Wednesday, August 29, 2012

Yesterday's Adolescent Idiopathic Scoliosis Visit, and afternoon 50 yo with same curve!

At Hey Clinic, we treat patients of the entire age spectrum with scoliosis, from young children with congenital and early onset scoliosis, through the adolescent idiopathic period, young and older adult.  Over the years it has been helpful to treat this wide age range, since we get a chance to see the effect of different scoliosis patterns during each phase of life.

Early yesterday morning, I met a very mature young man named Logan and his mom, who were seeing me for a second opinion regarding his 47 degree thoracolumbar scoliosis.  The curve had progressed about 15 degrees in past couple years, but the last 2 X-Rays done more recently showed no significant change.

He was asking me about the potential effect of choosing to just watch the curve in years to come.  He has developed some back pain, but it is not too severe.

I shared with him that the curve could remain stable, but due to the asymmetric loading of his lower lumbar discs, that there was a possibility that the lower curve could collapse, and lead to a painful degenerative scoliosis that could even result in spinal stenosis.  I've seen countless cases of patients in their late 20's, 30's, 40's, 50's, 60's and beyond who were told their curve was "stable" and they were "done growing" as a teenager finishing off treatment for adolescent scoliosis, only to find out a few or many years later that the curve had begun to progress again.  Logan is extremely bright, and seemed to get the long-term choice he faced, given the possibility of realigning his spine now when he is younger, and possibly be able to save the bottom 2 or 3 discs for a lifetime, while also enjoying a better posture.

Yesterday afternoon, after fixing a big double curve scoliosis in a 64 yo woman, I met with a woman named Sherrie in her 50's who was suffering with significant low back pain, and a long history of adolescent idiopathic scoliosis.  Her curve pattern was the same as Logan's, who I had seen that morning, and was also a little less severe than Logan's when she was in her 20's.  At that point, Sherrie only had occasional back pain, and her discs still looked great even with her large trunk shift and 40 degree thoracolumbar curve.

However, now her curve has progressed to 67 degrees, and she has a fairly significant lateral listhesis at L34, which is compounding back and leg pain, contributing to her spinal stenosis.

Logan's adolescent curve could be fixed with a fusion from T5-L3 or L4, sparing the pelvis and the bottom 2 or 3 discs.  Sherrie will require a bigger operation, since all of her lumbar discs are severely degenerative, requiring fusion from T4 or 5 to the pelvis/iliac wing.  Both are fixable, but "a stitch in time can save nine" or more, and the adolescent or younger adult can enjoy many years of improved posture as well as less years of suffering from less optimal quality of life.

Late yesterday evening, I got a nice email from young Logan, who told me he had been prayerfully considering his long-term decision for his spine, and had decided that he wanted to go ahead and get it fixed now, rather than wait.  I think Sherrie, if she had the chance, would tell him from her experience "down the road" that he is making a good choice.

This morning I saw yet another adolescent young lady with a 55 degree newly diagnosed thoracolumbar curve, and this afternoon saw two 18 yo twins with scoliosis --- one of whom had a double curve treated elsewhere with residual 45 degree double curve and very large residual rib hump, for which they were considering thoracoplasty.   The same discussion of long-term consequences of untreated deformity, especially with these lower curves was discussed as these teens seek to make the best long-term choice to preserve their lower lumbar discs, while restoring proper balance and improving posture. 

 My nurse practitioner Brittaney, PA Leslie and I spend quite a bit of time teaching using the X-Rays, and spine models and other references to help families know their options for treatment, with the pro's and cons of each choice.  Families seem to appreciate this extra time and explanation so they can feel peaceful about their long-term choices.

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery
A Southeastern US Center of Excellence for Spinal Deformity for Patients of All Ages

Wednesday, August 22, 2012

15 yo Britney from South Carolina w preop 77 degree adolescent idiopathic scoliosis fixed this am

Britney 15 yo 77 deg scoli did awesome this am. Nice correction. Surgical time 4 h. Ebl 800. No blood transfusion.
Sent to us by Dr. Steve Poletti, excellent spine surgeon in Charleston SC.
Family very happy
Dr. Lloyd Hey --

Monday, August 20, 2012

55 yo w painful 80 degree kyphosis fixed thus am

Surgical time 4 h
Ebl 1300 cc
Complications none
Correction really nice

Time to show family xrays!
Dr. Lloyd Hey --

Sunday, August 19, 2012

Note from little Quinna's parents 3 months postop from her early onset scoliosis surgery

I received an email this past week from Quinna's parents recently that they wanted me to post to the Blog. Quinna's scoliosis is likely the result of Rett's Syndrome.

Thanks Keith and Kaileen for sharing!  We look forward to see you back with more pictures of "Straight Quinna"!


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


Thank You Dr. Hey! At the 3 month post-Op point our little Quinna is sitting straight and looking great! When we look at her today it is hard to imagine that a few short months ago she had an almost-90-degree spinal curve!

We cannot thank you and your team enough for the incredibly thoughtful approach you took to her higher-risk surgery: the pre-surgical feeding/diet regimen, the thorough and re-assuring family consultations, the pre-Op prayer and comfort, even intra-Op updates and the wonderful follow-up care that she received – Quinna and our family simply could not have imagined a more complete, comforting experience.

We know that Special Needs patients such as Quinna can pose all kinds of additional challenges in a major surgical setting; but the careful preparation you prescribed (not only for her, but for us as parents) and expert surgical execution overcame those challenges in a miraculous way. Quinna is now leading a happier, healthier, more comfortable life, and we remain thankful for your efforts every single day.

Thank you Dr. Hey!

Wednesday, August 15, 2012

58 yo woman from Stanley, NC fixed today

Degen scoli w severe pain

Dr. Lloyd Hey --

Katelyn gets sweet correction of her severe AIS scoliosis

EBL 750

Folks will be happy.  Heading out to see them now.

Dr. Lloyd Hey --

An answered prayer from 12 yo girl with scoliosis.

On morning rounds today, I saw our postop woman in her 40's who had the big thoracic scoliosis that we fixed on Monday.  She is doing very well this morning.  She stopped me as I was about to leave and told me the following story:

When she was 12 years old, she knew that she had a fairly severe scoliosis.   She prayed at that time that God would straighten her some day.  She told me that this prayer has now been answered, some 30+ years later.

Our 27 yo young lady from Philadelphia is doing great this morning as well, who had the kyphosis correction yesterday.  She actually looked great even yesterday evening, with her trunk and chest now back in a normal position.  She said she can tell the difference lying in bed as well, with her thoracic hump now removed.  Her significant other actually got decent night sleep next to her on the pull out bed in their private room.  We will get her up today.  She is going to be way taller.

After that, I whizzed over to clinic to see a very nice 14 yo young lady and her mom from near Charlotte, NC.  They were not happy with the evaluation of their daughter's scoliosis and came in for another opinion.  My PA Leslie and I spent a good half hour with both of them.  The patient has a 34 degree thoracolumbar curve which we remeasured, and had significant trunk shift down and to the left creating a bit of a skin crease below her rib cage on right.  Patient has significant growth remaining, with physes open and menses beginning only few months ago.  She has significant back pain, especially carrying heavy book bags, or prolonged sitting.  She has noticeable hump on her left low back.

We took a lot of time to go over best treatment options for her for both the back pain, and her scoliosis.  We talked over the option of scoliosis brace, vs. the thinner light-weight brace to help treat the back pain portion of her problem.  After reviewing all aspects of the purpose of the  scoliosis brace, with the research (it may help decrease chance of scoliosis surgery by skeletal maturity, but does not improve the curve) vs. the commitment of 18 hours per day for several years, the patient and mom opted for follow-up in a few months and not to do the brace.  We spend a lot of extra time to explain the pros and cons of bracing, and try to enable the teenager to think through what they are willing and not willing to do, and also consider the family dynamic.  At the end of the day, the adolescent really has to be willing to wear the brace for the required time period each day, but also know that the brace is not a guarantee that surgery will not be necessary in future, and that it won't make the curve smaller.  I have dealt with some very unhappy patients in their late teens and twenties who ended up needing surgery, who were braced for several years, and thought that their commitment to wearing the brace meant that they would never have to have surgery.  One 21 yo patient I remember, from New Jersey, had a complete meltdown in my clinic over at Duke when I told her that her curve had progressed to over 50 degrees.  She screamed and pounded her fist and told me that it wasn't "fair", and that she was promised that she could choose the brace vs. choosing surgery.  Now she was really upset that she needed both, and would have never worn the brace if she knew that surgery was possibly still on her future.  I think the brace does help in some cases, but there is some "cost", psycho-social development and family dynamic "cost", that in some cases outweighs the possible benefit.  The key thing is to empower the patient and family with the information so THEY make final choice, not me.

Just about to scrub in to help Katelyn, a 13 yo who lives about 3 hrs away who has a 66 degree severe thoracolumbar scoliosis.  She arrived late this morning, so we are getting a late start.   Time to scrub up!  I would definitely prefer to operate on these curves BEFORE they get to 66 degrees, since we are able to get a better correction with less risk and less surgical time.  Hence the importance for careful scoliosis awareness and screening and follow-up --- an area where Hey Clinic seeks to help work with local pediatricians, chiropractors, and family physicians as well as other surgeons in Southeast to ensure that we catch a "stitch in time" to save "nine."

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery

Tuesday, August 14, 2012

27 yo woman from Philadelphia with 80 degree preop Scheuermann's Kyphosis now straight

Just finished Amanda's surgery, and she did great.  She's a 27 yo woman from Philadelphia, PA with painful kyphosis greatly affecting her quality of life for many years.

Her surgery today went great.  T3-L3 instrumentation and fusion.
Estimated Blood Loss:  400 cc.  Cell saver 110 cc.  Blood Transfused: None.
Complications: None.
Correction: really nice.
Surgical time: 3 hrs 20 minutes.

 You can see in the picture above the dramatic difference to her side profile, just before and after surgery, correcting her large kyphosis now down to normal range.  X-Ray before and after shown on the right side.
Had two physical therapy students from Rochester, NY observing today named Kara ant Tony who enjoyed the learning with the Room 12 Team here at Duke Raleigh Hospital.

Time to go talk to the family and see our next patient for surgery this afternoon.

Hope you are all well.

Dr. Lloyd Hey

26 yo young lady from Philadelphia w painful 80 degree kyphosis to be fixed today

This young lady has suffered with severe Scheuermann's Kyphosis since teenage years. Greatly affects quality of life and posture.

Surgery to start shortly.

Dr. Lloyd Hey --

Monday, August 13, 2012

Like Son Like Mother!

This young lady in her 40's has had back pain related to her scoliosis and curve progression as an adult.

I did scoliosis for her teenager a few years ago. Now it's mom's turn to get straight!

Surgery very well. Family wanted me to post this right away for friends and family near and far.

Dr. Lloyd Hey --

Sunday, August 12, 2012

Spine Surgeon On Vacation and Treating Serious Fishermen with Spine Problems!

Well, for the first time in many years, I actually took a two week vacation.  Although the weather was a bit on the rainy side, it was really nice to have some time with family and friends, and get some time outdoors.

The first week, I got a bunch of projects done around the house, cleaning gutters, fixing some drainage problems, and such.  I've always been a "Mr. Fix It", and really still don't mind getting my hands dirty, and getting things fixed up and ship shape.

I also roughed it for a couple of days, hiking a section of the Appalachian Trail out along the Tennessee - North Carolina Border with family, sleeping out under the stars (as well as rain and thunder and lightening!)  Went to an awesome coffee shop called the Coffee Company, in Elizabethton, TN for lunch and late afternoon coffee on return trip.

I bought a new backpack for this trip at REI, and was quite impressed how the newer backpacks really mold themselves to the thoracolumbar spine, and also bear the load well on the iliac wings!!  My friend Jim suggested getting a new air camping mattress -- that helped my back too.  We hiked all over the place, across Roan Mountain and adjoining bald-topped mountains, made up our campsite with fire, and saw awesome sunset.  Did not see any bears!  I did, however, learn that I can actually survive without my phone and pager receiving wireless signal for a couple days!  The peace and quiet was actually quite therapeutic!

This past week, spent quite a bit of time on the ocean, getting together with friends and family, and doing other repair jobs.

I spent some time with an expert fisherman named Bob, who has a problem with his low back with spondylolisthesis and spinal stenosis.  Saw him in my Beaufort NC clinic back in June that we started up, and got him connected with some great conservative therapy including special back brace, NSAID's, core exercise program, etc.  A couple weeks later, he sent me an email with a bunch of pictures showing me how he used this new back brace to help capture the smallest Blue Marlin he had ever seen!  After taking these photos, the marlin was released back into the Gulf Stream.  He said the brace really helped!

Over the last 15 years of practice, I've taken care of a lot of athletic and outdoor enthusiast patients with spinal problems, many of which I have stayed in touch with.... many have memorable stories.

I will never forget "Captain JJ"  -- who I met probably 15 years ago when I was on faculty at Duke, and had a remote clinic in Smithfield, NC.  Captain JJ was from Morehead City, NC, and captained the "Blue Marlin" charter boat out of Morehead.  He had a severe collapsing degenerative scoliosis, and severe spinal stenosis and was getting to the point where he could not only not fish, but could hardly walk across the room due to back pain, leg pain and leg weakness and spinal claudication.

After trying conservative therapy for quite a while including epidural steroids, bracing and the like, he continued to do worse, so I scheduled him for surgical consult back at DUMC.

On that day, I remember my clinic nurse called me and told me that "There were some very large gentleman down here who wanted to speak to me" ----  I arrived downstairs and found Captain JJ in the room with 3 huge guys in front of him, arms crossed --- his son and two crew members.  His son said in firm voice:  "What are you plannin' to do with our Cap'n JJ?"  ... and went back to a grimace along with his well-tanned rough-looking crew buddies.

I explained Captain JJ's spine problem, showing them the spine model, and X-Rays, but they didn't seem to understand.

So I used another analogy:  "What if you went down to the Blue Marlin and found that the flybridge was coming loose due to dry rot, and was collapsing.  Would you go back to sea?

"Of course not", he answered.  "I'd fix it and then go"

"Well, your dad's spine is collapsing, and the nerves are getting pinched in between causing to have pain going down the legs and trouble standing and walking", I replied.

I could see the light bulb go on in all 3 crew members, and they softened their stance, and actually smiled a little.  "Well, let's get Captain JJ fixed up then!"

Captain JJ did very well with his surgery, and was back walking and actually back on the water running charters a few months later.  I actually got to fish with him once, and he took my family all out to lunch, introducing us to the Morehead/Beaufort area, and actually was the first to tell me about the National Seashore including Cape Lookout.  It was great to see him back to life.

A few years later, I cared for owner of another offshore fishing boat named Dave, who is in the flooring business.   He's convinced he banged the heck out of his low back with rough offshore running for fishing tournaments, crashing over waves, lifting heavy ice chests, and lugging equipment.  He had a Grade 1 spondylolisthesis with severe stenosis, and after failing conservative treatment, I helped him with an L45 decompression fusion with instrumentation and L4 laminectomy, removing the hugh ugly arthritic facet joints there are L45 and taking pressure off the compressed nerves.

Dave did great after surgery, and actually took me out for a day to fish the Big Rock Fishing Tournament for a day out of Morehead City.  What an exciting day, and a great introduction to offshore fishing.  The Gulf Stream is truly a magical place -- a dark blue, clear river in the middle of the ocean, filled with sea life including flying fish, dolphin, and countless species of fish.  You feel like you are on another planet.

Well I didn't get out to the gulf stream this past week, but I did get to do some fishing, and caught some Spanish Mackerel which we then had for dinner the same night.  Nothing beats fresh fish.  I also got to take some long walks on the beach, and take a swim, and make some new friends while just enjoying the outdoors while "recharging the batteries."

Now it is almost 9:30 pm, and I've looked over my surgical schedule for the next week or two.... and the vacation is definitely over!  We start off at 7:15 am tomorrow morning with a big adolescent scoliosis, then a revision extension instrumentation and fusion.  There are a bunch of scoliosis surgeries on for the next several weeks, and I am seeing scoliosis and kyphosis consults every day this coming week as well.  I am thankful for my wonderful Hey Clinic staff who have held down the fort while I was away.

It will be good to be back at Duke Raleigh Hospital and Hey Clinic tomorrow.  It's been a good break, but I'm ready to go back and see the team again, and get back to serving in the clinic and operating room again.

Thanks for being patient while I took my break!

Hope you are all well.
Thanks Bob for sharing the Blue Marlin photos and for being a good coach!

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery