Tuesday, August 19, 2008

Yesterday morning's Scoliosis Surgery: 13 yo R thoracic scoliosis

Yesterday morning, we helped straighten up Sarabeth, who had a 44 degree R thoracic curve that has progressed significantly over the past year.
One of the nurses in the Preop Area, gave her a really cool little bear, who kept an eye on us during surgery, and has been snuggled in with her ever since!
Her surgery took a little less than 3 hours, and she got an excellent correction, with complete elimination of her R rib hump.
She did well during surgery and in recovery room, not requiring any blood transfusions, receiving cell saver only.
Her mom got to stay with her in her large private room last evening.
Today, she got up and around, walking up and down the halls, and going up and down stairs.
Tomorrow, she will learn how to go in and out of the car, and then will likely go home tomorrow after 2 night stay in hospital.
Some of our teenagers stay 3 nights, but most stay 2. Once in a while a teenager or young adult may stay 4 nights when they are from far away, but that is pretty rare.
Most are eager to go home!
We do let them shower right after surgery, since we do a subcuticular plastic surgery-type closure with Dermabond, which allows them to shower right away.
The R thoracic curve post-surgery patients can also return to virtually all sporting activities right away, including swimming, tennis, cheer-leading, soccer, etc.

I have a special place in my heart for the teenage patients, since I was a teenage patient many years ago, and have 2 teenagers of my own.
My physician assistants and I also really enjoy doing the scoliosis screenings and follow-ups for the many scoliosis patients who visit us each day.
This morning before and after surgery I got a chance to see 2 very happy teen-agers with small curves, both of whom are interested in becoming doctors someday.
Friday, my last patient of the day was a 12, almost 13 yo girl who had a curve progress up to 35 degrees since the last visit. She was there with her mom and dad and little brother, and my PA and I had a long talk going over the pro’s and cons of bracing vs. continued observation. The girl and her parents were able to make a team decision that they all felt comfortable with, taking into consideration the best literature and clinical experience.

We have a special internship program at Hey Clinic, where we “inspire” the next generation of high school and college-age students to get a taste of what it is like to care for patients in the clinic and in the hospital.
Several of our scoliosis teenagers and college-age students hang out with us each year, as well as Pre-Med students from local universities including Duke, UNC, and NC State.

Surgery for the teenager and younger adult is much simpler and with much better surgical corrections with less levels needed to be fused, and much quicker recovery.
It’s nice to have a mix of scoliosis patients across the full age range, though, from the little toddlers up through the pre-teens, teenagers, college-age, young adult, mid-range adult and older adult.
The many years of experience I have had caring for both the adult and adolescent and child with scoliosis has allowed me to develop and learn “tricks” from the adult group which I then can use in the younger group, and vice versa.
All groups can benefit from surgical and nonsurgical treatment, and each have their own unique quality of life issues they wish to solve.

Last night I stayed up kinda late finishing Connie’s movie, the 57 yo from the Los Angeles area, who had the very large double curve scoliosis that I fixed last Tuesday. That surgery was quite a challenge, requiring 6 hours of surgery, with much longer fusion and instrumentation needed. I was hoping to run it over to Connie and Ed’s hotel this morning on my way into the hospital, but they left WAY early this morning for the airport. Connie did extremely well, but Sarabeth’s surgery yesterday was like a dream compared to Connie’s! However, both are thankful for their new shape, and I am very glad that Connie got her curve fixed when she was 57 and not 67 or 77.

On a separate note, I’m a little nervous what Connie’s husband Ed is going to think about my 5 minute movie of Connie’s surgery. He is a professional expert animator for Dreamworks with 30 years experience also with Disney. We mailed it off to California this morning, as Connie flew out early this morning via Atlanta to Los Angeles. If Connie and Ed say it is OK, I may share her surgery video on the blog after they have a chance to see it.

In general, it is easier and safer, and you end up with a better correction with quicker recovery when scoliosis and/or kyphosis is fixed when you are younger.
However, many older patients can still benefit from scoliosis and/or kyphosis reconstruction if their quality of life is greatly affected, or if the curve is progressive.

Lloyd A. Hey, MD MS
http://www.heyclinic.com
Hey Clinic for Scoliosis and Spine Surgery
Raleigh, NC USA

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