Zachary goes home, sitting up straight!

Zachary is a 9 yo boy who had surgery six days ago at WakeMed in Raleigh NC for severe kyphosis, secondary to brain injury due to “shaken baby syndrome”.  He actually sustained a couple of thoracic fractures at that time, and with his severe brain injury, has gradually slumped forward into severe kyphosis with growth.  His thoracic kyphosis was around 90 degrees preop.
Last Wednesday, I performed a T1-L3 Instrumentation and fusion with multiple osteotomies.
He did well with surgery, and did very well up on the WakeMed PICU for one night, and a few nights on the regular pediatric floor.
Zachary’s new posture is quite evident, and even meant that Zach needed to get used to swallowing his own saliva, which used to just run out of the front of his mouth, since his head hung down so low.
He definitely sits up much better in his chair as well.
We delayed his discharge back to the children’s rehab where he lives a bit since they were having a bit of a flu epidemic.
Thanks to all the caring nurses and doctors and others who helped Zachary this past week!

Dr. Lloyd Hey
http://www.heyclinic.com

Sylvia, who suffered with severe kyphoscoliosis shares her story and pictures after recent reconstructive surgery with Dr. Hey

We saw Sylvia from New Bern NC at Hey Clinic on Friday, who was looking great after her recent kyphoscoliosis surgery. She shares her story in this short video clip from clinic, along with photos of herself before surgery.

You look great Sylvia!
Dr. Lloyd Hey
http://www.heyclinic.com

Tracy's Talk On Compassion @ Hey Clinic Weekly Quality Meeting Thu Nov 8 2007

Tracy, one of our Hey Clinic associates,  shared with us this week in our weekly Quality Conference, on the meaning of “Compassion”, one of our Core Values.
Thanks for sharing from the heart, Tracy!
Dr. Lloyd Hey
http://www.HeyClinic.com


COMPASSION
 
Compassion by definition is a feeling of deep sympathy and sorrow for another who is stricken by misfortune, accompanied by a strong desire to alleviate the suffering. Not to be confused with empathy, as being compassionate towards another takes it one step further – coming up with a solution to help that person.  Compassion is often characterized through actions.  These acts generally take into consideration the pain of others and attempt to alleviate the pain or fix the problem.  (such as with surgery, medications, or to just lend a helping hand, etc). Often people have a lack of compassion if their own pain albeit mental or physical is so great that they can not recognize the pain of others.  In the healthcare industry, compassion for others is key.  It’s the name of the game.  Whether it be for a patient who is suffering or a coworker who is struggling with an issue, compassion is imperative.  If we stop thinking negatively about someone, we can have a clearer view of the good qualities in that person.  Being negative only hurts you on the inside. Negativity, anger, gossip, etc. causes one to feel shame at the end of the day rather than leaving you with a rewarding feeling.  We should remember that we may not know anything about the circumstances in a person’s life or what that person might be struggling with.  While compassion with our patients and coworkers is important, we all must remember to have self-compassion as well. Knowing that you work hard and give it all you’ve got on a daily basis will give you the confidence you need to help someone else.  You must believe in yourself.  You will not be perfect always.  The flesh is weak and we all fail at times; but being too hard on yourself will trickle into all areas of your life and others’ lives.  I recommend a book titled, “Don’t Die On My Shift” written by William Sayers.  It is a true story of a patient with polio and was in an iron lung (respirator) for 13 years.  His only view of the world was from a mirror on the iron lung.  He describes being in excruciating pain and asking a nurse for water.  The nurse kept walking by, saying, “I’m not your nurse.”  We often must remember that although our patients, coworkers, and even our own self may seem “crazy” at times, we are all God’s creatures and should be treated as such.  Always keep in mind that you are everyone’s “nurse”, even your own. You may make the difference between unhappiness and true happiness for someone.    

Hey Clinic Surgery Wed Nov 7 2007 @ Wakemed: 9 yo Zachary w/ 90 degree kyphoscoliosis gets straightened up.

A few weeks back I had a Blog entry regarding Zachary, a wonderful 9 yo boy, who was the victim of “Shaken Baby Syndrome” as an infant, with severe brain injury and subsequent severe motor and other deficits.
He had a couple of thoracic fractures at that time, and has developed a huge kyphoscoliosis to the point where he cannot sit in his wheelchair, and is experiencing significant pain, and cannot be braced.
Today, we did posterior reconstructive surgery using pediatric pedicle screw instrumentation from T1-L3.
Zachary did just great.  Estimated total blood loss was 400 cc.  He received one pint of blood, and 123 cc of cell saver and had a postoperative hemoglobin of 12.
His curve was very stiff, not correcting significantly when he was prone.
Extra care was needed to position him, given his severe kyphosis.
I performed 4 posterior thoracic osteotomies to try to free up the spinal mobility to aid in the correction of the deformity.
The spinal correction was performed in a step-wise fashion, starting at the top and then working my way down the spine, attaching the rods to the screws on each side, while gently pressing down on the rods like a lever.
Intra-operative radiograph as well as postoperative physical examination shows excellent correction of his kyphoscoliosis.
Zachary was extubated immediately after surgery, and is doing well tonight in the WakeMed Pediatric Intensive Care Unit (PICU)

Many thanks to the wonderful team who helped out today in OR 9 at WakeMed Raleigh, which included:  Katherine who assisted me as FNA, Yan Yan and Sheila as scrub techs, Vondella and Angela who helped out as nurse circulators, Martin and Melissa who were our CRNA and SRNA, and Dr. Jeremy who was our anesthesiologist.

Lloyd A.  Hey, MD MS
http://www.heyclinic.com
Hey Clinic for Scoliosis and Spine Surgery
Raleigh, NC USA

Hey Clinic Surgery Nov 1: Carolyn's Anterior/Posterior Reconstruction for pseudarthrosis and "Flat Back Syndrome"

Carolyn is a delightful 64 yo woman from Georgia who had an L3-S1 posterior instrumentation and fusion performed elsewhere, who suffers with flat back syndrome, with low back pain and trouble walking.
Her X-Rays and CT scan suggest possible pseudarthrosis at the L5S1 level, where she also has an anterior spondylolisthesis.  Her lumbar lordosis preop measures 40 degrees.
This past Thursday, we performed an anterior L5S1 disc removal and fusion using an “ALIF” interbody titanium spacer, followed by a posterior removal of old instrumentation with removal of old hardware, and revision L2-S1-Iliac wing instrumentation and fusion with decompressive laminectomies at L2 and L5 where she had stenosis.  Her S1 sacral screws were both very loose, and were removed and replaced, along with the remaining hardware.   I performed a posterior osteotomy at L2 and L5 to help improve lordosis as well as the placement of the anterior cage at L5S1 which helped to “jack up” that disc level anteriorly.

Her surgery went very smoothly, and was all completed on one day, but in two stages, with the anterior procedure performed first.  Total surgical time was approximately 5 hours.
Intra-operative radiographs showed her lumbar lordosis improved to 58 degrees, from 40 degrees preop, and you could actually see a noticable improvement in her lower back contour at the end of surgery.
Postoperatively, she has done very well, and stood up for first time yesterday, and stood up perfectly straight!
Her preoperative posture problem was really the result of the “toggling” of screws at S1, causing pain which caused her to pitch forward, on top of a fairly low fixed lumbar lordosis as well, and the spinal stenosis that also causes people to want to pitch forward away from the nerve pinch.

All three of these issues were addressed with our reconstructive surgery.


She will spend the weekend with us at Duke Raleigh Hospital getting physical and occupational therapy twice a day, while her very supportive husband gets to stay with her in the large “suite” rooms, which have 2 full beds for patient, as well as family member.  She will likely get discharged Monday, and possibly stay around in Raleigh for a couple days before heading home to Georgia.

Correcting flat back syndrome is one of the most rewarding things we do with Hey Clinic.  Allowing someone to stand up straight again not only affects their appearance and self-image, but has a great effect on quality of life in terms of standing and walking distance, pain, and endurance.  Pain can sometimes even be caused up in the neck region with flat back syndrome, since the neck has to hyperextend in order for person to look where they are going, which strains the neck, aggravating existing neck arthritis and neural impingement.

Lloyd A. Hey, MD MS
Hey Clinic for Scoliosis and Spine Surgery
http://www.heyclinic.com