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Magnets May Pull Kids With Sunken Chests Out Of Operating Room

Jul 30, 2012
Originally published on July 30, 2012 8:24 am

You may not have heard of pectus excavatum — or "sunken chest," as it's commonly known — but there's a good chance you know someone who was born with it.

It's the most common deformity of the chest wall, affecting roughly one in 500 people — boys much more often than girls. And while sunken chest can be corrected with surgery, the procedure is invasive and very painful. Many families won't do it.

But a new method using magnets and an external brace, developed by Michael Harrison, a pediatric surgeon at the University of California, San Francisco's Benioff Children's Hospital, could provide an alternative to the surgery.

People with pectus excavatum have chests that are concave. Sometimes, the condition is evident at birth. Other times, it develops gradually. It's not life-threatening, but it can put pressure on the lungs and heart.

"They'll tell you they get very fatigued when they exercise vigorously," says University of Minnesota Medical School pediatric surgeon Daniel Saltzman. "In fact, there's a vicious circle set where they don't want to exercise so they sit out, play video games, things like that."

But probably the worst part, at least from the perspective of a teenage boy, is how it looks. For 14-year-old Justin Rosales, it's just embarrassing.

"I show my friends that I trust," he says. "But not that much."

Rosales is from Stockton, Calif. That's in the Central Valley, where the average July temperature is 94 degrees. But Justin never swims without a T-shirt, says his father, because he's embarrassed to show the indent in his chest.

Justin is an only child. His dad works two jobs, but the whole family drives an hour and a half to Benioff Children's Hospital in San Francisco, where Justin is taking part in Harrison's clinical trial for the new procedure. The magnet procedure is in its second Food and Drug Administration trial, with about 15 children taking part.

At the base of Justin's concave chest is a small scar. He's been implanted with a powerful magnet, just beneath the skin.

To demonstrate, Harrison holds up a little refrigerator magnet, which snaps to Justin's chest.

And that's pretty much how it works. Every day and night for about two years, Justin will wear an external brace containing a second, powerful magnet. If all goes well, the magnets will attract each other with enough force to gradually pull Justin's chest wall outwards.

Traditionally, doctors have used one of two surgeries to correct sunken chest. Saltzman, who operates on a few hundred patients a year, says both surgeries work well. But they're major procedures, requiring hospital stays. And he says the pain can be quite profound.

Some surgical patients stay on pain medication for months.

"Many of us surgeons have seen children become addicted to opiate narcotics because of pain meds they have to use," he says. "We've sent a couple to treatment to get them off their pain meds. It's very, very hard to watch."

So Saltzman is excited about the new technique that Harrison is developing. The magnets are virtually painless because they work gradually.

"The way to fix something that's structurally malformed like that is not to rip the whole thing apart and put it together over a matter of hours," Harrison says. "A better way to do it, and to think about it, is to fix it like the orthodontist does your kids' teeth — a tiny little bit, a millimeter every day."

The key, says Saltzman, will be getting patients into care while their chest walls are still soft. Wait until after puberty, and it may be too late for the magnets to work.

He's enthusiastic, he says, about any way to help these kids feel better about themselves.

"Once you repair the deformity and you see their self-esteem grow, like a flower opening when you water it, is spectacular," he says. "It's an amazing experience."

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LINDA WERTHEIMER, HOST:

This is MORNING EDITION, from NPR News. I'm Linda Wertheimer.

RENEE MONTAGNE, HOST:

And I'm Renee Montagne.

Today in Your Health, teaching teenagers how to drive safely without scaring them. First, though, let's hear about treating children with pectus excavatum. That's commonly known as sunken chest. It's the most common deformity of the chest wall, affecting roughly one in 500 people - boys much more often than girls. And while sunken chest can be corrected in surgery, that procedure carries with it a great deal of post-surgical pain.

From member station KQED in San Francisco, Amy Standen reports on an attempt at a gentler fix.

AMY STANDEN, BYLINE: Before he even meets a new sunken chest patient, Daniel Saltzman, a pediatric surgeon at the University of Minnesota Medical School, can spot them across the room.

DR. DANIEL SALTZMAN: They will sit with what I call the pectus posture, with their shoulders slumped and their arms crossing their chest. And their backs are very rounded.

STANDEN: Pectus excavatum kids have chests that are concave. In severe cases, kids sometimes joke that you could eat a bowl of cereal out of it. Sometimes, the condition is evident at birth. Other times, it develops over time. It's not life threatening, but it can put pressure on the lungs and the heart.

SALTZMAN: They get very fatigued when they exercise vigorously. In fact, there's a vicious circle that'll set where these kids don't want to exercise and so they tend to sit out and play more video games and things like that.

STANDEN: But probably the worst part, at least from the perspective of a teenage boy, is how it looks. For Justin Rosales, who is 14, it's just embarrassing.

JUSTIN ROSALES: I show my friends that I trust, but not that much.

STANDEN: Rosales is from Stockton, California. That's the Central Valley. Average July temperature: 94 degrees. But Justin never swims without a t-shirt, says his father, Carlos Rosales.

CARLOS ROSALES: He's very embarrassed about taking his shirt off in front of his friends or even family.

STANDEN: Justin is an only child. His dad works two jobs, but the whole family has driven an hour and a half to the Benioff Children's Hospital at the University of California San Francisco, where Justin is taking part in a clinical trial for a new procedure, developed by pediatric surgeon Michael Harrison.

DR. MICHAEL HARRISON: Do you mind taking your shirt off? You don't have to.

ROSALES: Oh, I don't mind.

STANDEN: At the base of Justin's concave chest is a small scar. He's been implanted with a powerful magnet just beneath the skin. To demonstrate, Harrison holds up a little refrigerator magnet, which snaps to Justin's chest.

HARRISON: You can just stick it to him.

STANDEN: Wow.

ROSALES: Oh, I didn't know you did. I was scared for a second.

STANDEN: And that's pretty much how this works. Every day and night for about two years, Justin will wear an external brace that contains a second, powerful magnet. If all goes well, the magnets will attract each other with enough force to gradually pull Justin's chest wall outwards. As Justin jokes with the doctors, his mom, Elizabeth, watches him carefully. She worries.

ELIZABETH ROSALES: I pray every single day for him.

STANDEN: Traditionally, doctors have used one of two surgeries to correct sunken chest. Daniel Saltzman, in Minnesota, operates on a few hundred pectus patients a year. And he says both surgeries work well. But they're major procedures, requiring hospital stays. And, he says...

SALTZMAN: The pain can be quite profound.

STANDEN: Some surgical patients stay on pain medications for months.

SALTZMAN: Many of us surgeons have seen some children become addicted to opiate narcotics because of the amount of pain medicines that they have to use. We've sent a couple children to treatment to get them off their pain medicines.

STANDEN: So Saltzman is excited about this new technique that Harrison, in San Francisco, is developing. The magnets are virtually painless, because they work gradually, which Harrison says is the whole point.

HARRISON: The way to fix something that's structurally malformed like that is not to rip the whole thing apart and put it together in over a matter of hours. A better way is to fix it like the orthodontist does your kids' teeth. A tiny little bit, a millimeter every day.

STANDEN: The key, says Saltzman, will be getting patients in while their chest walls are still soft. Wait until after puberty, and it may be too late for the magnets to work. He's enthusiastic, he says, about any way to help these kids feel better about themselves.

SALTZMAN: Once you repair the deformity and you see their self-esteem grow, like a flower opening on a morning, is spectacular. It's an amazing experience.

STANDEN: The magnet procedure is in its second FDA trial, which will treat about 15 kids.

For NPR News, I'm Amy Standen in San Francisco. Transcript provided by NPR, Copyright NPR.