FW: Halloween Picture at Hey Clinic

------ Forwarded Message
From: OLIVIA
Date: Sun, 31 Oct 2010 15:58:43 -0700 (PDT)
To: Lloyd Hey
Subject: Re: Halloween Picture at Hey Clinic

Dr. Hey
 
Thanks for the picture. You may put it on your blog and the TV in the office. Thanks for much for taking time with Olivia. She thinks so much of you.
I will show Olivia. I know she will be excited.
Take Care,
 
Pamela

Happy Halloween from Hey Clinic! Bracing for Early Onset Scoliosis / Juvenile Scoliosis

After four great days of scoliosis surgery this week, the Hey Clinic team rolled into clinic yesterday ready to go.  There were some signs of Halloween among the Hey Clinic staff, with PA Brittany spurting her purple horns, and Tracy wearing her Halloween Fall Scrub top.

To help us get in the Halloween mood, our clinic received a great “Shivers Down My Spine” Halloween card from Diana, one of our scoliosis guests from Ohio.  She is coming in this coming week to have an anterior/posterior revision extension instrumentation and fusion done for flat back syndrome after an old Harrington rod fusion.  

But the highlight of our Halloween clinic on Friday by far was Olivia and her sister, who came into clinic all made up, and absolutely ready to “Trick or Treat”.
This put us in a bit of a bind, since we weren’t expecting REAL Trick or Treaters in Clinic.  Fortunately, I had a couple of giant chocolate chip cookies on hand for Olivia and her big sister.
Next year, we’ll make a better effort to be ready with official Treats.

Olivia has Early Onset Scoliosis, or Juvenile Scoliosis, and is being treated in a brace.  She’s growing out of her brace now, over this past year.  The brace seems to be working, but Olivia is growing like a weed.

We saw another Early Onset Scoliosis yesterday as well, who showed off her pretty pink brace for us, with excellent stickers, including a 3D tropical fish!
Her curve is doing very well in the brace, and her brace is fitting well.  We fine tuned the brace tension with her parents.
The younger children seem to tolerate and cooperate with  the scoliosis braces (Boston Brace) much better than the older ones who are becoming teenagers.
Hormones and growth change everything!

This coming week we’ll be having guests coming into see us from Ohio, and from Baltimore, Maryland.  
Yesterday, I saw one of our patients from Harrisburg, Pennsylvania who has a painful 78 degree Scheuermann’s kyphosis.  We’re going to be trying a round of physical therapy for him, but if his quality of life does not start improving, he may be considering surgery for early 2011.

When my kids were young, I used to love to take them around Trick or Treating.  Since the fall is usually fairly warm here in NC, I often went as a surgeon in my typical Duke Blue scrubs.
Kids grow up quick — savor those precious moments when you can.

Several of our guests in clinic, especially our younger guests, asked me what I am going to be for Halloween this year.
I’m not quite sure yet, but I am open for suggestions.
At last check, Jenny and her husband were going to go as Batman and Robin....  I think Jenny would make a great super hero!

Hope you are all doing well.
Have a great weekend.

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery

Little People Can Have Scoliosis and Stenosis Problems Too!

I saw Franklin today who popped in to drop off some MRI's for us.
Franklin had severe lumbar stenosis, which is common in people with
achondroplasia. I did a multi-level laminectomy for him a couple years ago,
since he was having severe problems standing and walking. Now he walks
great and is working full-time.

Franklin is active in the Little People societies, and also is our favorite
actor in the Raleigh "Christmas Carole" --- Hey Clinic has now made it an
annual tradition to go out to dinner together, and then see this great play
together in downtown Raleigh, NC.

Right after bumping into Franklin, I saw Dawn as a patient, who is also a
little person at 48 inches tall. She has scoliosis, kyphosis and has new
thoracic stenosis with myelopathy. We're going to get her fixed up with
surgery Monday.

Franklin said it was ok to put this picture of the 2 of us up on the blog.
Thanks Franklin!

--------------------------------
Dr. Lloyd A. Hey
Hey Clinic for Scoliosis and Spine Surgery
http://www.heyclinic.com

L45 spondylolistheis and lumbar spinal stenosis fixed this am

Had severe back and leg pain.
Fixed w L45 decompression and Fusion w TLIF.
No complications.
Very athletic former marine should be back to better quality of life shortly.
Home from Duke Raleigh hospital tomorrow.

Did 2 big scoliosis surgeries yesterday: T10-iliac wing extension decompression and fusion for a gentleman w progressive thoracic myelopathy. Second patient was young lady in 40's w progressive very painful Thoracolumbar scoliosis fixed w T5-Iliac wing instrumentation and fusion w TLIF. Her surgery was 4 hours. First surgery yesterday was 5 hours w tough 7 level lamimectomy, including complex revision laminectomy through old noninstrumented fusion. Whew. Long day. Got home about 9:30 pm. Both of those patients are doing well this am w woman who had scoliosis telling mr her severe leg pain she used to have all night was gone! Her husband, a surgeon, stayed w her in private room last night.

Today's surgery: failed spinal cord stimulator w degenerative scoliosis and previous laminectomies

If you are considering spinal cord stimulator or morphine pump and you have scoliosis, Spondylolisthesis and possible spinal stenosis, it is helpful sometimes to get second or third opinions from someone who does complex spinal revision surgeries and deformity.

This woman ha previous laminectomies w ongoing back an leg pain w trouble walking. She ten got stimulator which didn't help at all.

Today we removed the stimulator, did complex 4 level revision laminectomy and T12-iliac wing instrumentation and fusion.

Surgical time: 2 hrs 55 minutes.
Ebl: 1400 cc.
Blood transfused: none.
Cell saver returned: 565 cc
Complications: none.

Adjacent level failure w Spondylolisthesis and lumbar stenosis fixed this afternoon

Removal of Steffee Plates, L3-S1 extension fusion w L3 laminectomy.

Surgical time: 2 hours 05 min.
Ebl: 650 cc
Blood transfused: none.

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spone Surgery

Presto Chango!

This is the "after" xray from this morning.
Surgical time: 2 hrs 45 min.
Complications: none.
T11-ilia wing instrumentation and fusion w osteotomies and laminectomies.
Excellent correction of lordosis and scoliosis.
Ebl: 600 cc
Blood transfused: none.

Good Monday morning!!

Dr. Lloyd Hey
Hey Clinic

This morning's challenge

Severe back and leg pain with trouble walking.

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery

TwistedSister Wins first Hey Clinic Clinical Puzzle!!

Well, ladies and gentleman, we have our first winner of the Hey Clinic Challenge Question.
Yesterday we received this answer from “TwistedSister” via the Hey Clinic Blog:

“I suspect that her neck pain may be attributed to her trying to hold her neck in a normal vertically straight upright position. Thus, her neck musculature is competing against the "natural" gravitational force caused by the scoliotic curvature...just my guess (unfortunately deduced from personal experience). “

Posted by  twistedsister  to  The Hey Clinic for Scoliosis and Spine Surgery <http://drlloydhey.blogspot.com/>  at  October 15, 2010 1:23 PM

Twisted Sister is absolutely correct!!!
If you look carefully at the X-Ray, you’ll notice that I actually drew an angular measurement in the upper thoracic spine, showing 14 degree “lean” to one side.  This gives the neck a tilted “foundation”, so that in order for her to keep her head level, she has to bend her neck back about 14 degrees or so to get her eyes level.  This puts extra strain on the neck.  As we all get older, and our neck gets more arthritis / degeneration in the facet joints and discs, it is harder and more painful to compensate for this.  

This particular patient will be having surgery with us, and we’ll straighten that up for her along with the rest of the deformity, which should help her posture as well as pain and functioning for a better quality of life for the long run.  That unbalanced gravitational force is what also can cause scoliosis to progress more rapidly in later years, as the discs and facets break down, and the “moment arm” or lateral force becomes stronger.  That’s why they had to fix the Leaning Tower of Pisa before that unbalanced loading would have caused the 500+ year old tower to come crashing down to the ground if it had gone beyond the critical few degree threshold.

Patients who have kyphosis also have trouble with neck pain.
Years ago I saw a 50 woman from Chicago who had a normal neck MRI with severe neck pain.
It turned out that she also had a 90 degree thoracic kyphosis, which meant that she had to hyperextend her neck all the time in order to just look straight ahead.
I fixed her kyphosis, and her neck pain went away!  
She also told me that she no longer looked like a “Turtle” --- a posture she never liked since she was a teenager.
Here’s web link to her interview with me after surgery:   http://web.mac.com/drhey/iWeb/Dr%20Hey%27s%20Blog/Podcast/E6422EF7-7EC5-45C3-9C46-C51722F4425F.html

TwistedSister — strong work on the quiz.  Sorry to hear you had to learn it through your own painful experience.  If you send in a web request with your correct email through heyclinic.com, Tiffany in my office will send you out an official Hey Clinic T-Shirt this coming week, in white, or pink (our breast cancer walk color).

Hope you are all having a great weekend.
If you like the clinical puzzles, let me know and I’ll come up with some more.
Gotta get you thinkin’ and learning even more.

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery
http://www.heyclinic.com.

The first Hey Clinic Clinical Puzzle.. 2 matching curves.

Earlier today, I saw this woman who drove up from Alabama to see us for a
second opinion for her severe scoliosis with large trunk shift.
Surprisingly, her pain is primarily in her neck.

Question: Why is she having neck pain, when her obvious problem is in her
thoroaculumbar spine?

I welcome suggested answers via comments.
First correct answer wins a Hey Clinic T-Shirt!

Other notes this week that are interesting:

Yesterday, I saw a 12 yo girl with a 33.5 degree thoracolumbar scoliosis.
She has occasional low back pain, but it is not limiting. Her folks
initially came up to see me from Florida for another opinion. They now live
in far western North Carolina. Since her curve has been stable since last
visit a few months ago, we all decided to wait on surgery. She still has
some growth remaining, as documented with her iliac wing growth plate
carilaginous edge.

Later in the day, I saw a 19 yo young lady, who had the exact same curve
pattern, and exact same 33.5 degree curve. However, she had a larger trunk
shift to the side, and is having significant back pain throughout the day at
college. It is also starting to greatly affect her posture and standing
appearance. She was braced for quite a while during her younger teenage
years, which she did NOT like! Even though her curve is under the 40 degree
measure where surgery is considered, her quality of life at this point is
unacceptable and getting worse.

The main point of this comparison is to show the importance of taking more
than just the curve measurement into consideration ---- age, symptoms,
progression, and other factors should be taken into consideration. We need
to be careful to take care of the "whole person", not just the Cobb angle of
the scoliosis curve.

Have a great rest of your week!

Dr. Lloyd Hey
Hey Clinic

Erik comes back to see us from Kentucky after Flat Back Syndrome Surgery at Hey Clinic

During Friday’s clinic, we saw Ekic and his family who drove seven hours (341 miles) from his home in Richmond Kentucky to come back to see us for his one year postop visit.
Erik had a previous scoliosis fusion done years ago, and has had difficulties with flat back syndrome for many years with severe deformity and pain.
You can see his previous blog entries here:
Surgery Sept 15 2009: http://drlloydhey.blogspot.com/2009/09/36-yo-gentleman-from-kentucky-sp.html
Postop Day 1 Sep 15 2009: http://drlloydhey.blogspot.com/2009/09/back-to-my-old-self-standing-3-inches.html
7.5 months postop: http://drlloydhey.blogspot.com/2010/05/fw-eric-37-yo-gentleman-w-flatback-flat.html

In this Blog, 38 yo Eri and his family share their thanks to Hey Clinic and Duke Raleigh Hospital Staff, for his new posture and new life off narcotics and enjoying family again.

Great to see you Erik, and thanks for making the trip to come back and see us!
Take care,

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery

"Do you think that laminectomy might have affected my scoliosis?

I think I need to hire a scribe to follow me around all day, to help me capture all of the interesting stories our guests share with us, and what we learn from serving them each day.  The past couple weeks have been filled with lots of great people visiting us from all over.

The woman pictured here was diagnosed with scoliosis as a teenager, but it was considered mild.
She did fine for many years, but about 8 years ago had a minimally invasive microdiscectomy and laminotomy done for a pinched nerve in her lumbar spine.
Soon after that, her posture began to lean to the right and forward, and she developed severe progressive pain and deformity.

Now she walks with quite a limp, and has quite a lean to the right and is quite kyphotic.
Her X-Rays show a severe collapsing double curve kyphoscoliosis and MRI shows severe spinal stenosis in lumbar region.
We can help her with a thoracolumbar sacral iliac wing instrumentation and fusion, with laminectomies and osteotomies, since her quality of life is bad, and getting worse each week.

Early detection and life long follow-up for scoliosis and kyphosis, as well as caution especially when considering laminectomy only in face of deformity are all  helpful suggestions to help prevent severe curve progression and more complex reconstructions, and also prevent lost quality of life days!

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

Hey Clinic on Breast cancer walk !!!

Over the past several months, Shelbi and others in our office have been
organizing fund-raising and awareness for breast cancer research. We even
created a pink version of our Hey Clinic T-Shirt that we have been giving
out to our guests who made a donation for the American Cancer Society -
"Making Strides Against Breast Cancer" Walk October 1st.

Our Hey Clinic team helped raise over $1,100 for the charity with the help
of many of our Hey Clinic guests who have visited us. THANK YOU SO MUCH TO
EVERYONE WHO HELPED OUT WITH THIS EFFORT. Your donations have been given to
American Cancer Society, and Shelbi, Jimmy and Sue are pictured here for the
actual "Making Strides" Walk held at North Hills, in Raleigh NC. Many
thanks also to the Hey Clinic associates who made this happen.

Most of our families, including my own, have been touched by cancer,
especially breast cancer. Learn more about the event at :

http://sacancernews.org/2010/10/making-strides-against-breast-cancer%C2%AE-e
vent-to-draw-thousands-to-walk-at-north-hills-raleigh-nc/

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery
Raleigh, NC
http://www.heyclinic.com