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'Iron Man' revels in new look, enjoys benefits of pectus surgery

Dawn Brazell | MUSC News Center | October 13, 2014

Pectus excavatum
Photo Provided

Carson Quick poses for his mom shirtless, something he wouldn't have done before his pectus excavatum surgery this past summer. Read story about how the surgery works here. 

They call her son Iron Man now.

Jade Quick of St. Petersburg, Florida, loves that. The stainless steel bar he has in his chest has done wonders for the 12-year-old, who now is active on swim team and has no qualms about shedding his shirt.

That hasn’t been the case until recently. Carson has a congenital deformity known as pectus excavatum that has caused his chest to have a caved-in appearance that can worsen during the growth spurt of adolescence and affect the functioning of the heart and lungs.

Quick said they noticed it first when Carson was 2. They took him to a specialist who basically brushed them off, saying the issue wasn’t significant enough to discuss.  Fortunately, the next specialist she saw was Andre Hebra, M.D., who was practicing in Florida at the time. He explained Carson’s condition and advised her to keep an eye on it, adding that if surgery becomes necessary, the best time would be his early teens.

Quick said she’ll never forget the experience.

pectus excavatum
Photo provided
Carson Quick's chest before his surgery had a caved-in appearance. 

She went from being dismissed by one doctor who told her he had to leave to do an important heart surgery to someone who spent 30 minutes with her patiently explaining a condition she had never heard of before. “I would have gone to Alaska if he had moved there,” she said of her decision to come to Charleston this past summer to have Hebra, director of MUSC’s Division of Pediatric Surgery, do the pectus repair for Carson.

Carson’s condition had worsened, and it was affecting his breathing and heart function, she said. It also psychologically was taking its toll. At an age when “they want to be like little ducks in a row -- all the same,” her son avoided being seen without a shirt. He had gotten to the point he was buttoning his shirts up all the way, she said.

The surgery takes careful consideration, though. Even though a minimally-invasive version of the pectus correction called the Nuss procedure can be done, it is one of the most painful pediatric procedures that is performed. Surgeons insert a steel bar that immediately raises and braces the sternum (See story describing surgery here.) The bar remains in the chest for remodeling effects for three years before being removed.

Hebra said he makes sure patients know what they’re getting into. Though he’s done the surgery for more than a decade and perfected many of its techniques, it’s still a major procedure.

 Dr. Andre Hebra
Sarah Pack
 Dr.  Andre Hebra performs a pectus excavatum surgery.

Pectus repair used to be done through the Ravitch procedure, which involved a fairly large incision in the front of the chest, removing certain ribs affected and fracturing the sternum to make it flat again. The newer Nuss procedure is minimally invasive. A steel bar is inserted upside down and then flipped up, immediately repairing the chest depression. It has less scarring and blood loss, but recovery still is painful and requires several days in the hospital to manage pain. Most patients have a thoracic epidural analgesia, which lowers the need for other pain medications that can cause significant side effects for patients, he said.

There are many misconceptions about the procedure even among physicians.

“The most common misconception is that a child will grow out of it,” Hebra said, adding that he has never seen it improve and that in 90 percent of cases it will worsen. The reality is that because it is a genetic defect of the growth of the rib and sternum as a patient is growing, particularly in puberty and adolescence, that accelerated growth is going to go in the wrong direction, he said.

Medical Necessity

That was the case for Chelsea Smith, another patient who had the operation this past summer as well. At 23, she’s older than most of the patients who have it done in their teenage years, but Smith decided to wait to do the procedure until it felt medically necessary.

Her father’s family has several members who have had this condition, so it was accepted in her circle. “It was looked at as cosmetic until it became problematic,” she said. Smith was fine until a couple of years ago when she realized her chest would get tight when she would stand a long time or exert herself. She felt light-headed at times.

pectus excavatum 
Chelsea Smith 

When she began fainting during her medical school training in Greenville, she knew it was time, she said. She consulted experts and the name that kept coming up was Hebra’s.

Since her medical school training would accelerate in her third year, Smith said the timing seemed to be right to do something. She also didn’t want to have to worry about complications that might arise during pregnancy later in her life, since that may cause symptoms to get worse.

Though her main goal was to deal with the medical issues, she admitted it would be nice to go to Victoria’s Secret and have more than one bra to pick from. “I tried every bra and only one fit right. It’s been ridiculous. I can get rid of the grandma bras.”

Smith said she has been surprised how fast she recovered from her July 8 procedure  and is happy she did it. The last five months before her surgery were the worst. Her blood pressure and heart rate were going up, she suffered panic attacks and had moderate mitral valve prolapse and tricuspid regurgitation. Those conditions have improved and she has more stamina for her medical school work, she said.

She now can run up and down flights of stairs and can go all day without being worried she’ll pass out. She went hiking recently and only had to take one five-minute break.

Another benefit is she has been able to educate colleagues about the benefits of the procedure and correct misconceptions about it. “It’s not just cosmetic.”

Smith had the same nurses for almost her entire stay, which she really liked. “They became advocates for me,” she said, adding that Hebra was very calm during the entire experience and never made her feel flustered.

Quick agreed, saying that Hebra has a gift of putting patient’s fears at ease. “You feel at peace with him. He was talking to Carson like he was a human being. He changed our lives. He’s so dedicated. He came every day to see us. He was like a friend, caring and considerate. I trusted him. I felt like Carson was in amazing hands."

Carson Quick - pectus excavatum 
Carson Quick picked up a new sport of swimming after his surgery and no longer has to use his inhaler. 

Quick said before surgery in June her son couldn’t take deep breaths or laugh really hard. It was starting to affect his posture and his breathing. “He would laugh and he couldn’t get a full laugh in. It hurt my heart.”

Quick said Carson was brave about having the surgery, and everything went well. “From start to finish, it was an amazing thing.” She said Carson still talks about the nurses. “It was worth the trip, 100 percent.”

Quick said Carson used to call the depressed area in his chest the hole. “For him it was a big deal. When they wheeled him out and lifted up the covers, and it was like ‘Oh my God!’ He was thumbs up. When he got home and showered and took a good look at himself, he said, ‘I can’t believe it’s fixed. My hole is gone.’”

Carson, who hasn’t had to use his nebulizer since surgery, swims six days a week, has shed some pounds and exudes confidence. “He’s out there with all these other boys showing them his scars.”



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