Saturday, July 10, 2010

"I'd Rather Be Fishin'!!!" --- Hey Clinic Update for the Week ending July 10 2010

Well, so ends another exciting week at Hey Clinic and Duke Raleigh Hospital.
A lot has been going on since I was enjoying a good fish dinner at Sanitary Fish Market a week ago, down in Morehead City, NC. That's where I met one of my adolescent scoliosis friends — Brittany, who was our family’s greeter at the door!

Since then, we helped Austin, a 17 yo young man with a 70 degree severe thoracic adolescent idiopathic scoliosis. His curve was causing a major deformity of his rib cage, which was already quite narrow. When I saw him in the Preop Area at Duke Raleigh with his family, he was wearing his Hey Clinic Hat. His hat, however, had been upgraded with several slogans written on the front and side and back of the hat. The most striking one was across the front of his hat: “I’d rather be Fishin’” ----- which sure made sense in comparison with having major scoliosis surgery! On the side of his hat it says “Let’s You and Me get One Thing Straight!” The other side of the hat says “What would Bubba Do?” We all had a good laugh about that. Austin clearly has a potential future in advertising and marketing.

I didn’t admit that even I might even rather be fishin’ than being inside doing complex surgery all day. Well, we can’t fish all the time, so getting straightened up, or bending scoliosis rods to help straighten up Austin is just about as much fun (and probably more important in long run) as bending fishing rods out on the ocean with a big fish! ---- Hey Austin, maybe sometime soon you and I can go out there and actually go catch that big one, and bend a rod or 2!

Austin did great with his surgery, and gained probably over 2 inches. His girl friend, who I met after the surgery, found this to be a little bit of a problem since she was already at a height disadvantage to Austin. Oh well. At least she can wear high heels! Austin’s posture looks a whole lot better now, and I was able to pull that really sunken area on the left chest out quite a bit, and derotate the spine so that the hump on the right was leveled out, and his shoulders are level. He went home after I think 3 nights in the hospital. His family stayed with him in the large private Duke Raleigh Hospital Orthopaedic room.

Other memorable scenes for this week:

I did a big anterior/posterior reconstruction for a 48 yo woman who had a thoracolumbar fusion done when she was a teenager without instrumentation, which gave her flat back syndrome, similar to what we typically see with Harrington Rod fusions. She was fused down to L5, and over the years, that last disc wore out, and collapsed, pitching her forward, and making it difficult and painful to walk and stand. I reconstructed this with anterior L5S1 discectomy and ALIF (anterior lumbar interbody fusion), followed by posterior osteotomy, with laminectomy and posterior instrumentation. We got a huge correction of her lumbar lordosis through that one segment, and now she can stand up and walk straight! She’s now home doing well. Her daughter an mom stayed with her in the hospital. I need to get her X Rays up on the blog, since her daughter keeps looking for them!

As soon as I finished that anterior-posterior reconstruction, I met a new patient who was a 45 yo hair dresser from Puerto Rico, who also had almost the exact same flat back problem with a Harrington Rod. Her flat back is really affecting her quality of life and ability to work. She’d like to get it fixed as well.

We did surgery on a lady from Tupelo, Mississippi with a degenerative scoliosis and severe spinal stenosis, here with her delightful niece. She has done quite well postop, and will be heading home to Mississippi probably Monday morning.

Friday was a busy clinic, seeing a bunch of our adolescent scoliosis patients back for follow up, looking great and with lots of great stories from summer. Some of our adult patients were back as well, including a gentleman from West Palm Beach doing great after revision scoliosis and stenosis surgery with excellent relief of his back pain, and much improved gait. His son-in-law is a doctor at Duke Medical Center. This patient still runs a group of funeral homes down there, and is a delightful man. He is sending us a pastor he met who is suffering with severe kyphosis.

We saw a couple of older patients, both in their 80’s who had scoliosis, but actually had stable curves, and were both doing very well. One of them, in the picture here, actually plays golf, and exercises regularly. Her curves are well balanced, and are not very large. Good example that some people do fine without surgery in the long run, but everyone with scoliosis should still be followed throughout life with routine exams and xrays to ensure that the curves are not progressing.

We got some special 3D CT reconstructions on one of our 5 yo patients who has a severe juvenile scoliosis which has been markedly progressive, planning osteotomy surgery for later this summer. Our skilled radiologists have been so helpful here to help us map out the anatomy so we can plan the surgery.

Our attorney guest from Myrtle Beach who had revision surgery for adjacent level stenosis and problems with osteoporosis around top pedicle screws is doing well after his surgery this week, and will be heading home early part of week. We supplemented his bone with some bone cement called “PMMA”, which will help increase the strength of the construct, and also took the pressure off where the nerves at the level above his fusion were getting pinched. It seemed to help quite a bit even the day after surgery.

I saw a pastor with severe disc herniation at C56, C67 in clinic who has been suffering fairly badly now for 4 weeks. Traction doesn’t seem to be helping, and he has some weakness in his tricep muscle. We’re trying some steroids as well. While I usually like to give it at least 6 weeks of conservative treatment before considering surgery, I think we’ll need to get him fixed before then, since his pain and weakness are significant. I can definitely relate to his pain, since I suffered with a severe C67 disc herniation about 7 years ago for a whole year — wow did that hurt, and affect my quality of life. When I had it fixed, it was like someone took the ice pick out of the back of my scapula and arm. My tricep strength also came back. That was a very happy day. Going through that pain gave me greater insight into what my patients also experience.

I did an L45 microdiscectomy on a 24 yo gentleman who is the son of one of my other surgical patients, who had similar problem a few years ago. Herniated discs may have a genetic component. There have been quite a few families where I have done surgery on spouses, or children, or even grand children! There is one family where I did surgery on all 3 generations — the youngest had a spine fracture from a rollover of a lawnmower on a hill. Since most of the surgeries I do are major deformity surgeries, we all enjoy helping our guests with the simpler problems of herniated discs in the neck and low back area. This gentleman had severe sciatica going down his right leg. I took out the disc herniation using microsurgical techniques, and his leg pain was gone in the recovery room! He spent the night, gave me a hearty hand shake and headed home the next morning. A few years ago, one of my scrub nurses gave me an “Easy Button” from Staples --- When you push the button, this little device then says “That was Easy!” -- the advertising slogan for Staples. For while, when we had an easier surgery like a discectomy or single level fusion, one of the staff would then hit the “Easy Button!” I’m not sure where that Easy Button went, but we could have hit it Thursday afternoon.

The Hey Clinic staff are doing well. Some of our staff went up to see Jaclyn, our former (and still well loved!) physician assistant for a batchelorette gathering tonight. Jaclyn gets married in the fall up in northern Virginia. Hope you guys had a great time today Jac!

Our OR surgical team is also doing very well. “Dan the Man” -- one of my “Black Belt” surgical techs celebrated his 49th birthday on Friday by riding his Harley Davidson out to the mountains of western North Carolina. Dan plans to write a book, called “The Last Room Running” -- about great stories from our surgeries. Since my OR room seems to be one of the last rooms running each day, doing 2 large surgeries, I think many of his stories may be from our room. Maybe I’ll get a chance to write the Introduction. I think Dan may also include some of his stories of his “Bike Weeks” in Florida, and his motorcycle club/gang experiences as well. Stay tuned. Should be a best seller! Be safe out there, Dan!

Nurse Kelly continues to keep all of us in line as our circulating nurse. Kelly helps keep our patient’s families up to date during surgery, while also ensuring the surgical team has everything they need at every time, and that all check lists are thoroughly completed. She runs a very tight ship! Scrub Sheila was with us for a couple days this week, and was helping train up Jill, who is doing just awesome. Scrub Robert was with us as well this week --- another Hey Clinic Black Belt Scrub Tech. Scrub Erline has also become a regular part of our team. She shared with me on Thursday some of her experiences growing up in the segregated NC South. We’ve come a long way since then, but still have some ways to go, no doubt.

One of the funniest scenes from this week was when one of my patients, in her mid 80's, took out a magazine during her appointment and told me that I reminded her of "Dr. Oz" on TV. Now I knew who the Wizard of Oz" is, but I had to confess I hadn't heard of the gentleman. She showed me his picture, and described his caring ways, and good ways of explaining medical conditions. She also thought his wife looked like my wife! Right after seeing this patient, my next teenage patient was wearing a "Wizard of Oz" T-Shirt, which prompted further discussion of Dr. Oz. The mom of the teenage patient thought my personality was similar to Dr. Oz, but that I didn't look much like him! So there you have it. Light moments like this help us all to have a little smile together.

Our family has taken great interest in the new reality TV show about the Boston Hospitals, which include some of the hospitals I trained in years ago, including Boston Children’s Hospital, and Mass General Hospital. We’re taping them on DVR, and plan to take a look. I was on a Discovery Channel reality TV show years ago, before Reality TV was such a big deal. Bill Hayes did an awesome job as the producer of this show called “The Hospital” -- and they followed the story of one of my young adult scoliosis patients through the process of pre-surgery, surgery and postop follow-up. That was quite an experience, including having about 8 extra people in the operating room with booms, cameras, and lots of questions! I hear I’m still on the re-runs on the Discovery Channel, although I haven’t seen the show for years.

Well now you all know a little bit more about our Hey Clinic “Reality” this week. I hope all of you are doing well. Please drop us a note, add a comment, or drop us an email. We’d love to hear from you.

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery

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