High-tech device allows paralysed former soldier to breathe without ventilator
As he did when he was a tank squadron commander, retired Canadian Forces colonel Greg Hug sets for himself objectives: short, medium and long-term.
But the horizons of his ordered ambitions have changed utterly in the six months since a body surfing accident in Barbados left him paralysed from the neck down. Hug is focused now on mastering a new breathing method, reducing his dependence of a mechanical ventilator, and graduating from the Ottawa Hospital’s intensive care unit.
“I am focused on having a mission and accomplishing that mission,” said Hug, 63, who commanded an army tank squadron and Lord Strathcona’s Horse, an armoured regiment, during his military career.
“Fundamentally, it’s about defining objectives and coming up with a plan to achieve those objectives, and executing the plan. But this is obviously going into an unknown area for me.”
Hug is today able to breathe on his own for extended periods of time thanks to a high-tech pacemaker that helps power his lungs. The device was installed in late July in a first-of-its-kind operation in Ottawa.
The pacemaker sends electric pulses to the diaphragm, the layer of muscle and tendon that expands the ribs during the breathing process. The dome-shaped diaphragm https://www.youtube.com/watch?v=hp-gCvW8PRY is the body’s major breathing muscle: When it contracts, air is sucked into the lungs.
In the operation, the Ottawa Hospital’s Dr. James Villeneuve used small, laparoscopic tools to implant four electrodes into Hug’s diaphragm — two on each side — then tunnel wires to the right side of his chest. The wires connect there to a box that Hug wears in a harness outside his body.
The device provides regular electrical stimulation that contracts Hug’s diaphragm to initiate his breathing.
“It’s going to be a game-changer for him,” said Dr. Villeneuve, a thoracic surgeon. “He will have options and it means he will not necessarily be tied to a ventilator during the day.”
Villeneuve performed the operation under the guidance of Dr. Raymond Onders, an American pioneer in the field. Onders, a professor at Case Western Reserve University in Cleveland, performed the same type of surgery on actor Christopher Reeve — eight years after the late film star suffered a broken neck in a riding accident. Onders is now exploring ways to use the same technique to help ALS patients, and those with other muscle-wasting diseases.
The first time Hug tried the diaphragm pacemaker, he could only use it for two or three minutes before growing breathless and tired. “It was very, very difficult at first,” he remembered. “I was really quite disappointed: I didn’t think it was going to work out all that well.”
Since then, however, Hug has made steady progress. Last Friday, he used the diaphragm pacemaker for nine-and-a-half hours, his personal best. He’s hoping the pacing device will allow him to eventually return home rather than move to a long-term care facility.
“My hope is that I won’t have to use the ventilator at all,” Hug said. “The main key is to gain a measure of independence.”
Dr. Villeneuve said Hug is the ideal patient to test the device, which could be adapted in the future to take more ICU patients off mechanical respirators. “Greg is extremely determined,” said Villeneuve. “He is all about the repetitions, and the sessions. Personality-wise, he’s the perfect fit for this first try at this procedure.”
Less than two years ago, in December 2014, Hug retired to focus on travel, family and volunteer work. He had served 25 years in the military, and had developed a successful second career as owner of MAGI Consulting Inc., a project management and training firm.
In early February, he flew with his wife, Maria, to Barbados as part of a travel plan that was supposed to carry them to the Rocky Mountains and to New Zealand.
But a rogue wave on the south-eastern shore of Barbados changed everything in an instant. Hug was body surfing in the rough Atlantic Ocean when he saw one wave “considerably larger than the others.”
Greg Hug, a former Canadian Forces colonel (pictured with his wife, Maria Rocha-Hug) was paralyzed in a body surfing accident earlier this year. Julie Oliver / Postmedia
“I didn’t think it was going to be a major issue,” he said, “and I launched myself into the wave. The wave broke over me and pushed me down so that I hit the sand underneath the water. I hit the sand hard and I could tell something fairly serious had happened in my neck and my reaction was, ‘Oh, s–t.’ After that it becomes fairly vague.”
Hug had suffered a fracture high in his cervical spine, an often fatal injury. He was rescued by another swimmer, resuscitated on the beach by two doctors — both of them from Toronto — and rushed to hospital. Within 36 hours, he was on a medevac flight back to Ottawa.
He spent the next eight weeks in the ICU at the Ottawa Hospital’s Civic campus, where he slowly came to understand the profound nature of his injury. He mourned the loss of his independence and his favourite activities: cycling, swimming, skiing, fishing and hunting.
Ultimately, his doctors helped him move forward by handing him some new objectives. They challenged him to learn to speak using a valve on his tracheostomy tube; the device allows air to pass over the vocal cords. (A tracheostomy takes away a person’s voice by directing air below the vocal cords.) Most thought it would take him months, but he learned the technique within three weeks.
The pattern would often repeat itself in the following months.
“When the doctors set objectives, I typically try to surpass the dates they set,” Hug said. “There’s a degree of stubbornness on my part, I guess.”
In late March, Hug moved to the General campus, where he has formed a close bond with his nurses, doctors, respiratory and occupational therapists.
His ICU team has developed a detailed care plan to help wean Hug from his ventilator and to manage his environment. They’ve taught him how to employ mouth- or chin-controlled devices to control his wheelchair, call for nursing help and sip water on his own.
“The care has been fantastic,” said Hug. “They’re positive, very upbeat, they know my routine.”
He does not yet have a target date for leaving the hospital. “I know I’m going to be in the ICU for the foreseeable future,” said Hug, who has three adult children and two grandchildren. “Ideally, in a few months, I’ll be out of the hospital and in a normal — or as normal as can be — environment.”
His home in Orléans is not designed to accommodate a wheelchair, so the family will have to move to a bungalow or condominium.
“The best case scenario is that I’m living a fairly full life,” Hug said. “Obviously, I’m not going to be doing the activities I used to do, like downhill skiing, cross country, or cycling, that kind of stuff. But I still want to travel. I want to spend time with family. I want to see my grandchildren grow up, graduate from high school … I want to get out and do things with people.”
Greg Hug and his wife, Maria Rocha-Hug Julie Oliver / Postmedia
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