Thursday, December 13, 2018

15 yo Rachel from Tennessee had 40 degree progression of her AIS over a couple years, then surgery this week with 90 degree curve



Rachel is a wonderful 15 yo young lady from Tennessee diagnosed with scoliosis just a couple of years ago with a curve in the upper 40's, possibly low 50's.  She then had follow-up X-Rays just recently when experiencing increased pain, and her curves had jumped up to around 90 degrees x2.

Her family made the long drive from Tennessee to Raleigh this Saturday just ahead of the huge snowstorm that crashed in on us here in the Triangle, dumping 10 inches on Sunday, and another 3 inches on Monday!   They stayed at the hotel across the street from Duke Raleigh Hospital, and luckily I was able to make it in early Monday morning to do her surgery.

She did very well during her nearly 5 hour surgery using our special electronic checklist quality and safety control system that has over 400 safety checks that enables our team to work seamlessly together.  We were able to get a very nice correction safely, and she woke up smoothly, nice and warm, using some new warming techniques that worked like a charm.

Rachel bounced back quickly from surgery, and stood up next to her "big" (older) sister postop day 1, and realized that her bigger sister was now shorter!!! Rachel had gained about 3 inches in one day!


Rachel advanced quickly on her diet and walking program, and felt ready to make the drive back to Tennessee this morning after being cleared by physical and occupational therapy today climbing stairs and getting into and out of a test car in they physical therapy room at Duke Raleigh Hospital.  Rachel and her family stopped by our Hey Clinic office right next to hospital after discharge, got her ultra-low radiation ultra-HD EOS X-Ray in our office, and wanted a quick photo together before driving the 8 hours home through the mountains.
 


She also took a minute to give thanks to all of the kind nurses, scrub techs, implant reps, neuromonitoring techs, CRNA's, SRNA's, anesthesiologists, nursing aids, Hey Clinic PA's and support staff who helped make her dream come true.



Meanwhile, Rachel won over the hearts of ALL of the Duke Raleigh nursing and other staff who worked with her, as Rachel shared thankgivings to everyone with kind words, but also hand-written thank you notes and drawings!!



Get well soon Rachel, and thanks for brightening up all of our lives here.... you brought a smile to many caregivers!!! 

Lloyd A. Hey, MD MS
Hey Clinic for Scoliosis and Spine Care
http://www.heyclinic.com
https://www.instagram.com/heyclinic/

Tuesday, November 13, 2018

Is there such thing as "Minimally Invasive Scoliosis Surgery"? Can a herniated disc give you scoliosis? Define "Cattywampus" and can it be treated?





I just saw 20 yo Hannah back for her 4 week postop visit, and she is one happy young lady!  I saw her a few weeks ago and she was completely "cattywampus" preop, several inches to one side with a thoracolumbar scoliosis and trunk shift and having quite a bit of pain.   For those who are not familiar with the medical term "cattywampus", you can google it, and Google the Answer Man says:

"adjective. The definition of cattywampus, often spelled catawampus, is not lined up or not arranged correctly, or diagonally. An example of something cattywampus are the positions of the items on the top of a coffee table after a two year old has been playing with them and moving them around."  -- yourdictionary.com

Cattywampus when it comes to scoliosis is a super obvious trunk shift, so that one hip sticks out like crazy and in some cases it looks like the patient literally is going to fall over to one side, like the leaning tower of Pisa... maybe worse.  

So what made Hannah so cattywampus?   As you can see above, the root cause was a disc herniation at L45 on the left, which was causing her to unconsciously lean forward and to the right, AWAY from the pain.  After failing conservative therapy, I performed a minimally invasive microdiscectomy, and her posture and pain began to improve immediately.  Her scoliosis has improved 11.3 degrees from 38 to 26, and trunk shift has improved 5cm from 8 to 3 cm.   Her sagittal posture has also improved dramatically.  The way to think about this is that the disc herniation is like a "hot poker", in this case on the left at L45.  The patient instinctively leans AWAY from the hot poker, and also may lean forward.  When the disc herniation and foraminal stenosis is removed, then the spine can gradually come back to a more normal position. 

Since "Sad Crooked Hannah" is now "Happy Much Straighter Hannah", I gave her option of doing some Schroth therapy to keep working on getting that 26 degree curve hopefully even lower down into the teens to help prevent back problems and progression later in life.  I also gave her the option to just observe and see if it progresses or improves.  We love to give people CHOICES, especially conservative choices that could train them with techniques that could benefit them for many decades to come.  She's opted for the Schroth therapy which we will get done closer to her home in Chatham County with our wonderful Schroth therapist colleagues at Advance Physical Therapy in Chapel Hill!!  After we finish our training class for 12 more Schroth therapists here at Hey Clinic in December, we should have many more sites around NC and SC to help folks locally to "get it straight" conservatively, sometimes with 3D CADCAM comfortable ultra-low profile braces like the Rigo-Cheneau that we fit and build here at Hey Clinic -- for children, adolescents and adults.  

So, is there microsurgery or minimally invasive surgery for scoliosis?  Yes.... but unfortunately not for everyone!  We can do microsurgery also for some patients who have severe sciatica with spondylolisthesis and/or scoliosis even if they are not catttywampus.  Anyway, especially for a rapid onset scoliosis this is good thing to think about.  Not all disc herniations need surgery -- some can get better with conservative therapy, but in cases that do not, microsurgery / microdiscectomy is a really cool solution that can be life changing for folks like Hannah.

Lloyd A. Hey, MD MS . --- Hey Clinic for Scoliosis and Spine Care.  http://www.heyclinic.com





Saturday, October 27, 2018

Can Adults with Scoliosis also be treated with a brace?.... and Can my daughter or son be a competitive athlete after scoliosis surgery? Celebrating Karmen's Georgia State Cross-Country Meet Today!

There is a growing excitement at Hey Clinic over the last few months with our Schroth Physiotherapeutic Scoliosis Specific Exercises (PSSE) and in-house fabrication of 3D CADCAM personalized (Rigo-like)  approach!!!   Alma, or Schroth therapist is doing a super job with a big smile, and is well loved by everyone -- keeping it simple, and motivating the troops.  She's  working evenings, Saturdays and some days to meet the need.  I think we are going to need 1 or 2 more Schroth therapists this fall.  Let me know if you are interested in getting trained in our December course if you are a physical therapist -- and maybe you can join our team!!!    KC our orthotist is also quite busy, tweaking the CADCAM software with our 3D EOS data and surface imaging, and special CADCAM software.  We tweak the design each week to get better corrections, and keep working to make it less visible, and also more comfortable.

It is exciting to see results similar to what I got a chance to see in the European countries that are WAY AHEAD of the USA, when I was at SOSORT this spring in Dubrovnik, Croatia.  Yesterday I saw a young teenage girl who improved her curve 17 degrees with her faithful wearing of the brace, and daily performance of the PSSE.  We literally gave this young lady a standing ovation in the clinic room for her dedication to improving her scoliosis through her daily choices that will have a HUGE effect on her quality of life in the LONG RUN.

We did have a couple of teens who had slacked off a bit on their PSSE and brace wear, and saw no improvement, and one where the curve had actually worsened.  Rather than coming down hard on the teen, we had really good dialogues about CHOICES -- daily choices they can make to be more intentional to get those curves down hopefully under 30 degrees, so they can much more likely live a happier, healthier life with better posture -- and be much less likely to need spine surgery in the future.  We're continuing to tweak our in-house 3D brace design to work on better corrections, but also to make it lower profile and more comfortable so that the brace is not very evident under clothes at school -- which helps with compliance.

We saw several others who had improvements in the 3-10 degree range as well, which actually included a 61 yo nurse practitioner who has degenerative combined with adolescent scoliosis, who had a 4 degree correction of her thoracic and  She feels absolutely great in her brace, which she wears for most of the day working in clinic, with excellent relief of her pain.  Patricia shared some tricks for how to wear a special bra that is much more comfortable under the brace.  She literally does not want to be out of that brace and had a really big smile the whole clinic visit, eager to share.  I actually learned about this adult bracing using the 3D CADCAM Personalized brace in Croatia as well, which included seeing an incredible video of an older man with severe kyphosis who was restored to an upright posture with the brace.  Who would have imagined that 3D CADCAM Rigo-like braces would actually not only give good relief, but also help with quality of life!

The other big news from this week is that the book chapter I've been working on for several years on "Scoliosis in The Adult "was published this week online on Uptodate.  UpToDate is a wonderful online medical textbook used by many physicians, PA's, NP's, nurses, residents, students and patients around the world, and is the reference linked to Electronic Health Records (EHR) like Epic.  Since my residency years working at Boston Children's Hospital with Dr. John Hall, John Emans and others, I have always wanted to provide life-long scoliosis care for children, adolescents and adults.  I saw that UpToDate had a great chapter on adolescent scoliosis and kyphosis, but nothing for adults.  While I am excited about this chapter getting published, UpToDate doesn't really have a way of acknowledging ALL of the people who made this chapter happen, so I want to give credit to the "village" who made this real over several years.  Several years ago, when I was serving on the Scoliosis Research Society (SRS.ORG) Adult Deformity Committee under Dr. Sig Berven, the vision of creating helpful texts for primary care doctors and many others to better understand adult spinal deformity was begun.  Dr. Jeff Coe worked with me, along with several other committee members to begin the process, which was really quite challenging.  I then had a phenomenal pre-med student named Tom Turner who spent 2 years working for me at Hey Clinic as a medical/research assistant apprentice.  Tom continued that writing process with me and began to work with UpToDate.... and now Tom doing great in medical school.  THANKS SO MUCH TOM FOR YOUR FAITHFUL WORK.  IT IS FINISHED AND PUBLISHED!  Couldn't have done it without you. 
After Tom went off to medical school, I worked directly with UpToDate editors, including Dr. Dan Sullivan.  Dan and I spent many hours on the phone together really talking through this important topic.  Dan has since chosen to leave UpToDate to return to practice and teaching in Boston, MA but want to thank him so much for his creative input and pushing this project forward.  Dr. Mary Torchia then took over the project, and made the final edits and figures, and was also a pleasure to work with.  Her assistant, Emma Needham was also quite helpful. 

Many thanks also to Kad, one of my young adult scoliosis patients, who had an 88 degree curve who was willing to share photos of his back and his X-Rays to show the UpToDate readers to know what to look for on physical exam.  Thanks Kad!

BUT NOW FOR THE BIG, BIG NEWS!
The last big news just happened today...  We talk frequently at Hey Clinic with our pediatric and adolescent patients that we try to take advantage of this growing "window" of time to do what is best for the LONG RUN.

Well,  many of our patients are actually awesome athletes, and one particular patient named KARMEN from Dublin, Georgia needs a big STANDING OVATION for her incredible accomplishment earlier today.... Karmen won the Georgia State Cross-Country Championship Race!! Karmen had her scoliosis surgery here at Hey Clinic / Duke Raleigh Hospital in March 2017, and got right out there with her training as soon as she got back to Georgia.  This is one DETERMINED YOUNG LADY..... Watch out World!!  Her mom, a nurse,  texted me photos while I was working hard outside this afternoon, and actually texted me photos from today's race, and her regional WIN earlier this week and gave her blessing to share this with all of you.  
Postop Scoliosis athlete Karmen wins regional cross-country meet October 15, 2018 in Georgia
Oct 27 2018 Karmen leads the pack GA XC championship
Oct 27 2018: Karmen with her 1st Place ALL-STATE Cross-Country Championship Award
 I truly enjoy getting to know my patients and families, and being a part of their life, as they are a part of mine.  "What are you going to be when you grow up" -- one of my favorite questions to ask... and it is truly a blessing to see how many of these precious young people move toward healthcare careers as they go through their scoliosis journey.... and I'm confident they will be great caregivers, knowing what it is like to be a patient.  It's quite a privilege to be a part of the journey of these precious caregivers of tomorrow!!!

This weekend, I'm preparing another talk for Triangle Christian Medical and Dental Association (TCMDA) for Friday November 9th on "Burnout Prevention and Treatment - How To Enjoy The Journey in Hope", as well as working on some home chores, rounding, and working on our multi-site eChecklist project with our POSNA grant.  Today I worked outside all day -- absolutely beautiful fall day here in North Carolina.  Now it time for dinner.  Time is UP!!  Have a great evening.

Lloyd A. Hey, MD MS ---- Hey Clinic for Scoliosis and Spine Care . -- http://www.heyclinic.com







Sunday, October 7, 2018

FoxSports Ken Rosenthal Baseball Expert Talks About Scoliosis and Scoliosis Research Society (SRS.ORG) on TV Tonight!

I just got word that Ken Rosenthal will be speaking again tonight on national TV for National League Baseball about one of his important "Bowtie Charities" ---  scoliosis and the Scoliosis Research Foundation (http://www.srs.org).  SRS has been around for over 50 years, advancing scoliosis care for children, adolescents and adults all over the world.  I've been a member for years, and am actually writing this blog just before boarding the plane for Europe for our annual meeting in Bologna, Italy!!

As you can read from his story, he actually had scoliosis as a teenager, and had Harrington rod surgery as a teen as well. His daughter, a dancer, also had scoliosis surgery as a teen.

He will likely also be discussing / tweeting about the National Scoliosis Foundation (http://www.scoliosis.org), which helps to promote early scoliosis detection and treatment to help decrease suffering due to spinal deformities, and also decrease need for scoliosis surgery.

2022 EST update
Ken Rosenthal did get a chance to specifically mention in a separate TWEET, he National Scoliosis Foundation:  https://twitter.com/Ken_Rosenthal/status/1049041954850443265

"Another worthy scoliosis organization - National Scoliosis Foundation . Promotes scoliosis awareness and screening. Modern bracing and physical therapy can prevent suffering later in life. Catching scoliosis early can actually result in reversing curve"




Curvy Girls is another great organization that works alongside which helps with local support groups for girls and their parents with scoliosis. I had the pleasure of speaking at the Raleigh chapter of Curvy Girls recently, which was just awesome -- 20-30 girls there, and their moms (and sometimes Dads!) -- sharing some of the latest research coming out on the effectiveness of more modern 3D bracing and physiotherapeutic scoliosis-specific exercises (PSSE) such as Schroth Therapy. Many of the girls downloaded scoliometer apps and learned how to do their own screening!! One of the girls wants to help improve scoliosis screening across all of North Carolina, starting with her own city and county. Amazing. All of of these organizations (SRS, NSF, and Curvy Girls) do a phenomenal job, and deserve your support, small or large to promote scoliosis awareness, screening, research, innovation, and care

Monday, September 24, 2018

Does scoliosis bracing always work in the long run? What happens if my curves progress later in life? Scoliosis surgery before pregnancy?

At Hey Clinic, we are HUGE advocates for conservative treatment for scoliosis and other spine conditions for children, adolescents and adults.  This includes in-house affordable low radiation high resolution EOS imaging (without the hospital facility fee), SCHROTH PHYSIOTHERAPEUTIC-SPECIFIC EXERCISES (PSSE), and in-house custom molded Rigo-Cheneau braces from 3D surface data.  As a result, we have a very good success rate with conservative treatment for a large percentage of our guests in all age groups.

We are also HUGE advocates for life-long scoliosis follow-up, collecting scoliosis measurements not just during childhood and adolescence, but during adulthood as well, since 60-70% of scoliosis will progress during adulthood.  Having that longitudinal data over time, combined with dialogue and assessment of quality of life, height loss, posture and appearance changes over time combined with osteoporosis assessment and prevention are all super helpful for the patient and family to clearly understand your CHOICES at each stage of this life-long scoliosis journey.

From time to time we have patients and families who want to share their stories anonymously to share part of their life-long journey.  I received this story this evening from one of our young adult patients who gave her OK to share it with all of you!  Enjoy and thanks for sharing S!!!
----------- Dr. Lloyd Hey . http://www.heyclinic.com . Hey Clinic for Scoliosis and Spine Care

"I was diagnosed with scoliosis when I was 12 years old. When I first met with my pediatric physician he recommended a night time brace which I wore for three years. The brace was successful in halting progression as I grew and by the time I was 21 my curves had remained at 32 and 37 degrees for several years. I was told it was unlikely my scoliosis would progress in adulthood and for several years I put it out of my mind.  
When I was 28 years old I began noticing changes in my body. My ribs stuck out, my sides and shoulders were more uneven than they used to be, and I began to feel discomfort in my back and sides. I found Dr. Hey online and chose to go to him because of his experience and reputation for being an excellent surgeon. At my first appointment I learned that both of my curves had significantly progressed. Dr. Hey was informative and discussed my options with me. I felt absolutely no pressure from Dr. Hey to have surgery. He left it up to me to determine how I felt it would be best to move forward. Because I was in a hurry to start a family I made the decision to be proactive and have the surgery before I had children.

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I had surgery 7 weeks ago and I am thrilled with my decision. I was extremely nervous before the operation but Dr. Hey and his wonderful team answered all of my questions and helped set my mind at ease. I spent four days in the hospital and felt very well taken care of by the nursing staff. The first three weeks of recovery were difficult, but I could feel myself getting stronger each day. I am now seven weeks out from surgery and my incision has completely healed. I can also walk with ease and bend down without much trouble. I still have sensitivity near the incision site and a bit of stiffness, but I am very close to feeling completely back to normal. I am confident that I made the best decision for myself in moving forward with the surgery and I am looking forward to a brighter future uninhibited by scoliosis."