‘Pectacular!’
Program helps children prepare for major surgery
Alli Smith, age 15 at the time, had waited nearly seven years for Dr. Lisa Smith to give the go-ahead. Alli was born with pectus excavatum and pectus carinatum, two chest wall deformities that left her yearning to be “a regular girl.” Both deformities occur
when the sternum, ribs and surrounding cartilage do not properly form.
One in 500 children, most commonly boys, are born with pectus excavatum — where the chest appears “caved in” — while pectus carinatum — where the chest “bows out” — occurs in roughly one out 1,500 births.
Alli compared the shape of her chest to a “roller coaster,” so finding clothes that fit her body was an ongoing challenge. And as an avid basketball player, she said she was using an inhaler every five minutes to help her breathe during games.
“Where my chest was sticking out, the goal was it would cover itself up when I matured,” Alli said. “Then, my heart started to move from the chest
wall pushing in, and Dr. Smith looked at me and my mom and said, ‘It’s time for her surgery.’”
The chest wall reconstruction technique that pediatric surgeon Lisa Smith specializes in was new when she first performed one in 2002, and she’s learned a lot since then.
Most patients with chest wall deformities will not need surgery, but others with more severe cases may find it helpful to correct breathing problems and fatigue that occur when their heart and lung function are impaired. Improved body image is another major reason patients undergo surgery.
During the surgery, a metal bar is placed into the chest in order to reshape it. The complex endeavor requires a multidisciplinary team of physicians, nurses and therapists, and the results are much better when patients prepare in advance.
“This is a major surgery, and it’s different than a lot of other surgeries,” said Stacey Miles, a pediatric physical therapist at Children’s Hospital at Erlanger — where Smith practices along with others from her medical group, University
Surgical Associates.
“Patients can’t push or pull anything, and they can’t raise their arms above shoulder height or twist and bend at the waist,” said Miles, adding that once patients return home, family members must help them get in and out of bed for six weeks.
About eight years ago, Smith officially dubbed the program “Pectacular!”
She calls the time spent preparing her patients for surgery “pre-hab.” Much
like athletes in training, patients do exercises to strengthen their chest muscles and open their rib cages to better receive the bar. The results are a safer surgery with less pain and faster recovery.
“Dr. Smith has made this program what it is, because she’s involved with every single person that touches the patient,” Miles said. “It shows how well something can work when you bring everybody to the table.”
Smith said communication with her team and patients are the keys to success.
“You have to listen to the patient, and if you don’t care enough to listen and take care of them, you’re just operating on them,” she said. “Doctors and nurses and other professionals all have a different perspective of what’s important to patient care. I realized that if you just focus on the surgeon or surgeons’ concerns, that misses other perspectives.”
In a never-ending quest to improve the program, Smith constantly tweaks her methods. Holding an ice cream social in the spring for patients and their families who have been through the program to return and mentor newcomers was an idea that came about several years ago.
“They can tell each other and teach each other things that I never could,” she said.
Patients get to rotate between “stations” and meet the other medical professionals involved in the surgery, including pain management, anesthesia and therapy teams.
Many travel from across the region to Chattanooga for Smith’s chest wall expertise, including Alli Smith, who’s from Crossville, Tennessee. Smith averages about 15 chest wall reconstructions per year and patients are typically teenagers. However, her oldest chest wall patient was age 44.
“My goal is to make this better each year, and I promise you I’m not getting complacent,” Smith told the attendees. “I really think there’s always a new direction we can go, so returning patients, don’t be jealous, because it’s from you that we took your comments seriously.” This year, she’s taking a more “nutritional approach” by having the kids carb load and drink an electrolyte-based sports beverage before surgery.
Nurse practitioner Julie Lively told a group of parents and their kids that will help them bounce back quicker post-surgery.
“Even when they’re in the bed, that body is really working hard, because you just had a big, ole hairy surgery,” Lively said. “So we need your body to have the energy to do the work it needs to do to heal.”
Alli was one of those returning patients. Her mother, Staci Smith, spent some time sharing her journey with Stacy Kight, whose son Noah Riley will be undergoing surgery with Smith this summer.
“I remember how much it helped my family, especially my mom,” Alli said. “I was ready, but watching her prepare made me feel good, so I was like, ‘OK, we’re going to have to keep coming back.’ I want to share my experience with people and let the other ones know they’re not alone.”
Now 17 years old, Alli said she’s running full basketball games and enjoying her “normal chest.”