An innovative surgery helped Eric Furtado-Rodrigues (above) achieve his goal of becoming a member of Canada’s wheelchair rugby team. Photography by Doug Nicholson
There was no question about what was at stake for Eric Furtado-Rodrigues. He became a quadriplegic after a 2009 snowboarding accident in Spain where, following the accident, surgeons there implanted a titanium plate to repair his spine. He returned to Canada, but with time the plate shifted, causing a three-by-two-centimetre hole between his spine, esophagus and trachea. By 2015, Eric was having trouble swallowing food and experiencing recurrent infections.
Eric now needed a feeding tube and a tracheostomy tube, which made it difficult to speak and impossible to eat or drink anything by mouth. He wanted the best quality of life possible, something he expressed profoundly to Dr. Danny Enepekides, Sunnybrook’s otolaryngologist-in-chief and chief of surgical oncology.
At just 37, Eric still had much to achieve. He would push his doctors to think outside of the realm of possibility, so that he could once again do the simple things that used to bring him joy, from being a world-class athlete to enjoying fine food, including his wife’s cooking. To get Eric to that place, Dr. Enepekides and his colleagues were inspired to do everything they could.
“It was one of the most rewarding things I’ve ever experienced. He reminded me why I do what I do.”
– Dr. Danny Enepekides, otolaryngologist-in-chief and chief of surgical oncology
They would need to repair the hole and perform intricate microsurgery to mend his damaged trachea. It was a challenging prospect. “If the procedure failed, I would make him worse,” says Dr. Enepekides.
One of Eric’s goals was to earn a spot on the Team Canada Wheelchair Rugby Team. His high expectations, determination and optimism inspired Dr. Enepekides to think of ways to get this young man back to playing sports again.
Over multiple appointments (30 to 40 in total leading up to the surgery), a deep relationship – one marked by trust, caring and mutual respect – formed between doctor and patient.
“When I met Eric, my heart went out to him, his wife, Susana, and his family,” recalls Dr. Enepekides. “He is a genuine person. Despite all of the challenges he faced, he always had a very positive attitude. He was full of life – very inspirational.”
Eric was confident that Dr. Enepekides could successfully repair the hole in his trachea surgically. “At that point, I was fed up,” recalls Eric. “I had nothing to lose. My quality of life wasn’t good. And even though [the surgery] had never been done before, I just had a good feeling everything would work out.”
It took almost a year to plan the surgery. Dr. Enepekides and his surgical colleague, Dr. Kevin Higgins, spent countless hours meticulously mapping out every step of the procedure to mend the hole that was causing so many problems for Eric. In the back of their minds was the fact that Eric wanted to pursue his love of athletics once again and compete at an international level.
Both doctors understood there was a lot riding on the success of the surgery and they had never seen a case where there was so much damage. After much analysis, Dr. Enepekides believed he had a solution that would work to fix Eric’s cricoid (the ring-shaped cartilage around the trachea that also forms part of the voice box) and save his larynx. He would harvest a small amount of tissue from the patient’s scalp and transplant it to repair the hole in the cricoid.
“It’s an area that is quite tricky,” explains Dr. Enepekides. “Because of where he was injured, the option most likely to succeed would have been to remove his voice box. If I did that, he would lose his ability to speak. Instead, I opted for techniques I’ve used before in cancer surgeries.”
One of those techniques was the use of a fluorescence imaging system, a high-tech tool that allows physicians to visualize microvascular blood flow. Patients are injected with the special dye indocyanine green (ICG), which causes blood vessels to glow brightly when exposed to a laser beam attached to a digital camera recording how and where the dye is moving. It’s invaluable to surgeons looking for a highly detailed map of a patient’s vascular system.
Sunnybrook’s fluorescence imaging system was donated by a former patient to the Division of Plastic Surgery. Though the imaging system is often used in breast reconstruction, the surgical team was able to take a customized approach and utilize it in Eric’s procedure.
“The system helped increase our confidence going into his surgery,” says Dr. Enepekides. “It is a very useful tool.”
On the day of the surgery, Dr. Enepekides had covered the wall of the operating room with a large chart, precisely outlining each step of the surgery to ensure its success. It took more than 10 hours to complete the intricate procedure that included splitting Eric’s voice box to get to his trachea. Now, it was watch and wait, allowing time to heal.
At Eric’s follow-up appointment with Dr. Enepekides, the question remained if Eric would be able to drink and eat normally again. While his feeding tube and trach tubes were still in, a barium swallow suggested the hole had been sealed and both were feeling optimistic.
Dr. Enepekides handed him him a glass of water and asked him to take a sip. Eric held the cup to his lips, then drank. He was able to swallow for the first time in nearly a year and a half.
“[The water] felt so cool going down,” he remembers. “It was the best feeling. Dr. Danny and I just looked at one another and we smiled.”
Post-surgery, Eric was able to enjoy eating again. He remembers his first full meal after the surgical procedure fondly – Susana’s homemade shepherd’s pie. Once he had finished healing, he was able to focus on earning a spot on Canada’s wheelchair rugby national team.
When he was selected in March 2017, one of the first e-mails Eric sent out was to Dr. Enepekides. “I’m officially a member of the team!” it said and included a photo of himself in action at the tryouts. Dr. Enepekides still has that message.
Eric has been attending rugby training camps in preparation to compete at the 2018 Wheelchair Rugby World Championship of the International Wheelchair Rugby Federation (IWRF), to be held in August in Sydney, Australia. Says Eric, “There’s no way I’d be doing what I am right now without what Dr. Danny did for me. He’s a special guy. I’ve dealt with a lot of doctors throughout this experience and he is in a class of his own. I was so fortunate to be taken care of by him and such an incredible team.”
Meanwhile, Dr. Enepekides and his team continue to use the knowledge gleaned from Eric’s surgery for other Sunnybrook patients.
“I was incredibly thankful to be able to help Eric,” notes Dr. Enepekides. “It was one of the most rewarding things I’ve ever experienced. He reminded me why I do what I do.”