Tuesday, September 4, 2018

Can my Adolescent Idiopathic Scoliosis Curve and Posture actually Improve With Schroth PSSE and modern Rigo-Cheneau Brace? EF Teen Story

I received the following letter from EF, one of our adolescent idiopathic scoliosis (AIS) patients we are treating here at our new expanded Hey Clinic for Scoliosis and Spine Care here in Raleigh, NC.  The patient and her mom gave permission to share her story with all of you.  We are seeing many success stories like this now as we ramp up Schroth Scoliosis Physiotherapeutic Specific Exercise (PSSE) here with two therapists here at Hey Clinic, and also working with our expanding network of PSSE therapists across North Carolina and beyond.  We actually just had an Intro class here for Schroth a couple of weeks ago, with therapists from across NC and beyond joining in to learn the basics, and will be holding a full Schroth Certification at our Hey Clinic Learning Center here in December. 

Our In-house scoliosis bracing facility is also now fully up to speed, allowing us to take 3D images of the patient, also with our EOS X-Ray machine contributing high resolution, low radiation imaging data including 3D data.  We can then take that data into special software to design and fabricate a very comfortable, and effective brace for 3D correction based on the principles of Rigo and Cheneau derotation --- a huge step forward from the Boston Brace and Charleston Brace.   

Thanks EF for sharing your story of not only improving your Cobb angle, but your pain level, quality of life and appearance, with great improvement in your trunk shift!!  

Here is EF's story:   

"Two years ago while shopping for bathing suits with my mom, I noticed that my right hip was higher than my left. The next day my mom took me to my regular doctor. He took several x-rays and then referred me to Dr. Hey.
When I went and saw Dr. Hey, I got more detailed back and spine x-rays and he explained to me that I had scoliosis. My curve was 20 degrees in my lower back. When I first found out that I had scoliosis, I was really anxious because I didn't know if it was going to get worse, or if my hips would ever look normal again. I was also worried if it would effect me playing sports because I played soccer, did cheer, and swam. The only discomfort I had was pain in lower back, but it was manageable with some advil.
My next two six months appointments, my x-rays were still the same. I was worried that my curve would never go decrease and that my hip discrepancy would only get bigger. I expressed my discomfort and concern to Dr. Hey and he recommended bracing. My first thoughts were “there’s no way I’m wearing a huge brace to school every day.” I thought it would be  really uncomfortable, and I would look weird in it.
After talking to my parents, I decided to move forward with the bracing process. When I first started wearing it, it was a difficult adjustment. I felt the brace pushing my left hip and shoulder up. I would wear my brace when I got home from school and I would wear it to sleep at night. After a few weeks of getting used to it, my brace actually felt good putting it on; I felt like my hips were straight.
I continued wearing my brace every night for the next 7 months! At my last appointment, when I took my x-ray, Dr. Hey told me my curve had gone down by 5 degrees! I was so excited that my back was finally getting straight and that my hip discrepancy was actually not as noticeable. My hips look much more even and normal now.
Even though at first, I was scared, nervous, and unsure with my bracing journey, I  could not be more happy with the results I have gotten so far. This summer, when I was at the beach, I actually felt comfortable in my bikini! I will definitely continue to wear it every day to help my back improve more. "

Saturday, June 9, 2018

June is Scoliosis Awareness Month, and also celebrating opening of the new Hey Clinic!

New Hey Clinic Open House June 7 2018 with Dr. David Zaas, Duke Raleigh Hospital CEO kicking off Scoliosis Awareness Month with Roy Cooper's Proclamation
This past week has been a very busy, but joyous one at the newly opened Hey Clinic, as we all celebrate the kickoff off June as Scoliosis Awareness Month. Many thanks to Wendy from Hey Clinic (a scoliosis mom) and for Roy Cooper and his office who worked hard to make this happen, as North Carolina joins with other States around the US, and other nations around the world to be more aware of spinal deformities.  The truth is that the United States, while great in a lot of things, is way behind other countries around the world when it comes to scoliosis screening and early intervention.  

Scoliosis, kyphosis and spondylolisthesis awareness is important more than ever as evidence continues to mount that "an ounce of prevention is worth a pound of cure", starting with the 2013 NEJM scoliosis bracing randomized control trial with Weinstein and Dolan.  Since then, other studies coming out of SOSORT and other sources showing how physiotherapeutic scoliosis-specific exercises (PSSE) like Schroth, which have actually been widely used in Europe for decades, can in some cases actually IMPROVE scoliosis, especially during the crucial early curve progression period in early adolescence.  I actually spent a week this past April over in Dubrovnik Croatia learning from conservative scoliosis treatment experts from all over Europe and the rest of the world how we can possibly redirect the miraculous, complex 25 segment core structure of every human being.  For example, there also is growing evidence of the synergistic benefit of PSSE combined with more modern custom 3D derotation scoliosis braces like Rigo-Cheneau, which seem to be resulting in higher patient compliance, which is linked to effectiveness.

After a very busy couple years planning and building the new Hey Clinic, and also very busy writing lectures, and developing new patient safety "apps" using checklists that we will be rolling out to other scoliosis centers this summer, and training up new interns to help out with our quality improvement projects, I hope to take a little more time now to share what we've been learning here on the blog. 

Stay tune for more, and let's all try to figure out ways to increase scoliosis awareness, and think and act creatively to ensure that every precious growing child in North Carolina and elsewhere has the opportunity to get screened, and have an early intervention like PSSE and/or bracing that can help prevent decades of suffering and possibly disability later in life.  So download a Scoliometer App for your phone, and learn how YOU can even help identify children and adolescents at risk for scoliosis.  Even adults can be identified with scoliosis and kyphosis and still benefit from detection and careful follow-up and conservative care.   --- Lloyd Hey

Here is the text from Governor Roy Cooper's Proclamation

State of North Carolina
Roy Cooper Governor
National Scoliosis Awareness Month

WHEREAS, increasing public awareness of scoliosis can help children, parents, adults and healthcare providers understand, recognize and treat this and other complex spinal deformities; and
WHEREAS, scoliosis is an abnormal curvature of the spine that affects an estimated 3 percent of the population, or 7 million people in the United States; there is no known cause for scoliosis, and the condition can affect people of any age, race, gender or ethnicity; and
WHEREAS, an estimated one million scoliosis patients utilize health care yearly and approximately one in every six children diagnosed with this condition is required to receive medical treatment, sometimes involving surgery; and
WHEREAS, the primary age of onset for scoliosis is between ten and 15 years; females who have scoliosis are five times more likely to progress to a curve magnitude that requires treatment; and
WHEREAS, screening programs allow for early detection and for treatment opportunities which may alleviate the worst effects of the condition; and
WHEREAS, National Scoliosis Awareness Month is an opportunity to raise awareness and support for those combatting this spinal condition, and to advocate for increased research and funding to reduce pain and suffering it causes;
NOW, THEREFORE, I ROY COOPER,  Governor of the State of North Carolina, do hereby proclaim June 2018 as "NATIONAL SCOLIOSIS AWARENESS MONTH" in North Carolina, and commend its observance to all citizens.

Signed Roy Cooper, Governor
In witness thereof, I have hereunto set my hand and affixed the great seal of North Carolina at the Capitol in Raleigh this first day of June in the year of our Lord two thousand and eighteen and of the independence of the United States of America the two hundred and forty-second.

Friday, March 31, 2017

HAPPY BIRTHDAY AHMAD!! What do neurofibromatosis, scoliosis, burnout, patient safety and "flow" have to do with one another?

 After going to a wonderful Duke Patient Safety Conference last Thursday which discussed ways of avoiding and treating burnout, and also finding "flow" in your life, I've been inspired to start writing my blog more regularly again.  Dr. Shanafelt from Mayo Clinic shared that 45% of doctors and nurses are burned out, and that burnout leads to patient safety issues, retention issues, and even health consequences for healthcare providers and patients!!  Bryan Sexton, PhD from Duke also shared his research and interventions that could possibly help prevent burnout.  I was really struck that this is an issue that we as a medical community need to work together on.  It reminded me of a lecture I gave almost 3 years ago at Cornell to a Phi Delta Epsilon premed Honor Society entitled "Finding and Maintaining Your Joy and Idealism through your Medical Career Journey"  -- that talk was very well received with over 1/4 of the audience coming down to talk with me afterwards since I was providing hope to escape the cynicism that was already pervading their path.  The main point of that talk was COMPASSION -- what can drive us to keep serving, as we realize the precious people we serve in healthcare, and the precious people we work with in service together as a team.  So here's my plan -- I want to help improve patient safety, and also improve work culture by writing down thankful encouraging miracle moments when they occur so we can all take better care of our patients, and enjoy the journey more, and inspire the next generation to do likewise!!!

While events are still fresh in my mind, I want to try to remember the inspiring patients and families and events that remind us why it is great to be a surgeon, nurse, PA, nurse practitioner, medical assistant, X-Ray tech, scrub tech... you name it!  Every day there are little miracles that occur that make you smile.... and I often say that I should write them down while the "energy spike" of the moment is fresh.... but usually I don't!

Well, I want to make an effort to share a bit more now, so as time goes by I can remember, but maybe also inspire some others to take heart and be encouraged as well.  We are all quite blessed to be able to interact with precious people, and to be able to be in a compassionate profession.  But we are also blessed to be working WITH EACH OTHER, showing compassion to one another as well as to patients and families.  Taking special notice of those moments of compassion and healing can help maintain a thankful spirit, which is a great treatment and prevention for "burnout", which I learned affects 45% of physicians and nurses in healthcare today!!

The miracle guy I want to focus on first is my friend, and future MD partner Ahmad.  Ahmad is 12 years old, and will be 13 years old tomorrow, April Fool's Day!!  HAPPY BIRTDHAY AHMAD!!!  He has neurofibromatosis, which has caused a very severe scoliosis, around 110 degrees. This makes it tough to grow, tough to breathe, and can become quite painful.  We admitted him for cervical traction at WakeMed Children's Hospital for several weeks, gradually stretching out his spine, which allowed his lungs to work better, improve his spinal alignment, and also improve his nutrition.

Yesterday I got a chance to see Ahmad and his mom and Pre-Med sister at Hey Clinic for his 6 week postop visit doing very well.
12 yo Ahmad, before and after scoliosis surgery

His mom brought us two big boxes of Dunkin' Donuts which our staff and patients fully enjoyed, even though it broke my "low carb" promise I had made to myself.  Ahmad then gave me a very special gift that he had made for me, that he designed himself:


When I opened up the box and took out this beautiful clear award, I just had to laugh as I read the inscription around his before and after X-Rays etched into the glass:  "Get it Straight... Dr. Lloyd Hey... COOLEST DOCTOR AWARD" !!!  

The hand-written card from Ahmad and his parents was also quite precious...ending with "I love you"

So Ahmad has already told me that he wants to join Hey Clinic as a doctor when he grows up, but he doesn't plan to do surgery, since he "doesn't like blood."  His older sister, a pre-med definitely is is surgically minded and wants to help as well.   They will likely be working alongside Jonathan R, a boy a little older than Ahmad who had a 110 degree scoliosis we fixed at WakeMed about 2.5 years ago.  Jonathan just entered a special medical health high school program so he can fast track toward a career in medicine.  As an interesting coincidence, I actually got invited to Jonathan's 14th birthday party, which I went to as Jonathan was making transition to manhood!  What a joy to be included in that special celebration with his family and friends.  We are all part of a web of relationships... it's not just work!!!

So, Happy Birthday Ahmad, and thanks to you and your family for blessing me and our whole team at Hey Clinic and WakeMed with your words of encouragement, your gifts,  and your friendship.

I love you too, Ahmad.
I was a patient once, too, and still love my surgeon who saved my life and my leg.

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery

Tuesday, February 21, 2017

I just received a beautiful letter from a guest of Hey Clinic I just had to share!
This is one of the remarkable reasons I became a surgeon-Thanks Kara and to your wonderful family as well-Keep Dancing-Dr. Hey

"Dr. Hey,

This a link to a video of Kara doing a dress rehearsal for her dance solo this year.  The dance is based on her journey this year with her surgery.  I want to thank you and all of your staff for making this possible.  5 months ago when she went in for surgery I really had my doubts that she would be up and dancing this quickly.  She learned this dance in December just 2 months after her surgery.  Her teachers are amazed at what she is doing.  Hope you enjoy.  Thank you again for what you do for everyone that suffers like she was. We are so grateful for Hey Clinic!!"

Saturday, May 21, 2016

What do early onset scoliosis (EOS) and adolescent idiopathic scoliosis (AIS) patients really think about scoliosis surgery and recovery? A brother and sister create their own interview video!

A few months ago, we had the opportunity to care for a brother and sister, Ava and Luca, who had progressive adolescent idiopathic scoliosis (AIS) and early onset scoliosis (EOS) -- both of whom had rapidly progressive curves over 50 degrees and growing.   This morning I received an email from their parents that the two of them actually created their own movie, interviewing each other about their experience.  We'll see what you think, but I think the two of them did a great job putting this together with their parents.  Understanding scoliosis and scoliosis treatment through the eyes of the patient and family is super helpful, and this family did a really good job sharing their amazing journey through the preoperative, surgical, and recovery phases of care.  They share about their concerns before surgery, and their postoperative recovery, including when they were able to go back to school, and return to sports, dance and gymnastics.  They share about their improved posture, preop and postop pain and much more.

Strong work Ava and Luca, and your amazing Mom and Dad!  You guys did a wonderful job documenting your journey to help other children and adolescents, and their parents, and also to thank the people who helped care for you at WakeMed Children's Hospital in Raleigh, NC and Hey Clinic.

Lloyd Hey, MD MS
Hey Clinic for Scoliosis and Spine Surgery