Sunday, March 21, 2010

Katrina's 31 Things I Learned from Shadowing at Hey Clinic on Friday

When I was growing up, my dad and mom loved to teach and inspire and learn — which they definitely passed onto me and my brother and sister.
I’ve done a lot of learning and teaching and inspiring since then, including during residency and fellowship at Harvard, fellowship at Duke, faculty at Duke, and now Hey Clinic for the past 5+ years.
One of the special things we do at Hey Clinic is have “interns” join us for a day, a week or more — many of whom are former scoliosis guests of ours who do school projects to explore career options with us.
Katrina has been with us for several weeks, but spent her first full day with me in clinic.
One of the things I used to always challenge my residents and fellows to do was to “Learn at least 3 things every day.” -- I would have them write down what they learned on an index card. After their first surgery with me, or first day on rounds, they’d be scribbling way more than 3 things.
On Friday, I challenged Katrina, a 16 yo Junior in High School to jot down what she learned, to see if she could learn at least 3 things.
Well, she did WAY better than that!

Here is her list of things she learned from one day at Hey Clinic.
She is pictured with me at Hey Clinic, proudly holding up her “Learning List” at the end of a busy clinic!
Strong work, Katrina!
Keep learning!

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery
Member, Scoliosis Research Society (

Date: Sat, 20 Mar 2010 03:34:11 -0400
To: Lloyd Hey <>
Subject: Katrina's 31 Things I Learned from Shadowing

Dr. Hey,

Attached is my list of 31 Things I Learned from Shadowing. I know I originally said I had 35 things, but when I got home, my unintelligible handwriting prevented me from understanding 4 of them... :)

Thank you SO MUCH for allowing me to come in and follow you around all day. It was a huge privilege and such a great day!! Please thank your entire staff for me too, because they are amazing!

Katrina Wertz

(Shadowing at the Hey Clinic: March 19 – 8am-3:50pm)

1. “The Grocery Cart Sign”

· Learn to carry Dr. Hey’s business cards around at all times. You never know when you will be shopping in Harris Teeter and notice that the woman standing next to you in line probably suffers from spinal stenosis because she is forced to lean forward while gripping her grocery cart in order to keep standing and walking. This helps take pressure off spinal nerves.

2. Quality of Life

· You should be able to stand for about 30 minutes at a time without experiencing significant pain. If your pain is so severe that you find yourself unable to do your daily activities, your quality of life is not good.

3. Treat the person, not the X-ray.

· In the end, whose testimony matters more? The living patient or the speechless photograph?

4. Danger of the Spinal Cord vs. Nerves

· Watch out for the spinal cord above all else. It’s a fragile gift from God!

5. Why Doctors Do Those Seemingly Silly Reflex Tests

· When a doctor looks at an MRI, he has a special secret that most of us don’t know. He already knows what he is looking for! He is not studying the MRI for answers; the MRI is merely confirming what he already suspects. Remember earlier in the appointment when the doctor did those reflex tests on you? At the same time, he was also noting areas of weakness, areas that directly appertain to specific nerves. Now he is cognizant of which nerves he needs to pay attention to on the MRI!

6. Nerves regenerate 1 millimeter per day.

· Positive: they can heal

· Negative: they could take a while…

7. History of a Patient

· Being aware of the history of a patient is vitally important to a doctor’s assessment and planned course of action.

8. “The Glacier Analogy”

· Think of the slip of a vertebra like the earth’s tectonic plates shifting. If 1 vertebra slides over another, the space within spinal canal or around the nerve roots often gets smaller (stenosis).

9. How Do Doctors Fix…?

· Doctors fix stenosis by laminectomy. Doctors fix slips of the vertebrae by reconstructive surgery using hardware and bone grafts.

10. Two Functions of the Spine

· “Mechanical” à stability and motion

· “Electrical” à impulses from the nerves

11. On X-rays, arrows are bad…

· Enough said.

12. Three Views on an MRI

· “Loaf of Bread” = Axial (horizontal view seen from the top)

· “Side” = Sagittal (vertical view seen from the side)

· “No Cool Nickname” = Coronal (vertical view seen from the front)

13. The spinal cord stops at L1 (it does not continue all the way down the spine).

· I didn’t know that!

14. It Takes 2 to Tango.

· This is basically an unofficial contract between you and the doctor before surgery. You as the patient are immeasurably important and deserve the full attention, expertise, and care of the doctor. But we all know that one person can’t tango by themselves… well, actually I guess they could, but it would turn out poorly J So, you as the patient also need to “get tuned up for the game.” That means eating well, sleeping well, and just following the doctor’s instructions… well.

15. “The Leaning Tower of Pisa Analogy”

· In deciding to operate on a patient, don’t fix 1 problem and leave another. What would happen to the Leaning Tower of Pisa if someone decided to remove the bottom section to correct its lean? The Tower would collapse and now you are left with a bigger problem!

16. The Disc That’s Not Really a Disc

· A vacuum disc, which is actually just gas, is a sign of disc degeneration.

17. Who Has a Risk of Blindness from Surgery?

· Those who are severely obese

· Those who are brittle diabetics

· Those who are in surgery for longer than 6 hours

18. It’s better to be proactive rather than reactive.

· A good example appears with scoliosis in children. Just because a child may be done growing does not mean that his or her scoliosis is done growing. Therefore, continue to get periodical check-ups just to be sure everything is doing well.

19. Pain and its Positions

· Pain can be better lying down instead of standing up because when lying down, the load is taken off of your spine.

20. The Neck Challenge

· Most people can easily crane their neck to look up at the sky. But what if I told you to keep looking up at the sky in that same position for the next 2 hours? Or 20 hours? Thoracic kyphosis patients constantly endure this craning of the neck. It’s no wonder that they often complain of neck pain – their necks have to work overtime to compensate for their back problem!

21. Don’t just blindly knock something out… know specifically where the pain is coming from and what you want to treat.

22. Factors in Predicting Scoliosis Progression in Children

· How big the curve is currently

· How much more the child will grow

23. Tests are not for fun. The doctor should only order one for a patient if it could change what he plans to do.

24. Smoking and Surgery

· Quitting smoking (or at least temporarily) before a surgery helps cut down the possible medical complications afterwards.

· In general, smoking and surgery don’t mix!

25. Surgery to correct kyphosis is less likely to result in paralysis than surgery to correct scoliosis.

26. Post-Op Pain

· It is common to experience some rib/side pain after surgery (even a few months later). The reason for this is because it is not just your spine that must become used to its new position. The ribcage too is slowly settling into its new orientation.

27. 5 Questions to Ask Before Surgery (you need a green light on all 5 for Dr. Hey to agree to operate!)

· Quality of life is unacceptable

· Conservative treatment has been ineffective

· There is a fixable problem

· Patient is medically able

· Patient understands the possible risks

28. A patient’s pre-op nutritional status has a huge effect on surgical consequences.

29. Braces after surgery are optional—although now you have braces that are already inside!

30. It is important to give the patient your undivided attention, listening to their symptoms and their perspectives. It is important to share stories and past experiences with the patient, making them feel more at ease and confident in your opinion. It is important to be honest with the patient and “lay all the cards out on the table.” It is important to be compassionate of the patient, letting them know that this is not just a job to you.

31. It is important to make the patient feel like you would drop everything to care for them.

Dr. Hey’s Clinic has taught me all of this and much, much more. It’s my favorite office to go to and is staffed by the most incredible people in the world. This is a special place to be.

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