Tuesday, January 26, 2010

Long day, but worth it. Total spine reconstruction.

Joan had multiple compression fractures w surgery done out in westrern
nc about 5 hrs away near Asheville. She continued to collapse, pulling
out screws. She also had severe stenosis.

I spent 5 hours straightening her up T2-iliac wing w osteotomies and
No complications.
Ebl 2475 cc
Correction: excellent

A good day.
We got delayed for several hours during day since pt had lots of
antibodies in her blood, which made cross match a real challenge.

Always tell your surgeon if you have had blood transusions or previous
transfusion reactions. This sometimes helps to determine who might be
tough cross match.

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery

Kaleb and his dad stopped by to say "Thanks" to Hey Clinic for mom/wife's successful complex scoliosis surgery yesterday.

Saw Julie's son Kaleb and her husband who I wrote about on the last blog this morning at Hey Clinic.
Hey Clinic is located right next door to Duke Raleigh Hospital, on this Duke Raleigh medical campus, which makes it very convenient for all of us to stay connected.

Julie is doing well recovering from her surgery from yesterday, and Kaleb and his dad just came by to pick up note for school and to say thanks, and pick up a Hey Clinic hat!

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surery

Begin forwarded message:

From: "Dr. Lloyd Hey" <hey@heyclinic.com>
Date: January 26, 2010 10:13:27 AM GMT-05:00
To: Hey Lloyd <drhey@mac.com>
Subject: Kaleb Julie chapmans son

Dr. Lloyd A. Hey
Hey Clinic for Scoliosis and Spine Surgery

Monday, January 25, 2010

Pedicle Subtraction osteotomy with removal of Harrington Rod for this 40 yo woman from South Carolina who broke her fusion mass

Today we helped straighten up Julie, a  40 yo woman who actually fractured her fusion mass at junction between her old Harrington Rod fusion and her extension fusion.
She had developed a large hump on her back and trouble standing up straight, as well as progressive pain.
Right before her surgery, this Julie’s young son gave me a big hug.  I took that to mean that he was trusting and counting on me to take excellent care of his Mom.  While my job can definitely be stressful, in times like this I feel like I am right where God wants me to be, helping to make a difference in the lives of real people and their families.  Sometimes scenes like that stick in my head afterward as an important moment not to be quickly forgotten in the busyness of daily life.   Life is precious.  Moms are precious.  Family is precious.  My entire focus for the next six hours was to take excellent care of his mom!

We solved this today by doing complex posterior reconstruction, which included removing the old Harrington Rod, performing a pedicle subtraction osteotomy at apex of her deformity, and then inserting 2 cobalt chrome rods from T3-Ilium with evoked potential monitoring.  Pedicle subtraction osteotomies are a great way to get a potentially very large correction at one segment, but requires quite a bit of care!

Her “hump” was completely gone at the end of surgery, and we had enough bone graft left over from the osteotomy and decortication of her old fusion mass that she required no allograft.
An approximately 45 degree correction of her kyphosis was obtained, which should allow her to stand up perfectly straight.
We started the surgery at 0855 and finished at 1432, making total surgical time 5.5 hours.
Estimated Blood loss was 2600, with approximately a liter given back to her as cell saver, and 3 units of PRBC transfused.
She was doing very well in recovery room after surgery, and will spend tonight in ICU.
Her husband and young son and other family members were very thankful in the conference room after surgery.
Julie’s son, who gave me the hug hours before gave me a real big smile, confident that his mom was ok.
Julie’s mom joined us by cell phone, and is eagerly awaiting this blog entry so she can see her daughter straightened up!

Best wishes to Julie and her whole family.

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery

Sunday, January 24, 2010

FW: thank you. From Abigail, who helped me at Jared's on Christmas Eve!!

------ Forwarded Message
Date: Sun, 24 Jan 2010 18:52:08 -0800 (PST)
To: Lloyd Hey
Subject: thank you

Hello Dr. Hey! I am sorry it has taken me a little time to get back with you, thank you for sending the picture from your visit to my store! It has been a just over two years since my first surgery and life is good! I thank God everyday that he brought you back into my life when I didn't even know I needed you. As a reminder our first meeting was back in 2003, when you were still at Duke, and you told me then I was going to need surgery. I thought that was too radical and there was no way my scoliosis was that bad! We then moved to northern Virginia and no one there was as interested in my back as you and I was consistently told I just needed physical therapy to stay healthy. Four years after our first meeting we met again by, what I thought, was an accident but later realized was by fate. From the moment I walked into the Hey Clinic I felt welcomed and comfortable. When I met with you I was shocked to realize we had talked before and you came to the same conclusion this time, I needed surgery. No one had paid any attention to the growing curves and neither had I. This time I listened and we scheduled my surgery. By the grace of your hands I was able to come out of surgery with an almost perfectly straight spine, amazing for my age and curvature degrees. Recuperation was not easy and took an unexpected turn at my three month post-op appointment, another surgery was necessary. Again, your hands took fabulous care of me and I had an amazing result. I would also like to thank everyone who assisted in both surgeries, including the hospital staff caring for me during my stays.
When I came to your office in September 2007, one of the main reasons for the visit was because my husband, Steve, and I were beginning to talk about having a family and needed to be sure my back was in good shape.

I wanted to thank you for your visit at Christmas and let you know what you have done for us. Thank you for being who you are and being so gifted with hands which change peoples lives everyday, you are one of God's true blessings. What I find most impressive is the fact that you remembered me, a patient you haven't seen since May, and my occupation and called upon me to help you with selecting something very important for your wife and daughter at such a wonderful time of year. That action was far beyond anything I have ever known or expected.
I hope all is well with you and your family and that the Hey Clinic is growing. Thank you again for everything.

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery

Friday, January 22, 2010

Young Adult David Reflects on His Scoliosis Surgery Experience and His Faith

------ Forwarded Message
From: David
Date: Thu, 21 Jan 2010 21:33:36 -0500
To: Lloyd Hey
Subject: Hello Dr. Hey! Please read!

Hey Dr. Hey. I am excited about coming back in to see you on Feb 1st, just to see how things are healing and going. I have been sharing my story with others because I feel God has allowed me to go through this for a reason and that is to bring glory to His name. People are emailing and sending what I have written to people across the world. I wanted you send you a copy so you could have it. God brought you into my life and I praise Him for it. So here is what I have written:

Before my surgery, I talked about how I came to the realization of just how vulnerable and fragile our lives really are. Before I went through my surgery, I knew that I would go through some very hard times in the future. I knew that there would be pain. December 15th my journey began, one like I have never experienced before. If you have not looked at the pictures of my back prior to the surgery and during the surgery and have read my surgeon’s blog, I would encourage you to do so.

        I cannot begin to tell you how crazy it is to feel your body completely change. The process of having my body adjust to the drastic changes of what it had gotten used to has been at times overwhelming. The first thing I remember saying when I woke up was, “I can breathe.” Over the past years, my spine had become so badly curved in one direction that it was crushing my lung. I had a new perspective on what it was like to breathe and it was completely amazing to me. My surgeon had to stretch out my lung because of how badly it was being constricted. Over the past month, I have had to relearn life. I have had to relearn how to walk, drive, sit, sleep, shower and even write. Your spine is sorta like the epicenter of every function of your body and when it gets moved as drastically as mine did, you have to learn to do things all over again. My organs are even moving inside my body, they are settling in to the places where they were meant to be but could
 not be there because of how badly crooked and twisted my spine was.
        There are several things that I have been learning through all this. As I stated before, I knew there would be pain but I never envisioned it to be as bad as I have gone through. I have learned that pain grows you, it molds you. It gets your attention! My pain was a guarantee but I also knew that if I was all about myself then the pain would always be in control. If I focused on the pain then the pain would be what owned me. Instead of focusing on the pain, I prayed and turned my attention and focus on Christ because I knew He was much bigger than my pain. I have asked myself so many times this past month how people get through life without Christ? I cannot explain to you the peace I had before my surgery. I can remember being taken into the operating room and as they were preparing to put me to sleep, I remember looking up and telling Jesus, “either I wake up in the recovery room or I wake up looking at You face to face and either one is fine with
 me.” I knew Jesus was right there with me, He gave me that peace that I could not explain. Since the surgery, there have been times of frustration. There have been times of depression, mainly because I am the type of person that likes to be on the move. I like to be doing things all the time. I loved working out, going to the gym and playing sports. Lifting weights was a huge passion of mine. I would be in the gym everyday putting up the weights because I loved taking care of myself. Now, all I can do is just take it easy and recover and while doing this I remember the things I would read and Jesus would be asking me, “am I really more than enough in your life?” As time goes on, I feel myself getting stronger and I know that I will soon be back doing the things that I love to do but my perspective has to stay the same and that is that Jesus is more than enough in my life, no matter what pain I go through, He is all I need and all I will ever need.

        I have looked at my surgery in comparison to our lives with Christ. My spine was at a 60 degree curve. Since your spine is the control center for your body, it has a pretty crucial job in keeping you alive and keeping things going. My spine was crushing my lung, causing me pain, making me so uncomfortable in all aspects of my life, nothing felt right. Pretty soon, my spine would have gotten worse and I could have ended up in a wheelchair and on oxygen and who knows what else. Isn’t that what sin does to us in our lives? It invades our lives and starts to take over the epicenter of who we are. Pretty soon we can’t function normally and we do crazy things. Scripture makes it clear that when God made us, He put that longing for Him in all of us, we all have the void that only He can fill. So many people try to fill that void with things that do nothing but crush the very life out of them.
        I remember my surgeon looking at my x-rays for the first time and telling me just how screwed up I was. I remember him explaining to me the problems that I will face in the future and then I remember him saying, “but I can fix you.” Those words were the most precious words I have heard in a long time. As you can tell from my surgery pictures and his blog, he had to move my spine and put two steel rods on either side of my spine and then screw them into the vertebrae along with doing bone fusions. In essence, my surgeon made me a completely different person from what I was. Those rods, screws and fusions have made my spine straight and will not allow it to go back to the twisted and crooked way it had been before. It is going to take time for my back to heal. It is going to take time for my body to get adjusted to the changes my surgeon made but things are new in my life. How true is that when people come to Jesus. Our lives are all twisted and
 crooked from sin. The sin is choking the life out of us and we want so badly for a change, we search and cry out for help. Because of the tortuous cross, Jesus became the steel rods that invaded our lives and changed us forever. He has made us new. There was nothing I could do to help the surgeon while I was on the operating table, all I had to do was lay there and trust him. There is nothing we can do to earn a relationship with Jesus, the barrier of our capacity to have a relationship with God has been completely broken by Jesus on the cross. He chose to make us compatible to Himself. Just like it takes time for me to heal and get used to this new life since my surgery, when Jesus invades a person’s life, it takes time for new believers to get used to the change that Christ has made in their lives. He chose to change their standing with Him and their actions will begin to change over time. Just as I am having to relearn life, new believers have to
 relearn life too. I am so thankful for the people in my life who have walked with me every step of the way through this surgery and after to help me get used to this new life. My parents, family and friends have been amazing!  Which has made me think, we need to be walking step by step with new believers as they come to know Christ to help them with this new life that Christ has started in them. What an amazing journey this has been for me. Jesus has shown me alot and He is still showing me so much. The thing that I have come to realize through all this is that life’s greatest treasure is in knowing Jesus. There is a song by Mercy Me called Bring the Rain that I think sums up what I have been through. It doesn’t matter the pain and circumstances I go through, that will never change who I am in Christ at all. The chorus is what I have been praying to God everyday, “Bring me joy, bring me peace, bring the chance to be free, bring me anything that
 brings you glory. And I know there’ll be days when this life brings me pain but if that’s what it takes to praise You, then Jesus bring the rain.” Jesus has done some amazing things through this journey and I cannot wait to talk to people about it! I know He wants me to share my story and glorify His name through all this and I can’t wait to see how He does it.

Thank you Dr. Hey for your ministry and for being such an awesome missionary! I thank God for you everyday...even when I am hurting. :-)
See you in a few weeks!



------ End of Forwarded Message

Wednesday, January 20, 2010

Anterior posterior complex spine reconstruction went well.

My friend and former patient Steve from coast sent me this 59 yo woman
sp previous posterior instrumentation and fusion w plif's done

She has painful paeudarthrosis w loose screws.

I fixed her anteriorly removing the plif cages and putting in alif
cages w bmp.
Posteriorly, took out unilateral hardware, and reinstrumentrd
bilaterally L4-iliac wing and did revision foraminotomies to take
pressure off nerves.

Anterior took 2.5 hrs and posterior took about 3 hours. Ebl was 1200
cc total.

Did complex a/p reconstruction yesterday as well for patient w
scoliosis and pseudarthrosis w severe adjacent level failure w spinal
cord pinch.

Our 11 yo scoliosis young lady is doing great pod number 2, he later
today or tomorrow.

Saw 2 adolescents after surgery yesterday who both had curves greater
than 80 degrees who decided not to do surgery when curve was in 40 's.
Better to fix when curve is smaller when possible, but we will still
fix both of these.

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery

Monday, January 18, 2010

David's Innovation to improve patient care

For the past 3 weeks, my son David has been working with our Hey
Clinic software developers to spearhead our new iPhone application to
help us care for patients in hospital and outside hospital.

David caught on quickly to software and database design, and is shown
here with the very first Hey Clinic Brief Operative Note actually
printed with his new software. Not only is this note much easier to
read, it helps us collect important information for the follow-up care
while also allowing us to measure outcomes for quality improvement.

David is now off to celebrate w a sub sandwich while I head back to

Strong work David. I will use this every day and think of you. I am
proud of you.

Dad (dr Lloyd hey)

11 yo w left adolescent idiopathic scoliosis fixed today

Ebl 300 cc
Surgical time: 2 hrs 45 min
Complications: none
Correction; excellent

Dr. Lloyd Hey
Hey Clinic

Friday, January 15, 2010

Doodle art left behind on paper exam table cover

We had an artistic young gentleman from South Carolina who left us
several awesome cartoon doodles.

My staff were psyched to show me the drawing he did of me, dr. Hey as
a rapper w sun glasses and low ride jeans and some bling! Next to it
it says "wazzup ... Cracks-lackin dose Spines, yo!"


Life is never boring at Hey Clinic. It's been a good week. Have a
great warmer weekend!

Dr. Hey

Big smile this morning seeing her new straight spine!

Chanice and her mom and grandma gave me a big smile after seeing her
new straight spine after her adolescent idiopathic scoliosis surgery
yesterday. I even got a hug! Happy Friday!

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery

Thursday, January 14, 2010

17 yo young lady w painful 58 degree thoracolumbar adolescent idiopathic scoliosis fixed this am

T5-L3 instrumentation and fusion.
Surgical time: 3 hrs 20 minutes.
EBL: 1100 cc
Complications: none.
Correction: excellent.

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery.

Monday, January 11, 2010

This is why I love my job!!!!

14 yo adolescent idiopathic scoliosis.
No complications.
Excellent correction.
No transfusions.

This morning we straightened up 12 yo w 54 degree curve.

Great day!!
Dr. Lloyd Hey
Hey Clinic

Saturday, January 9, 2010

Emily now 6 years after scoliosis fusion surgery with no pain during first pregnancy! Some advice for scoliosis and kyphosis with pregnancy, with or without surgery.

One of the questions I address quite often is the issue of pregnancy with our without scoliosis surgery.  
In this email I received yesterday, one of my young adult surgery guests who had her scoliosis fusion done 6 years ago shares how well she is doing during her first pregnancy.
If you have had a spine fusion for scoliosis, and you are pregnant, or planning to get pregnant, it is very helpful to know how low your fusion goes, and possibly show your obstetrician copy of your X-Ray — It may help your obstetrician and/or anesthesiologist to guide possible epidural analgesia placement, or determine whether it is possible or not.
In addition, if you have scoliosis and you have not had it fixed surgically, be sure to get your scoliosis measurements checked soon after each pregnancy, so you can decrease chance of radiation to next new possible baby, while also determining whether or not there has been any progression of scoliosis or kyphosis during pregnancy.  There is some debate whether scoliosis or kyphosis tends to progress during pregnancy due to the relaxin hormones having effect on spinal ligaments as well as pelvis ligaments, combined with the weight of pregnancy pulling down on spine more.  I have seen several cases over the years where women who I was following for scoliosis or kyphosis had significant progression during one or more pregnancies. Bottom line: it’s probably a good idea to check it.  I encourage these “after baby scoliosis/kyphosis checks” also for another reason:  we all get to see your new baby at Hey Clinic!  :)

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery.------ Forwarded Message
From: "Emily
Date: Fri, 8 Jan 2010 22:34:07 -0500
To: Lloyd Hey

Hi Dr Hey!

I hope you are well! I'm emailing to ask about a friend if mine- she's a 29 year old  who just found out that she's got a herniated disk between C5 & C6. It is pressing on the C6 nerve that goes down her right arm.  Is that something she should/ could come to you for?

News about me- I'm due with our first child (baby boy- "Barrett") in mid-March. I've had absolutely zero back pain so far, which is extremely encouraging. Thanks again for the amazing work you do for people like me!


(scoliosis surgical patient in Nov 2004)

FW: Tips for 2010/grateful patient

I received this very encouraging email late in the day yesterday, from Sandra, a nurse practitioner who had surgery with us back in November, with a revision decompression and lumbo-sacral-iliac wing instrumentation and fusion.  She was quite debilitated preop, having trouble working and getting through the day.  Now she is doing much better, as she shares in the email, along with some good advice for 2010!
Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery

------ Forwarded Message
From: Sandra
Date: Fri, 8 Jan 2010 15:14:46 -0500
To: Lloyd Hey <>
Subject: Fw: Tips for 2010/grateful patient

Hi Dr. Hey and everyone!  I wanted to thank you for all the wonderful care you gave me starting from the first e-mail I sent your office asking for help and through my spinal fusion.  I can honestly say that in the past 32 years in the medical profession I have never met a more devoted and dedicated physician, as well as physician assistants and all your committed office staff! I believe that God answered many of my prayers to find a physician like you to help me. (You were my 3rd surgical consult). You truly are a gift from God and the love of  God definitely shines through you! My surgery was 11/04/09 and I went back to work 12/21/09 (maybe a little early, but I had to get back to my clinic practice) and I have done fairly well-still healing and following my restrictions.  My stamina is not quite back as it once was, and I usually do better in the mornings, but  I feel fairly exhausted by the end of the day and have back discomfort,  though not debilitating as it was before surgery. I have adopted a  new goal for myself; "Failure is not an option"! Anyway, I wanted to send you something someone e-mailed me, "Tips for 2010".  I'll be seeing you for another check-up in February, and I will continue to send you referrals! Have a great New Year! Sandra  New Bern, N. C.


1.       Drink plenty of water.
2.       Eat breakfast like a king, lunch like a prince and dinner like a beggar.
3.       Eat more foods that grow on trees and plants and eat less food that is manufactured in plants..
4.       Live with the 3 E's -- Energy, Enthusiasm and Empathy
5.       Make time to pray.
6.       Play more games
7.       Read more books than you did in 2009 .
8.       Sit in silence for at least 10 minutes each day
9.       Sleep for 7 hours.
10.    Take a 10-30 minutes walk daily. And while you walk, smile.

11.    Don't compare your life to others. You have no idea what their journey is all about.
12.    Don't have negative thoughts or things you cannot control. Instead invest your energy in the positive present moment.
13.    Don't over do. Keep your limits.
14.    Don't take yourself so seriously. No one else does.
15.    Don't waste your precious energy on gossip.
16.    Dream more while you are awake
17.    Envy is a waste of time. You already have all you need..
18.    Forget issues of the past. Don't remind your partner with His/her mistakes of the past. That will ruin your present happiness.
19.    Life is too short to waste time hating anyone. Don't hate others.
20.    Make peace with your past so it won't spoil the present.
21.    No one is in charge of your happiness except you.
22.    Realize that life is a school and you are here to learn.  Problems are simply part of the curriculum that appear and fade away like algebra class but the lessons you learn will last a lifetime.
23.    Smile and laugh more.
24.    You don't have to win every argument. Agree to disagree...

25.    Call your family often.
26.    Each day give something good to others.
27.    Forgive everyone for everything.
28.    Spend time w/ people over the age of 70 & under the age of  6.
29.    Try to make at least three people smile each day.
30.    What other people think of you is none of your business.
31.    Your job won't take care of you when you are sick. Your friends will. Stay in touch.

32.    Do the right thing!
33.    Get rid of anything that isn't useful, beautiful or joyful.
34.    GOD heals everything.
35.    However good or bad a situation is, it will change..
36.    No matter how you feel, get up, dress up and show up.
37.    The best is yet to come..
38.    When you awake alive in the morning, thank GOD for it.
39.    Your Inner most is always happy. So, be happy.

Last but not the least:
40.    Please Forward this to everyone you care about, I just did.

Wednesday, January 6, 2010

Another update from one of my longer-term mentorees

Several years ago when I was on faculty at "Big Duke" in orthopaedics and
spine surgery, I also ran a clinical research and innovation lab called the
"Center for Clinical Effectiveness."
Ronnie joined my lab as a college grad with desire to go to medical school.
He had faced many trials during college which definitely set him back, and
made med school application a real long shot. Dr. Jim Urbaniak had known
Ronnie from his excellent service at a local country club, and had sent
Ronnie to me to see if I could help him work toward medical school.

With perseverance and a lot of hard work over a few years, Ronnie was
successful helping perform outcomes research, and also was able to prove his
academic abilities with advanced college and grad school classes. Ronnie
then was able to get into medical school, but I hadn't heard anything for
past few years since then.

Recently I took care of the husband of the residency director for Ronnie's
residency program, who told me that Ronnie was one of their finest residents
of all time!

Ronnie then got in touch with me, and even came by my clinic for a few
minutes right before clinic.

It was great to see him, and to hear how he's been finishing final
preparations to go out and serve as a physician.

Ronnie: I am so proud of you, and look forward to seeing you for coffee

On 1/4/10 8:21 PM, "Ronnie" <> wrote:

> Hello Dr. Hey!
> It was great seeing you in early December. I thought I would wait
> until after the holidays and new year to write you. I would love to
> catch up some time, our schedules permitting. I am halfway through my
> residency in Family Medicine at UNC Chapel Hill, and loving it. I
> could not have chosen a better fit for me, professionally or
> personally, except Orthopaedics! =) Anyway, this is my personal e-
> mail. Let me know if you might have some time to catch up, even if it
> is merely through technological means (e-mail, text, Facebook; the
> world gets smaller everyday). I hope all is well with you. As always,
> I thank you for your excellent tutelage and believing in me and
> helping me to achieve my dream. My work with you was monumental in
> helping me grow professionally and personally. I look forward to
> speaking with you soon.
> Humbly,

------ End of Forwarded Message

Re: Update from MIT student who "shadowed" 6 years ago now in medical school.

I do remember you!
What an encouragement to hear about your journey!
Give my best to your folks, and keep me posted on your career developments.
While the journey to become a surgeon is a long one, I can tell you confidently after almost 15 years of practice and 6,000 surgeries, and thousands and thousands of guest visits that it is definitely a journey that can help make a big difference in the lives of many.

Thanks for taking a minute to share.


Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery


On 1/5/10 4:36 PM, "Zachr" <> wrote:

Hi Dr. Hey,

Not sure if you remember me, but maybe this will help ring a bell: I shadowed you 6 years ago while I was still an undergraduate student at MIT. Recently, my sister, Jordan Brewer, a recent graduate of UPenn, also shadowed one of your PA's in your clinic. You also operated on my grandmother, Marie Meacham's back and still continue to see her. I just wanted to give you a brief update of my life. I am currently a third year medical student at Vanderbilt Medical School, 
and am half way done with the year, having already completed my medicine and surgery clerkships. Next up for me is pediatrics. Even though I have half of the year left, all of my classmates are beginning to think about residency. As of right now, I am strongly considering general surgery, with an interest in cardiothoracic surgery. I wanted to sincerely thank you for your guidance and tutelage during those few weeks. You most certainly helped spawn my interest in surgery. You may have sparked an interest in my sister as well. Having a significant impact on three members of my family certainly warrants my thanks. I really appreciate all that you did. Thanks again and keep in touch.

Sunday, January 3, 2010

Andy, graduating nursing student and structural engineer shares his thoughts after spending the day with us

Last week I had the pleasure of having Andy, a Watts Duke School of Nursing student spend the day with us, seeing 2 scoliosis surgeries and a couple of clinic guests in between.
Andy has a unique background, with a 14 year history working as a structural engineer before switching to nursing. Andy shared his story with me, that he considered being a doctor or other healthcare provider when he was growing up, but chose engineering instead. Once practicing as an engineer, he would often re-think this decision, and wonder about the road he chose NOT to take in healthcare. He shared that this was most evident after he went to see his own doctor for treatment, when he would then LONG for a career helping people in a healing profession. After 14 years of engineering and management, and after saving up his money, he left it all, and signed up for full time nursing school in his mid-thirties. That takes guts. But clearly he made the right choice.

Andy's enthusiasm regarding health, surgery, and caring for people was quite contagious! When I first met him in the operating room, he came in at the very end of one of my adolescent scoliosis surgeries and just sorta stood there and gawked at the pre-post X-Rays hanging on the board, saying "Amazing" more than once! Andy then stayed with us through the rest of the day, and even into the early evening, finishing up our second big scoliosis surgery around 7:30p that night! He hung in there the whole time, and his enthusiasm remained constant! His structural engineering background allowed him to understand at a deeper level the type of complexities I deal with reconstructing the spine on a living human being!

Andy -- it was a pleasure to spend the day with you. Always keep that passion for caring and learning, and you will serve well for many years to come.

In the paragraphs below, Andy shares a bit of his experience spending the good portion of the day with us.
Hope you enjoy it!

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery

Andy's Story from One Day Internship with Dr. Hey --- December 2009

It's hard to say what part of the day I found to be the most impressive. As a nursing student and a structural engineer, it would be easy to argue that several different aspects of the day were the most impressive. However, what I can say for certain is that this was one of the most enjoyable and educational experiences I've had and I would love to do it again.

When I arrived it was the end of the first surgical case and I was able to evaluate the outcome of the surgery. The patient had a very advanced case of scoliosis and I was able to see both the before and after x-rays. I was absolutely astounded by the amount of correction Dr Hey was able to achieve. I have seen my fair share of pre and post scoliosis surgery x-rays and I have never seen that degree of correction. In fact, I didn't think that amount of correction was even physically possible. Dr Hey invited me along as he met with the patient's family to update them on the outcome of the procedure and on the patient's condition.

Between surgical cases Dr Hey invited me back to his clinic. He gave me a tour of his clinic, showed me the information management system he developed, and then we saw two patients. The information system he developed is first class and appeals to me both as an engineer and as a nurse. It is the most inclusive, most global, and most user friendly system I've ever seen. The patient record is started by the patient as they enter the clinic. The extender or MD then expands on this record during the interview and examination. All x-rays, CT scans, and MRI's are imported into the patient record and can be reviewed ad lib. Outside reports are scanned and entered into the record as well. From this record, notes, consents, and reports are generated. So, each patient has one comprehensive electronic file that contains all of their information and it is readily accessible and readily editable. As an engineer, I am truly impressed with the seamless integration of data entry (both pre-formatted and free text), importation of images and text, and the ability to generate reports from the acquired patient database. As a nurse, I find myself a little jealous as the documentation/record systems at Duke, Durham Regional, and Duke Raleigh are nowhere near that integrated or that user friendly. All aspects of this system work well and work together. I would absolutely love to have a program like that for nursing.

Back in the operating room, I was able to see Dr Hey in his element. He was performing scoliosis corrective surgery and a laminectomy on a patient. These were two procedures I had not seen before but had really wanted to see. The incision was made from mid thoracic spine to the proximal sacrum. Portions of the spinous processes in these areas were removed and processed to be used as an autograft at the end of the surgery. After extensive prep work, Dr Hey began the installation of the pedicle screws that would hold the support rods. We discussed how the screws were placed. We discussed fastener length and diameter selection, installation angle, fastener placement and symmetry, hole preparation, and installation torque. Once the pedicle screws were installed, Dr Hey performed the laminectomy on the lumbar vertebrae. I was absolutely in awe on his ability to dissect away the lamina without so much as disturbing the dura mater (outer covering of the spinal cord). Once the laminectomy was completed, the patient was repositioned and measured for support rods. These rods were cut to length with a highly specialized device that appeared much like a rebar cutter. However, this cutter left a very clean cut end. Once both rods were cut, Dr Hey pre-bent each rod in three dimensions. He added sacral and lumbar curvature to each rod as well as bends in a perpendicular axis. Each rod was inserted into the pedicle screw heads starting from the sacrum. The caps were inserted with a device that closely resembled a 2-jaw gear puller. The two jaws of this device locked into slots on the heads of the pedicle screws. The center screw drove down the cap and pushed the rod down into the head of the pedicle screw. Several of these tools were placed in succession and advanced progressively to minimize stress on any one pedicle screw. This procedure was continued up the entire support rod as each pedicle was successively capped. The procedure was repeated on the opposite rod. An intra-operative x-ray was taken to confirm placement. Once confirmed, the caps were all given a final torque. Bone graft material (both the patient's and donor) was spread along the portion of the patient's spine immobilized by the rods. Closure of the wound began with deep suturing of the muscle with large gauge sutures. A superficial continuous run of light gauge sutures closed the subcutaneous and cutaneous layers of the skin. Dermabond provided the final approximation of the incision edges and provided a water-tight seal. With the incision closed, Dr Hey went to discuss the results of the operation with the family and I headed home after a pretty long day.

Watts School of Nursing '10