Someone with COVID-19 might expect to experience fatigue, cold and flu symptoms, and loss of taste and smell — but a paralyzed diaphragm would likely not be on the radar.
It was certainly a surprise to Gerald Branim, 55, a runner from Tennessee. His life took a drastic turn when COVID-19 damaged his lungs and diaphragm to the extent that he was unable to run or walk for a year.
Branim and his doctor, Matthew Kaufman of the Institute of Advanced Reconstruction in New Jersey, joined Fox News Digital in an interview to discuss Branim’s ordeal and recovery.
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When Branim got COVID in Feb. 2021, he was a fit, healthy 52-year-old who ran marathons.
In spite of that, the infection caused significant lung damage. He spent two weeks in the hospital and three months out of work.
For two months after leaving the hospital, Branim used a walker as he continued struggling with lung complications.
"For someone who had run marathons, it was quite humbling to have to walk with a walker for three months," he said.
After rounds of high-dose steroids and lots of antibiotics, Branim’s chest X-rays finally showed that his lungs had cleared — but he was still having trouble functioning.
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"I still couldn’t go upstairs without my oxygen dropping severely," he recalled. "I couldn't run 100 yards without my oxygen dropping into dangerous levels. I was severely out of breath."
"That's when they started saying something else was going on — that this shouldn't be happening."
After 10 months of not being able to walk or run, Branim’s condition was finally diagnosed via a "sniff test," which is also called a chest fluoroscopy or a video chest X-ray, where the patient is asked to breathe in and out.
Any paralysis will show up on the scan, as the diaphragm won’t move upon breathing.
Diaphragm paralysis — which is a "pretty rare condition," according to Kaufman, Branim's doctor — is paralysis of the diaphragm muscle, which is the primary breathing muscle.
Previous studies have estimated that the condition affects only about 1.31% of the population. In about 95% of cases, only one side is paralyzed, the doctor noted.
"We have two diaphragms, one on the right, one on the left," he said.
In cases where both sides are paralyzed, symptoms will be much more severe, usually requiring the patient to be put on oxygen.
"It’s become sort of a phenomenon," Kaufman told Fox News Digital. "The phrenic nerve, which is the nerve that controls the diaphragm, seems to be an area where the COVID virus can have an impact."
In some ways, he said, the condition can be considered part of long COVID, which is when symptoms of the virus linger for weeks, months or even years after infection.
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Most people with diaphragm paralysis won’t have difficulty breathing while sitting. Symptoms will typically emerge with exertion, such as walking or exercising, or when changing positions, such as lying flat in bed or bending over to tie their shoes, Kaufman said.
Some people are more susceptible than others, the doctor noted.
"We know that viruses tend to attack nerves in the body, as we’ve seen in Bell’s palsy," he said. "And now we’re seeing it with COVID causing injury to the phrenic nerve."
Because the condition is rare to begin with, he said, it’s not something that’s universally known.
"And then you take a condition like COVID, which causes respiratory symptoms from inflammation in the airways and lungs, and then you tie in what we consider to be a neuromuscular problem," Kaufman said.
"A lot of times, the physician or patient will attribute it to airway inflammation, when in fact it's a problem related to nerves and muscles that are part of the respiratory system."
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In some cases, patients will recover on their own, Kaufman said.
"We usually recommend a period of about six to 12 months of physical therapy, breathing exercises and cardiovascular fitness to try to see if this will come back on its own," he said.
If improvement is not noticed in that time frame, surgical intervention becomes a possibility.
In 2020 and 2021, Kaufman said he saw an uptick of patients who experienced diaphragm paralysis after having COVID. Although he is still seeing some cases, they are starting to trail off a bit.
"That could be because the classic COVID is not as virulent or severe," he said. "Or maybe it’s because more people are immunized."
Although the condition is generally not life-threatening, it can be more severe in patients who have existing respiratory conditions.
After Branim’s diagnosis, his lung doctor advised him to continue to give it time to heal.
"But it wasn’t getting any better," he said. "And I just wasn't satisfied with that being my new quality of life."
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That’s when Branim turned to Google to research surgical options. He came across an article by Kaufman, a plastic and reconstructive surgeon who specializes in an area called peripheral nerve microsurgery.
Kaufman specializes in conditions that cause either pain or paralysis due to nerve damage of the peripheral nervous system.
After meeting with Kaufman in a telehealth visit, Branim was identified as a prime candidate for the surgery, which is called phrenic nerve reconstruction.
If he had waited much longer, he said, his diaphragm muscle would have atrophied and the surgery would no longer have been possible.
After a lot of back and forth with the insurance company, Branim finally got the green light to travel from Nashville to New Jersey for the procedure.
The surgery went smoothly, although Branim was told that it wouldn’t be an immediate improvement. Once the nerve is fixed, the muscle still needs time to strengthen and rehabilitate.
"Dr. Kaufman told me that it would probably take a year or two to recover fully, and was preaching patience — but I'm not a patient man in the slightest sense of the word," Branim laughed.
He set a goal of running a half-marathon within a year of his surgery date.
After four weeks, Branim slowly began exercising again. After six months, he decided to lace up his running shoes and give it a try.
"My very first run after the surgery, I ran five miles," he said. "I literally cried. At that point, it was like a light switch had been flipped."
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Within six months, Branim had not only regained his ability to run, but exceeded his original goals, culminating in a half-marathon in April 2023.
In a triumphant twist, Kaufman, who is also a runner, joined his patient in completing the race in Asbury Park, New Jersey.
Now, Branim aims to raise awareness about diaphragm paralysis, an often-overlooked condition that is not on most doctors’ or patients’ radars.
"None of my doctors had even heard of this surgery," he said. "Had I not found the article about Dr. Kaufman and another runner online, I would have never been able to have the surgery — and I would absolutely not be running today."
Branim emphasized the importance of patients serving as their own advocates.
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"Doctors are human — they don't know everything," he said. "So you have to advocate for yourself."
For patients who are experiencing shortness of breath with exertion that persists for several months, Kaufman recommends visiting a primary care physician or pulmonary physician to get the necessary testing.
"While most tests will find more common ailments, it definitely makes sense to keep a paralyzed diaphragm on the list of things to rule out."
