Pediatric surgeon brings highly specialized surgical options to region

October 03, 2006
Around the time Justin Holmes turned 8 years old, his father began to notice something unusual. Justin’s chest began to indent toward his heart and lungs. His shoulders pulled together and slumped, and the simplest of activities left him exhausted. Making things worse, the growing boy began to become self-conscious about his appearance. “He couldn’t ride his bicycle the length of the driveway,” Phillip Nobles said of his son. “He’d have to go inside and lay down. . He wouldn’t take his shirt off. He couldn’t play any extended period of time.” Nobles faced another dilemma. The surgery Justin needed was traditionally done at academic centers where pediatric specialty surgeons practice. The nearest one to the family’s home in Chadbourn was 2 ½ hours away. But Nobles found what more and more parents are discovering in Southeastern North Carolina. The highly specialized surgical option they needed, pectus excavatum surgery, is performed by Dr. Don Nakayama at New Hanover Regional Medical Center. Dr. Nakayama operated on Justin about three years ago. Today, the 12-year-old fishes for bass, hunts, and plays like any boy his age. “He can do anything he wants to do,” Nobles said. “This changed him from being almost an invalid to a normal boy.” The chest wall defect known as “pectus excavatum” affects about one in 2,000, Dr. Nakayama said. As the child begins rapid growth, the chest drops rather than expands and gets worse as the child grows older. Boys are about twice as likely to be affected. Children sometimes have no other physical symptoms, but many experience respiratory problems, or pressure on their heart, as in Justin’s case. The children have low capacity for exercise and their self-image plummets. “They’re the kids with T-shirts on at the beach or in the pool,” Dr. Nakayama said. The surgery was not available at New Hanover Regional until late 2002, when Dr. Nakayama began his role as director of the general surgical residency training program for the Coastal Area Health Education Center. He brought with him the surgical skills that made him a national leader in the field. After helping start the North Carolina Children’s Hospital in Chapel Hill, he served as Surgeon-in-Chief there before moving to Wilmington. He has performed about 20 pectus excavatum procedures here. During the surgery, he inserts a curved titanium bar beneath the sternum, then flips the bar to curve the chest outward. The bar remains for about three years. Dr. Nakayama said the key to being able to perform the surgery is having the right team – including anesthesiologists who can work with children, nurses trained in pediatric specialty care, skilled operating room nurses and physiotherapists who can teach proper exercises for recovery. “We’re able to take care of kids having major corrective surgery through the skills of this multi-disciplinary team,” he said. “Kids who are severely injured or severely ill can get treatment here rather than break up the family and have to be transported 2 ½ hours away.” For Nobles, living within 60 miles of the hospital meant not having to find hotel rooms or miss work. “It was very convenient for us to come here,” he said. “Dr. Nakayama and the nurses were great and they’re fantastic people. Justin loves him to death… I wouldn’t want another surgeon to touch my child but him. He’s a very normal young man now and very proud of where he’s at.”For more information about specialty services for children, call the Pediatric Specialty Services clinic at New Hanover Regional Medical Center, 343.7001, option #3.