Thursday, July 28, 2011

Awesome sunset picking up ice cream.

Two bi scoli surgeries today which went real well. Second was actually kyphosis and thoracic fracture case w compression of spinal cord. Went well and family very thankful. He was bent way over an could barely walk.

After seeing Mia Postop w her mom, our 13 Yo scoliosis surgery from this morning, I headed home, had nice dinner and then went out to pick up ice cream.

The North Carolina sunset sky is an amazon pink. Driving through the countryside is magical at this hour --- out to Maple View Farms, which is dairy farm that serves awesome ice cream. Great place to go after a long day in operating room 12 --- from focusing on an area about 3 inches in diameter face down for 8 hrs (2 surgeries) to head up looking at a huge blue and pink sky ----- what a joy!

13 Yo girl w 40 degree Thoracolumbar adolescent idiopathic scoliosis fixed this am

T10-L3 instrumentation and fusion
Ebl: 350 cc
Blood transfused: none
Complications: none
Surgical time 2 hr 30 min

Very happy with correction.
Was able to spare her the longer fusion with less levels since thoracic curve was small enough and flexible enough --- good motivation to fix earlier!

We fixed a 24 Yo w scoliosis last week from Asheville nc area today, which I about 5 hours away, in the beautiful north Carolina mountains, west of Charlotte, Nc. I was there last weekend doing rock climbing at Chimney Rock w my daughter. Amazing experience!!!

Monday, July 25, 2011

Maggie and Me in Clinic on Friday!

I saw Maggie back for follow-up in clinic with her family on Friday.  She’s a few weeks postop from the Shilla Procedure for her complex early onset scoliosis, which also included an anterior 4 segment fusion.  She was only 45 lbs when we did her surgery, and had quite a bit of growing remaining.  The Shilla Procedure allows her spine to grow along the rods through pedicle screws at the top and bottom of her scoliosis construct, guiding the path for her growth.  It does not require the routine revision surgeries for adjustments which are needed for the growing rod technique.  Dr. Richard McCarthy was kind enough to teach me this technique with one of my patients, Janelle, who had surgery back in December.

She greeted me with a big smile and a big hug, and gave me a wonderful “Thank You” card she made herself.  On the back of the card she said “My back feels so much better!”

She then showed us how she could run down the hall.

What an awesome day.

Thanks for the great card, Maggie.  I will treasure it always.

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery

Sunday, July 24, 2011

Teenage Carson, looking great after kyphosis surgery, shares a portion of her first book!

Clinic was great on Friday, seeing many families back for follow-up and a few new families.
I always like to ask my younger guests who are high school or younger “what do you want to be when you grow up”?
Over the years I’ve gotten all sorts of answers to that question.  Some of my younger guests who have been through scoliosis or kyphosis surgery share that their experience as a patient influence them to pursue a healthcare career.  That’s pretty cool, because that is how I got interested in serving as a surgeon from my experience as a patient as a teenager.

When I asked Carson that question in clinic on Friday, she told me that she wanted to be “a writer or a lawyer”
She then told me that she just finished writing her first book!  It is about assissins!

She gave me permission to share a chapter for you to check it out.  It is being reviewed by publishers now.

Hope you enjoy it.  Wow, Carson, you are a very gifted writer!!!! Thanks for sharing this.

Dr. Lloyd Hey
Hey Clinic

Chapter 1: Seventeen Months Before

“The target’s arrived at the extraction point.” Ryan said, watching the girl get out of the car from behind the thick, burgundy curtain of the window. Her blond hair was whipping in the wind, a scowl still engraved on her face from earlier that day. A lazy smile crossed Ryan’s face. She was arguing with her mother about something as she slung a heavy-looking backpack over her shoulder. Homework she’d never turn in.

“You are ready, I presume?” The man on the other end of the line said icily.

“Of course.” Ryan said, striving to keep the irritation at being asked from his voice. “We’ve been ready for the past three days.”

“I should hope so.” The other man said in a voice like the Arctic wind, cold and cutting. “What of the brother?” A shadow slid over Ryan’s face. Yes, there was a problem indeed. He always hated pleading excuses, but sometimes they were necessary.

“He’s coming over at six.” Ryan reported. There was a silence on the phone for the space of a few heartbeats.

“Proceed with the extraction before he gets there, then.” The other man ordered.

“We could wait until tomorrow. It would give us a little more time to get away.” Ryan suggested lazily. The girl had gone inside the house, slamming the door behind her. There was another silence, this one lasting for several seconds as the other man considered this option.

“No.” He said at last, his voice decisive. “Your transportation is already scheduled. It would take far too long to find another way for you to get out of the country. Extract the target before the brother gets there, Ryan.”

“And collateral damage?” Ryan said, refusing to feel slighted. The man laughed.

“You know how we feel about that. No delays, Ryan.” The other end of the line went dead, and Ryan sighed.

“Yes, sir.” He muttered to empty air, rolling his eyes and slipping the phone back into his pocket. “Oi, Dom!” He called, wandering back into the kitchen and away from the window. His partner was at the table cleaning a Glock 17, his large hands capably handling the gun’s disassembled components.

“What?” He asked irritably, not turning away from the gleaming black pistol. Ryan grinned at him.

“The place is clean, yes?” He asked.

“Completely. No fingerprints, too little DNA for anybody to run tests, and absolutely no ID left laying around, as per instructions. Has been for the last three days. Why?” Ryan grinned again.

“We move. In two hours.” Dom did look up then, a small worry spot creased between his brown eyes.

“At five? What about the brother? Did you tell him about the brother?” Ryan tapped the phone barely showing in his jeans’ pocket meaningfully.

“Apparently, we can’t afford a delay.” Dom sighed, and Ryan quickly added, “But the parents are still ours. Think you can take them out in ten minutes?”Dom rolled his eyes, turning back to his pistol.

“Could do it in five,” He boasted. Knowing him, Ryan didn’t doubt it for a second. “The sooner we get this done, the sooner we get paid and go home. Six months on stakeout is far too long to be away.”

“Well, we’ll be back soon.” Ryan said comfortably, stretching against the doorframe. Dom grinned, his teeth a white flash against his dark skin.

“I can’t wait.”

*            *            *            *            *            *            *            *            *            *            *            *

Sam dialed his parents’ house number and waited patiently for someone to pick up the phone. He had time to wait: the drive from Virginia to Raleigh, North Carolina was long by anyone’s standards, especially for a frequent commute. A familiar young female voice came on the line. “Sam?” His name had just the barest hint of a question hanging on it.

“Hey, Jamie.” Sam said. “How’d you know it was me?”

His sister laughed. “Caller ID ratted you out again.” She informed him. “Wanna talk to Mom?”

“No, you’ll do.” He teased.  “What are you guys doing?”

“I’m busy lying in wait for you.” Jamie said. “Mom’s making a casserole, and Dad’s in the kitchen with her, giving her advice. I give him three minutes to live.” Sam laughed. Their father and mother couldn’t stand to share the kitchen with the other.  

“How’s school?” Sam asked. It had begun to rain, the windshield quickly becoming freckled with water droplets. Sam flicked on his windshield wipers, but their steady thud didn’t hide the small sigh Jamie gave.

“It’s fine.” She sighed. Sam frowned. He didn’t have to watch her facial expressions to know she was lying.

“Are you okay? And be serious this time, Jamie.”

“My calculus homework’s murdering me.” She said casually. “I think they bumped me up a level too high this time.” Sam frowned. He doubted that his sister’s problem was with her homework. She had skipped first, third, and fifth grade and was, at his parent’s last report, excelling with almost all AP-level classes. She was following in his footsteps, alright, and Sam definitely recalling his footsteps leading him into a horde of boys with something to prove.

“It’ll do you good to struggle with math with the rest of the mortals for a year.” He told her, resolving to get more information about the way Jamie was dealing with school from a more reliable source, also known as his mother.

“I’ll just finish it when you get here and can help me.” Jamie said. “Speaking of which, Mom wants me to ask you your ETA. Something about keeping dinner hot.” Her tone wasn’t accusatory, but Sam winced anyway.

“Maybe thirty minutes.” He calculated quickly, accelerating slightly so his estimate would only be short five minutes. He heard the muffled sounds of Jamie relaying the message through the phone, and his fingers tightened on the steering wheel as he stared at the road through the now-pouring rain. He hadn’t seen his family for close to four months now. Jamie returned to the phone, dragging him back to their conversation and away from his melancholy thoughts.

“Where were we?” she said happily. “Oh, wait, calculus. Change of subject, please. How’s the FBI? Is catching criminals hard? Is your boss a sadist?” Sam smiled faintly at his sister’s eager questions, her speech accelerating as she thought of more.

“You know, I think I should wait until I’m face-to-face with you to have this conversation. Security and all that.”  It was fun to make her wait. Knowing Jamie, she’d be about to explode.

“Loser.” Jamie said absently. “Could you hold that thought? Somebody rang the doorbell, and Mom’s busy with the casserole right now.” Sam felt an irrational twinge of foreboding.

“Jamie, Dad is home, right?” Jamie laughed.

“Don’t worry, brother dear. Both of our darling parents are here, courtesy of your homecoming. Ugh, Dad really needs to fix this deadbolt. It sticks- every- time-” Sam rolled his eyes as he listened to the sounds of Jamie struggling with the door.

“Remember, you push in, and then you turn it.” He reminded her patiently. It didn’t matter that he didn’t actually live with his parents anymore. Sam was the type of person who remembered details with an irritating and unfailing accuracy.

“Got it!” she crowed. “Knew it was just a matter of-” Her voice disappeared, followed by the loud clatter that meant she had dropped the phone. Sam pushed down that twinge of unease again. She had dropped the phone before this, and would probably do so again.

“Jamie?” He said patiently, just before a desperate shriek came over the phone.

“Sam, call 911! Call them no-” The cell phone went dead in Sam’s hand.

“Jamie!” Sam shouted into the useless phone. He pulled it away from his ear long enough to jab three numbers in as his mind worked with cool efficiency. His sister would have been standing right inside the door… And Sam felt the cold slickness of fear sliding over him, the awful certainty that something had gone terribly awry.

“911, what’s your emergency?” answered a cool female voice after what seemed like ages. Sam spat his parents’ address into the phone, then hung up. He revved the engine of his Dodge Charger as he pushed it to a speed far over the limit. It was one of the models of car used by the NC Highway Patrol. It could handle it.

He only prayed that he wouldn’t be too late.

*            *            *            *            *            *            *            *            *            *            *            *

Ryan waited patiently on the front porch, the brisk November wind ruffling his cropped hair and tugging at Dom’s jacket. He breathed in deeply as he depressed the doorbell, sending oxygen to every cell in his body in preparation of the coming extraction. Not that he expected much of a challenge from either the target or her parents. No, it was the brother Ryan was concerned about. If this took too long, he might manage to arrive before they were clear, and they certainly didn’t have time for a firefight. The deaths of two Vitas agents were already laid at the man’s doorstep, after all.

The girl opened the door, a portable house phone held to her ear with one hand. Ryan swore silently at this unexpected complication and fired the dart gun in his hand as Dom snatched the phone away from her. Dom tossed the phone down onto the porch and darted past the girl into the house, his freshly-cleaned gun already in his hand. The girl recovered quickly, given her age and the sedatives that were being pumped into her by the dart residing in her carotid artery.

“Sam, call 911!” She screamed. “Call them now!” Ryan smiled as he stomped on the fallen phone, crushing it, before stepping towards her and closing the door behind him. She tried to run, much to Ryan’s amusement. He grabbed her wrists in a blur of speed as the muffled blasts of a silenced gun ensued from the room Dom had disappeared into. The kitchen, if Ryan recalled correctly.

The girl twisted her wrists, sinking her all of her nails into the tender flesh near Ryan’s veins with enough force to draw blood. He swore with pain, not bothering to stay silent now that he knew the parents were taken care of. The sedatives weren’t working as well as he’d hoped: he’d have to use the syringe on her soon. She tried to kick him, and Ryan lost his remaining patience.

“Dom!” He yelled. His partner reappeared, a smile easing over his face. At the sight of him, the girl redoubled her clawing. Strange, Ryan mused distantly. She hasn’t screamed once since I grabbed her. Dom caught the girl’s wrists easily enough as Ryan shoved her towards him.

“You can’t even knock out one kid?” Dom muttered, spinning the girl around so she was facing him, her back to Ryan. Ryan ignored his jibe, retrieving a leather case from his pocket and pulling a hypodermic needle out of it. He slid it into her carotid artery with the ease of long practice. She yelped in pain, shuddering as the cold tranquilizers poured into her blood. Her frantic struggles were already slowing. Ryan withdrew the needle, slipping it back into its case and pocketing it before motioning for Dom to release the girl. He did so, and she fell forwards, doing nothing to cushion her fall. Dom laughed as Ryan scooped her up in his arms.

“Lights out.” He said, his dark eyes dancing merrily. “And with seven minutes to spare, too.”

*            *            *            *            *            *            *            *            *            *            *            *

It was pouring when Sam pulled up to his parents’ house and saw the flashing lights of several squad cars. The police had beaten him there. He jumped out of his car, running to the house.

A policeman grabbed him before he entered, stopping him. Sam tried to push past him, and the officer frowned. “Sir-”

“My family’s in there.” Sam snapped. “Are they okay?” The man’s face tightened, and he looked away. Sam’s stomach dropped. “No.” he whispered. “Please, what about my sister?”

“There was a girl?” The officer said, surprised. “I’m sorry, sir. We haven’t found her yet. Were you the one who placed the 911 call?” Sam nodded, feeling numb as he stared through the rain at the house. Jamie… “Sir, could you answer a few questions for me?”

They still hadn’t found her seven hours later when they had finished processing the crime scene and put out an APB. Sam was sitting on the porch steps when the officer who had stopped him first approached.

“Maybe she got away.” The officer said, sounding like he didn’t believe his own consolations. Sam laughed harshly. He was in the FBI. It was possible, but only just. And Jamie would’ve been standing right in front of whoever killed his parents. The man paused, hesitant. “Mr. Silven, I need you to come and identify your parents’ bodies.” Sam sighed and got up. It was procedure, nothing more and nothing less. He loathed procedure right now.

Jamie was gone. And there was nothing he could do about it.

Monday, July 18, 2011

14 Yo young man with Thoracolumbar scoliosis and 2 inch apparent leg length discrepancy fixed today

Got back from Wyoming last night. Awesome trip. Everyone al LE should Hime the Grand Tetons! Close to heaven.

This morning I met w evan and his parents in PReop. Dad asked how often I round (twice a day) and what I actually do on rounds with my PA's: check motor ab sensory exam, incision, pain level, physical And occupational therapy progress, vital signs and labs.

He also told me that his while Sunday school class was praying for me and our whole surgical team. This reminded and humbled me as I left the PReop room that I am just a small part of a caring network that stretches far and wide.

Evan's surgery went great.
PReop, he was really "caddy-wompus" with a HUGE apparent leg length discrepancy o one to two inches. I measured his legs, and they were actually equal. the pelvis was jus compensating for this huge curve.

Evan is growing like a weed, with wide open growth plates. His curve has progressed 21 degrees in just one year to 43 degrees and he has a ton o growth remaining.

Since we caught It early, his curve was more flexible. We got an awesome correction, and was able to keep fusion Shorter, down to L3 as opposed to L4 by working hard do derotate that lumbar segment, and osteotomizing the lower segments to free them up for better correction. This is great news for Evan, since he will have 3 movable discs at bottom as opposed to 2.

Great to be back to the Hey Clinic and Duke Raleigh Hospital team.

Saturday, July 16, 2011

Hidden Falls. Awesome

Inspiration Point, Jenny Lake. Grand Teton National Park

Just beautiful scene from creation!
Great place to recharge batteries and breathe in the cool dry air.

Wednesday, July 13, 2011

Moose in Wyoming!!

Had a good 2 days in surgery and Tuesday, including complex congenital scoliosis in 17 Yo young man.

Now enjoying some family time out in Jackson Hole Wyoming. Sun is setting right now over this huge rushing stream. You can see a huge moose in the background. The mountains are beautiful and air is clear and cool!!

Tuesday, July 12, 2011

Mike Tells Us Of Amazing SCUBA Trip Truk Lagoon, Pacific: "That's me in all the photos, and I would have never gotten there if not for y'all - Peace! "

The following are actual pictures of MIKE HIMSELF SCUBA diving at Truk Lagoon!

Photo credit goes to: Wayne Sumrell (Mike's dive buddy) and Robert Purifoy (Owner of Olympus Dive Center, Morehead City)

Mike’s radiant smile made my day on Friday when I opened up the exam room door, and he began to tell me of his amazing, once in a lifetime experience traveling half way around the world (24 hour plane trip!) to SCUBA dive in Truk Lagoon in Micronesia (also known as “Chuuk”. Check out Google Maps: this place is on the other side of the planet in the Pacific Ocean!

Mike had been hoping and planning to do this trip dating all the way back to 2009. However, he had progressive thoracic myelopathy, with a progressive kyphosis above an old spinal fusion. He was having clumsiness in both legs and trouble walking, and his posture was becoming increasingly pitched forward and painful. In August 2010, I performed a posterior thoracic laminectomy decompression and extension fusion with osteotomies to correct his kyphosis. This problem is called “PJK” -- proximal junctional kyphosis — and is a complication that can happen after spinal fusions, especially longer fusions. The reason for this problem is that there are higher loads at this junction point wear old fusion ends and unfused spine begins.

The Truk Lagoon Trip then became a MAJOR incentive to get through the surgery and rehab (as he says, "third only to God and family).

His evoked potential monitoring at beginning of surgery showed that his signals were not good going through the cord. By end of surgery, they had improved dramatically . Since then, he has made a wonderful recovery, and can now walk normally with normal posture and strength.

Mike is an incredibly active guy, and goes SCUBA diving often. However, before his recent spinal reconstruction surgery, his quality of life was unacceptable, and getting worse. For each of our guests, their goals for an acceptable quality of life are different --- for Mike it CLEARLY involved being able to travel and put on a big SCUBA tank and jump into the water without being in agony!

I did some additional reading on Truk Lagoon, and I think I want to go as well! From Wikipedia I learned that Truk Lagoon is in the central Pacific in Micronesia. It has 11 Islands, and has an unusually sheltered body of water in between the islands. Here’s a quote from Wikipedia as they describe the marine environment:

“In 1969, French oceanographer Jacques Cousteau and his team explored Truk Lagoon. Following Cousteau's 1971 television documentary about the lagoon and its ghostly remains, the place became a scuba diving paradise, drawing wreck diving enthusiasts from around the world to see its numerous, virtually intact sunken ships. The shipwrecks and remains are sometimes referred to as the "Ghost Fleet of Truk Lagoon". Scattered mainly around the Dublon, Eten, Fefan and Uman islands within the Truk group, a number of the shipwrecks lie in crystal clear waters less than fifteen meters below the surface. In waters devoid of normal ocean currents, divers can easily swim across decks littered with gas masks and depth charges and below deck can be found numerous human remains. In the massive ships' holds are row upon row of fighter aircraft, tanks, bulldozers, railroad cars, motorcycles, torpedoes, mines, bombs, boxes of munitions, radios, plus thousands of other weapons, spare parts, and other artifacts. Of special interest is the wreck of the submarine I-169 Shinohara which was lost when diving to avoid the bombing. The sub had been part of the attack on Pearl Harbor. The coral encrusted wrecks attract a diverse array of marine life, including manta-rays, turtles, sharks and corals. In 2007, 266 species of reef fish were recorded by an Earthwatch team and in 2006 the rare coral Acropora pichoni was identified.”

Mike emailed me this weekend with a bunch of the photos, which were truly awesome. He also gave his permission for us to share these photos and story with all of you. That’s Mike and I with his X-Ray at Hey Clinic for his one year graduation photo! When I was at college at MIT, I took SCUBA classes, and used to do work diving with my brother Ken to help make money for college and med school. SCUBA diving is definitely an awesome experience. It gives you the sense of flying, and being a part of another world that is beautiful and mysterious. If you’ve never tried it, it is something to definitely consider. Snorkeling can get you part of the way there, but if you get the chance take a dive somewhere. The North Carolina coast actually has excellent dive centers down in Beaufort and Morehead City, which go out to the many wrecks off our coast. Mike specifically has done a ton of diving at the Olympus Dive Center, where Bobby Purifoy works. I’ve done some fun dives now and then, but have NEVER been to a place like Truk Lagoon!

Hearing guest stories like Mike during clinic and via email, and seeing their smile and enthusiasm brings all of us at Hey Clinic great joy and a sense of vicarious pleasure --- this is what QUALITY of LIFE is about! It constantly reminds me how thankful I am for my own recovery from my severe left leg crush injury, which continues me to have an excellent quality of life at work, as well as hiking, biking and working out each day. Out of gratitude to God, and the people who cared for me when I was in trouble, I can continue to “pay back”, by seeking to restore quality of life and better posture to others. What a joy it is for all of us in our Hey Clinic and Duke Raleigh Hospital teams to be a part of this story, and help enable it to happen.

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery

Thursday, July 7, 2011

14 yo adolescent idiopathic scoliosis fixed today

We've been so busy past few weeks w adolescent idiopathic scoliosis and kyphosis surgeries that I haven't had time to blog!

Here's one from this afternoon. Surgical time: 3 hrs.
Ebl: 350.
Blood transfused none.

This am did similar r thoracic adolescent idiopathic scoliosis who did very well w. 2.75 hr surgical time and ebl 200 cc. No blood transfused. Got big hug from mom afterward, and nice handshake from dad!