen's diaphragm pacemaker works. "We optimized the stimulation for Sheila, adjusting how long it lasts, how strong it is or how frequently it occurs."
Breathing on her own
After receiving her diaphragm pacemaker at Mayo Clinic in Rochester, Minn., Lehnen was transferred to a facility closer to her home. Her care was overseen by Mark Lindsay, M.D., a pulmonologist with Mayo Clinic Health System in Eau Claire, Wis.
Dr. Lindsay coordinated care between Lehnen's Mayo Clinic physicians and the care facility's rehabilitation staff to strengthen Lehnen's diaphragm. Over a period of months, her time off the ventilator grew from minutes to several hours to complete liberation.
Joe Lehnen describes her progress. "In May, Sheila set herself a goal of being off the vent and using the diaphragm pacing for 7 hours. What did she do in the first two days of the week? She blew the record away with 8 and a half hours of pacing! Then, at the end of May, she was off the vent and using the pacemaker for 12 hours."
She's amazing," he says.
"She's a real go-getter," Dr. Lindsay says. "She's far, far, far outmatched all the expectations we've had for her from when she got here."
Dr. Reeves says helping her regain the ability to breathe on her own not only gives her increased freedom, it also reduces her risk of developing dangerous respiratory complications, such as pneumonia.
"The goal of implanting this device is to reduce the amount of time patients require mechanical ventilation," explains Dr. Reeves. "The ability to get rid of the tracheostomy tube — a foreign body in the trachea — is going to significantly lower her risk of infection."
In the future, he says, Lehnen may rely on the pacemaker only during sleep.
A surprise visit for her son
In November 2011, more than a year after her accident, Lehnen surprised her son, Matthew, by attending his school show choir competition at Chippewa Falls High School. It was her first big trip out of the hospital without a team of caregivers.
"I'm really happy Mom was able to come to the performance," says Matthew. "It meant so much to have her in the audience."
"Since I received the breathing pacemaker, I have the freedom to come and go as I please and not have to worry about the gadgets that had to go with me," says Lehnen.
Progress and inspiration
Every day Lehnen is making progress.
"Her eyes sparkle a bit and she gives off that radiance of confidence that she needs to beat this injury," says her husband, Joe.
"Her spirits seem positive. I always liked that in my wife: Strength, pride and determination," he says proudly. "Sheila has been an inspiration to me and everyone she comes in contact with."
"Her determination is her best medicine," Dr. Lindsay says.