Climbing higher after fix for sunken chest

The former wilderness ranger was in great shape, but still struggled hiking up hills. Then, surgery for a condition known as pectus excavatum freed him to climb peaks and hike into remote areas where he protects wildlife habitat.
June 25, 2018

The former wilderness ranger had spent most of his 20s hiking in remote areas in Montana and Oregon, hauling a heavy backpack and tools and building and maintaining trails.

Jonathan Proctor, an environmentalist and former wilderness ranger, sits on a rock in the forest. The sun is bright behind him. He was born with a condition called pectus excavatum. His breast fone was pressing in on his heart and causing shortness of breath.
Jonathan Proctor loves the outdoors. An environmentalist now, he used to be a wilderness ranger. For years, his inverted chest was pressing on his heart and causing shortness of breath. Now, after surgery, he’s able to hike, backpack and ski at high altitude. Photo by Cyrus McCrimmon for UCHealth

He was fit and loved the outdoors.

The wilderness work led Jonathan Proctor into the field of conservation, where he is now regional director for Defenders of Wildlife. In 2015, while hiking with friends up a little hill in Yellowstone National Park, Proctor was breathing hard and struggling to keep up. That didn’t make sense. He was in his 40s. The friends were in their 60s.

Clearly something was wrong. Proctor knew it was time to get help.

Teased as a child about his sunken chest

When Proctor was a young boy, others often teased him about his sunken chest. By the time Proctor was a teen, he became so self-conscious that he rarely let anyone see him without a shirt.

He wondered if the cavity in the center of his chest might be linked to high heart rate or shortness of breath he had long experienced when hiking and running.

“Even when I was young, I always had a hard time going uphill. I always would be breathing so much harder than everyone else. Downhill or on the flats, I was fine. Uphill, I was struggling,” Proctor said.

After the Yellowstone incident, Proctor searched online and learned more about a condition known as pectus excavatum, the medical term for his sunken chest.

He had suspected for years that the condition was causing more difficulties over time, but had delayed getting help.

“You tell yourself, ‘It’s not really a problem. It’s just cosmetic.’ You talk yourself out of the seriousness of the situation,” Proctor said. “Eventually I realized that my future would not be good if I didn’t get this taken care of.”

Very few doctors can help with pectus excavatum. But Proctor found a cardio-thoracic expert right down the street from his Denver home. Dr. Robert Meguid of UCHealth University of Colorado Hospital in Aurora is the only doctor in the Rocky Mountain region who does surgery to help adults with pectus excavatum.

Meguid is part of the UCHealth Comprehensive Lung and Breathing Program and Director of the University of Colorado’s Adult Chest Wall Diseases Clinic. Meguid did scans and tested Proctor’s lung and heart function and found that Proctor’s breastbone was pressing in on his heart and compromising his heart function, resulting in his high heart rate and feeling short of breath.

Finally, Proctor had a simple anatomical explanation for why he had struggled for so many years to breathe and stay active, especially at high altitude.

And Meguid was able to provide a surgical solution to reverse the harms from Proctor’s pectus excavatum.

Once impossible 14-er now ‘a piece of cake’

Proctor’s mother had had troubles breathing, had to be on oxygen late in her life and passed away at the relatively young age of 74.

While Proctor and his mom never discussed the precise source of her breathing problems, he now knows she also had pectus excavatum.

Jonathan Proctor sits on a rock in a meadow. He is the Rockies and Plains program director for Defenders of Wildlife and enjoys the outdoors.
Jonathan Proctor is the Rockies and Plains program director for Defenders of Wildlife and enjoys the outdoors. Photo by Cyrus McCrimmon for UCHealth

“She never smoked a cigarette and ate well. She ended up dying from COPD (Chronic Obstructive Pulmonary Disease) and heart and lung issues. I feared I was heading toward a similar future,” Proctor said.

Pectus excavatum runs in families. It’s more typical in males than females. In years past, doctors often told parents not to worry if their babies were born with sunken chests. Proctor ran into providers who discounted his condition, saying it was only cosmetic.

“It’s frustrating that so many doctors still say it’s nothing,” Proctor said.

Medical experts now know that the inherited anatomical condition can cause harm that worsens with age.

Proctor, now 50, is thrilled that he got help before he became even more incapacitated. His treks into the wilderness, both for fun and for work, have become much easier.

Meguid did surgery on Proctor in December of 2015, and within months, Proctor was zooming up a high-altitude peak for the first time in his life.

“I had tried other 14ers in the past, but I couldn’t do them,” Proctor said.

This time, just seven months after major surgery, he cruised up Mt. Bierstadt.

“It was a piece of cake. I couldn’t believe it. It was just amazing that I could do it without the pain and exertion that I had experienced in the past.”

Regaining the joy of life

Meguid said pectus excavatum causes a depression in the chest that looks like a bowl.

“Jonathan’s was severe,” Meguid said.

Dr. David Kuwayama, left, with Dr. Robert Meguid. They are smiling in a selfie at the top of a Colorado 14er.
Dr. Rob Meguid, right, while hiking a 14er with his friend and fellow doctor, David Kuwyama. Meguid is the only doctor in the Rocky Mountain region who does surgery on adults with pectus excavatum.

Most often, doctors see the condition in kids. About 1 in 1,000 has it. Meguid said no one knows the real number of adults who suffer from the condition since few adults with pectus excavatum know they have it or seek treatment.

“Shortness of breath that worsens with activity is the most common symptom,” Meguid said. “Frequently, patients will also have irregular heartbeats. The heart is squashed and that can disrupt heartbeats. Many also have dizziness along with the presentation of the depressed sternum.”

Meguid uses two surgical methods to reverse the condition. One is a minimally invasive procedure, where he makes a small incision and uses a camera to help guide him as he places one or more steel bars behind the sternum to push the chest bone back out to a normal position. The bars stay in the patient’s body for about three years, then the surgeon removes them. That method is known as the Nuss procedure.

Unfortunately, Proctor’s condition was so severe that he needed an open-chest procedure known as a Ravitch procedure.

“We remove the cartilage which is forcing the sternum backward. We reposition the sternum with a metal bar. After the patient heals for about six months, we take the bar out. This is useful when the sternum has twisting to it,” Meguid said.

Proctor, like other patients Meguid has helped, felt significantly better almost immediately.

“This gives the joy of life back,” Meguid said. “I’m so happy for him. This is why we live in Colorado.”

The southern hemisphere and backpacking at midnight

To celebrate after his surgery, Proctor planned some big trips. First, he spent a month recovering. Then, thanks to a two-month sabbatical from work, he took an amazing journey to the southern hemisphere.

“I headed down the coast of Chile to Antarctica, then to Argentina and Uruguay before moving on to Australia and New Zealand. Staying with good friends in many of these places sure helped.”Proctor had to be careful not to lift too much weight. And at first, he took only short hikes while on this trip.

Six months after surgery, to test his lungs, he took his first multi-day backpacking trip with friends in Alaska’s Denali National Park.

“Even though I was still recovering, I could already sense the improvement. We saw grizzlies from afar and caribou up close. It was such a great feeling to be out there in the wild. I remember being way up on a hillside, far above the valley and seeing for miles and miles,” Proctor said.

Jonathan Proctor celebrates feeling much better after getting surgery for a condition called pectus excavatum. Here, Jonathan holds his arms out to show how easily he can breathe. Behind him, you see the snow-capped Rockies.
Jonathan Proctor celebrates feeling much better after getting surgery for a condition called pectus excavatum. Photo by Cyrus McCrimmon for UCHealth

With the sun setting so late in Alaska, Proctor found himself able to hike and hike without the exhaustion he had always felt.

“We backpacked well into the evening before setting up camp. I was feeling so good that we kept going until about midnight,” he said.

Then, soon after the bar was removed from his chest in late June, he ventured up Mt. Bierstadt. He and his friends ascended on a clear and sunny day. As Proctor climbed higher and higher, he remembers being astonished and thinking, “Now I can do this.”

“It was the first time in my life that I could easily get past 13,000 feet,” said Proctor.

One week later, he was backpacking again, this time in Wyoming’s Wind River Mountains.

Proctor’s work as the Rockies and Plains program director for Defenders of Wildlife takes him throughout Colorado, Wyoming and Montana as he works to restore imperiled wildlife from bison to grizzly bears, wolves, wolverines and endangered fish and more.

While he’s seen plenty of spectacular animals and breathtaking places, the world’s wild places seem even more remarkable now.

“I’m so happy,” Proctor said. “Life is good. I love being out in the wild and now I’ve got my health back.”



About the author

Katie Kerwin McCrimmon is a proud Coloradan. She attended Colorado College thanks to a merit scholarship from the Boettcher Foundation and worked as a park ranger in Rocky Mountain National Park during summers in college.

Katie is a dedicated storyteller who loves getting to know UCHealth patients and providers and sharing their inspiring stories.

Katie spent years working as an award-winning journalist at the Rocky Mountain News and at an online health policy news site before joining UCHealth in 2017.

Katie and her husband, Cyrus — a Pulitzer Prize-winning photographer — have three adult children and love spending time in the Colorado mountains and traveling around the world.