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Monday, December 27, 2010

What Would a Caveman Do?

Post provided by Barbara Bergin, MD

In my opinion you’ve got to consider your body from a different perspective than you have been. It’s all about protecting our bodies for a very long life. It’s not about overworking them. It’s not about wearing them out. It’s not about high impact exercise and forcing our bodies to do things they weren’t meant to do.

I can’t say that I’ve stuck to this concept during my lifetime, but I’m asking you to follow my line of thought. I’m asking my kids in particular to listen, because at this time in my life I care more about their future happiness than I do my own. When I was given my children, I was given that Faberge egg; that finest of things I could hold in my hands.

But unlike the Faberge egg, these lovely possessions of mine have a mind of their own. They get to make choices about what they want to do with their minds and their bodies. But I can try my best to give them the tools they need to maintain their shine and value. And I want to share some of that with you, my reader.

Protection of that beautiful packaging you were born with, will be one of the most important things you can do to ensure happiness into and through your “golden years” (if ever there was a description more inappropriately used, it was this one).

There are a couple of important concepts and the sooner you understand these concepts, the more quickly you will come to understand what I’m talking about and the sooner you will start to be able to make your own decisions regarding the way you deal with your body; not only your musculoskeletal system, but your whole body and mind.

So here goes;

1: The human in the form of homo sapiens, has really not evolved in about a hundred thousand years.

2: Our bodies weren’t put together to last much past the age of about 25.

I don’t know how I decided that these two concepts were of key importance in telling you how to protect your bodies from the ravages of age. Maybe it was through reading. Maybe it started in college when I was taking comparative anatomy. Maybe it has to do with my own physical experiences and those of my patients. But as I try to impart my knowledge to you, I will remind you of those concepts and ask you to think about what a caveman would do. What would a caveman do? Maybe that will be our mantra.

Homo sapiens (that’s us), pretty much stopped evolving once we became intelligent. So I can’t sit here and say that we stopped evolving 100,000 years ago, or 125,000 years ago. But whenever we became smart enough to start modifying our environment, we stopped evolving.

Evolution is a process by which the species improves its ability to survive and reproduce. The function and the appearance of the organism changes so that they are better equipped to thrive in a given environment. In the natural world, this is an ongoing process. But once humans began to be able to modify the environment to compensate for our weaknesses, evolution essentially came to a standstill. We are no longer improving and in fact, as a species, we might even be devolving.

Let me give a simple example. Let’s talk about the anterior cruciate ligament. That’s something that’s dear to my heart, not just because I do bunches of operations on folks who have torn their ACLs, but because I have torn mine and I’ve had three other close blood relatives who have torn theirs. That means that my family is pre-disposed to tearing their ACLs and I have likely passed on the crummy ACL gene to my children. And if each of my kids has two kids and their kids have two kids…you do the math, mainly because I can’t.

But no potential spouse is going to count my kids out as a result of some theoretical potential to tear their ACLs or have kids with weak ACLs. However, if we were cavemen and living closer to a time when reproducing adults selected potential mates based on the appearance of vitality, the ability to get food and the ability to care for their offspring in the natural world, then a limping cave girl/boy would be rejected, just like a limping mare will be rejected by the stallion or vice versa. That lameness, no matter what the cause, would be naturally rejected as a potential weakness and over time, the knee ligaments of the human species would have improved rather than worsened, because we humans, as a species, have got to have some of the crummiest pieces of crap for knee ligaments and cartilages in the world of animals.

We learned how to modify our environment to keep from hurting our knees. We learned how to compensate for weak knees by being charming and having more things to entice potential mates other than the strength of our knees and bodies. And finally we learned how to do surgery on knees. As a species, our knee ligaments will NEVER get any better and in fact our predisposition to knee cartilage and ligament injuries will only get worse with the decades as people with bad knees get together and have babies with doubly bad knees!

I really want you to understand this concept because it is essential to understanding the way we are and why we have pain and disease. Hope you followed me and hope you see the correlation to human knee ligaments…and for a lot of things for that matter; like hypertension, diabetes, and a funny shape to the bones of our shoulders which predisposes us to having problems with our rotator cuffs (I’ll talk about that later).

This is an abbreviated verson of Dr. Bergin's Caveman blogs, to read more visit her blog at

Tuesday, December 21, 2010

Little League Parent Syndrome

Post provided by Scott Smith, MD

I love youth sports. The benefits are many: fitness, social skills, competitive outlet, self esteem, life lessons. I have four very active children who I have been blessed to coach over the last 15 years. In fact I am currently coaching my 27th season of youth sports. I love every part of coaching the kids. However one aspect that can be tricky is the parents.

Parents who have unrealistic expectations or exaggerated opinions of their child's abilities can ruin the purpose of youth sports. Isn't PLAYING a sport supposed to be fun? That's always my goal: SAFE and FUN! I want my players to continue to play for many seasons and to establish fitness as one of their lifelong habits. Many children stop playing sports before the age of fourteen. They frequently site harsh words and negative input from parents and other family as the reason for stopping. It is all about perspective. In my opinion sports for the vast majority of participants are a fun outlet to test their physical boundaries and develop self esteem. Continual berating and pushing by parents will diminish the benefits from sports. Asking "did you win?" places importance on winning when that is rarely the kids top goal.

Psychologist have a term for the parent in the crowd that berates coaches, players, parents and officials: Little League Parent Syndrome. These parents are living through their child's athletic performance. They feel their child's needs are greater than all others. Instead of focusing on fun and assisting their child's performance, these parents focus on winning at all cost. This all too frequently results in diminished fun.

Parents need to remember the purpose of sport is not to get a scholarship. It is to have fun, be healthy and develop life skills.

Monday, December 13, 2010

Vitamin D Deficiency Common Among Orthopaedic Surgery Patients

Post provided by American Academy of Orthopaedic Surgeons

New Study Finds Nearly Half of Patients Have Low Vitamin D Levels Authors Recommend Screening, Supplementation to Improve Post-Surgical Healing

Forty-three percent of patients scheduled to undergo orthopaedic surgery have insufficient levels of vitamin D and two out of five of those patients had levels low enough to place them at risk for metabolic bone disease, according to a study published this month in the October 6th issue of the Journal of Bone and Joint Surgery (JBJS).

According to the National Institutes of Health (NIH) , vitamin D helps the body absorb calcium and is essential for bone growth and bone remodeling. Without sufficient vitamin D, bones can become thin, brittle or misshapen. People can obtain vitamin D in three ways:

• by eating certain types of food (including fish, dairy products, eggs and mushrooms);
• receiving sun exposure; and
• taking supplements

All 723 patients in the study had been cleared by a specialist in internal medicine for elective orthopedic surgery. The researchers found that, of the 723 patients studied,

• 411 (57 percent) had normal Vitamin D levels,
• 202 (28 percent) had insufficient levels; and
• 110 (15 percent) were vitamin D deficient.

“We found that nearly half of the patients who were considered ‘healthy’ enough for surgery had significantly low levels of vitamin D, placing them at risk for poor bone healing, osteomalacia (bone and muscle weakness),” said Dr. Lane, who is also a professor of orthopedic surgery at Weill Cornell Medical College in New York. “This was very disconcerting since vitamin D levels can be determined with a simple blood test and low levels can be easily treated with supplements in just a few weeks.”

“Patients who are planning to undergo any orthopaedic procedure can request a screening (specifically, a blood test called the 25 hydroxy Vitamin D test) or ask to be placed on a medically supervised Vitamin D supplement regimen prior to surgery,” said Dr. Lane.

How much Vitamin D is enough? The American Academy of Orthopaedic Surgeons (AAOS) and recent research support that the body needs at least 1000 IU per day for good health — depending on age, weight, and growth. Indeed, many people need much more than 1000 IU to keep Vitamin D levels in a good range.

Thursday, December 9, 2010

Pain Pills- part 5

Post provided by Barbara Bergin, MD

Here’s the story of two fictitious young men. They are not actually my patients, but I see these two scenarios played out over and over in my practice. These are two teens, both of whom tore their anterior cruciate ligaments.

Hank asks for no pain pills following his injury, even though they were offered. He thinks he’ll do fine on Tylenol. Following the MRI, which confirmed the presence of an ACL tear, he wants to make plans for surgery as soon as possible. He’s in high school and knows he’ll probably have to miss a couple of days. He asks if it’s possible to get a handicap parking permit. That way he’ll be able to park a little closer to his school. He asks if the doctor can estimate when he’ll be able to go back to school so he can make arrangements with his teachers. He has his surgery and is encouraged to go ahead and take his pain pills as needed, but after a couple of days he discontinues them and takes Tylenol instead. He doesn’t like the way the pills make him feel and he can’t study while he’s on them. He goes back to classes even before his sutures are out. He quickly regains his muscle strength and range of motion and within a few weeks has stopped using crutches.

After his injury Alex got a bottle of narcotic pain pills from the emergency room. He’s been taking them every 4-6 hours, just like the directions on the bottle. They don’t really work that well anyway. Following the MRI, which confirmed the presence of an ACL tear, he wants to make plans to have surgery. He’s a freshman in college and so he’s going to let his parents know that he’s going to have to take off the rest of the semester and needs a note to take to the registrar’s office. His knee is killing him even before surgery so he figures it’s going to be even worse afterward. He has very little swelling but is having difficulty moving his knee. At the end of the visit he reminds the doctor that he will probably need another prescription for pain pills. He’s not out yet but he doesn’t want to get caught over the weekend without them and so he may as well stock up ahead of time. And he reminds the doctor that the Vicodin is not even touching the pain, so could the doctor make sure he gives him something stronger.

After surgery, he struggles with his rehabilitation. He takes the stronger pain pills every 4-6 hours, like it says on the bottle. He takes them before he goes to physical therapy so that he can tolerate it. He takes two before bed at night, just to be able to sleep. Sometimes he takes another one if he wakes up in the middle of the night. Six weeks after the surgery he is still requesting pain pills weekly and the doctor has to start a program of weaning him off the pills. The doctor gets a call from the pharmacy saying that Alex is also getting pain pills from his primary care physician.

Hank and Alex represent the whole spectrum of responses to pain. Alex isn’t a bad person. He’s not taking illegal drugs. He’s not selling drugs. Hank and Alex just respond differently to pain. But sometimes patients like Alex get into serious trouble taking prescription narcotics without even recognizing that there is a potential problem. Physicians don’t want to see patients suffer. So they’re reluctant to deny the pain pills when the patient is complaining. This can inadvertently lead to a pattern of prescribing narcotics that eventually contributes to addiction. Then drug seeking behaviors develop, which can last a lifetime.

The most important things to remember are:
1) Use narcotic pain pills only when absolutely necessary.

2) Use them sparingly and not necessarily “as directed” on the bottle. It’s not like taking an anti-biotic, which must be taken at regular intervals around the clock in order be effective. Take them less if possible. The prescription dose of a medication that is prescribed “as needed” means that you can take them less if a smaller dose works sufficiently.

3) Have a healthy respect for prescription narcotics. They are not benign medications.

4) Once you’ve transitioned from the narcotic to over-the-counter medications, such as Tylenol or Advil, then get rid of them by following the FDA recommendations on this website:

Tuesday, November 30, 2010

New South Austin office opens Wednesday, December 1st

Texas Orthopedics new South Austin office is located at:

3755 South Capital of Texas Highway, Ste. 160
Austin, TX 78704

The office is conveniently located just east of the Mopac/360 intersection and shares the parking lot with the Barton Creek greenbelt entrance.

This location will replace Texas Orthopedics Westlake office at 5656 Bee Caves Road. In addition to orthopedic care and MRI services, we will offer physical therapy in Suite 150.

Monday, November 29, 2010

Monday, November 22, 2010

Texas Orthopedics Employees Pick a Christmas Charity

Each year Texas Orthopedics employees donate to a local Austin charity during the holidays. This year, we are collecting donations for the Center for Child Protection. The Center for Child Protection is the first stop for children who are suspected victims of abuse and for children who have witnessed a violent crime. An accredited children's advocacy center serving Travis County, children are referred to the Center exclusively by law enforcement and Child Protective Services, and each child is brought to the Center by a caregiver for a recorded interview, forensic medical exam, counseling, and crisis intervention. All services are provided at no charge.

Each Texas Orthopedics office has a piggy bank to collect spare change. At the end of December, we will count the change and purchase items off the Center for Child Protection wish list with the money we have raised. Many of the items needed are safety related items, such as car seats, baby gates, outlet covers and cabinet locks.

Monday, November 15, 2010

Pain Pills- part 4

Post provided by Barbara Bergin, MD

So why do some people use a ton of pain pills and other’s don’t? Umm, it’s complicated.

1) Some people have a low tolerance for pain. It’s that simple and yet it’s that complicated. It’s hard to know whether it’s something psychological or physiological. No one wants to feel pain but everyone is different in their ability to tolerate it. And there is no pain pill out there that is going to keep you from feeling pain altogether, unless it also makes you stop breathing. Right…if you’re not breathing you’re not feeling pain. But there is some level of narcotization which will leave you not caring about the pain.

2) Some people have a high tolerance to the pain pills. That’s another enigma. I can’t explain that one in a few paragraphs. It’s also multi-factorial. Suffice it to say that it’s something genetic or physiological, or metabolic. It’s really not that important to know. The outcome with these folks is not any different than the folks who have no tolerance for pain. They end up needing a lot of pain pills.

3) Some patients get into the habit of taking a lot of pain pills. It just sneaks up on them and on their docs. They have a painful injury or surgery and they get plenty of pain meds when they ask for them. It seems reasonable to the doctor because their patient has a legitimate reason to take pain meds. After an extended period of using them, they just become habituated to their use and then it’s really hard to back down. Many patients have chronic conditions. It’s almost impossible to back down on pain pills in the face of persistent pain or worse; progressively escalating pain. It takes a tremendous amount of patience on the part of the doctor, along with willpower and newfound tolerance for pain on the part of the patient. It’s really one of the hardest problems I deal with.

4) Some patients are sharing their pain meds with friends and family. They’re very good hearted and really hate to see loved ones in discomfort. I’m sorry, but that’s against the law. And it’s probably the reason why some patients use up 40 narcotic pills in two days.

5) Some folks are selling their pain pills. It’s one of the other reasons patients use up 40 pain pills in 2 days. It’s also against the law. These patients get really good at fooling us docs. They’ve got it down to a science and it sometimes takes us awhile to figure it out. They know that and so they just keep doctor shopping, thereby staying under the radar.

The bottom line is that there are huge numbers of patients who begin to abuse prescription pain relievers, muscle relaxers and stimulants. It causes a lot of disability and costs the system a tremendous amount of money.

Wednesday, November 10, 2010

Texas Orthopedics volunteers at Race for the Cure

Texas Orthopedics employees, friends and family passed out water to the Komen Austin Race for the Cure participants Sunday, November 7th!

Monday, November 8, 2010

Pain Pills- part 3

Post provided by Barbara Bergin, MD

So I talked about tapering off pain pills as you feel your need diminish. But what are some other things you can do to decrease your need to take pain pills?
Don’t forget R.I.C.E.: rest, ice, compression and elevation. You’ve used that to help with pain after an injury. Well it works for post-operative pain as well.

Rest: We live in a busy world. We’re always wanting to get somewhere. We’ve got to go, go, go. When I was in college I had a job as a ward clerk in one of the big hospitals in Houston. People stayed in the hospital for weeks after an operation, which nowadays is done as an outpatient case. We don’t have the luxury of trained nurses waiting on us day and night for two weeks after our operation. Most of my patients can’t wait to get back to work, back to play and back to their routines. No one wants to rest. There’s nothing like rest to help us recover from an operation; whether that be resting our whole body or just resting the part on which we had surgery. But you need rest. It’s a crazy concept to take pain pills in order to return to work or to play golf. Stay home a little longer. REST!

Ice: Ice helps slow down the bleeding from the little capillaries in the wound/incision. Bleeding causes swelling and swelling causes pain. Apply ice, lots of ice. You really can’t use too much ice. Just be sure not to let ice bags rest directly on your skin.

Compression: This also helps to control swelling. Applying an ace bandage or thick dressings, when appropriate, helps to control swelling and therefore pain.

Elevation: Elevate the injured extremity as soon and as much as possible. When you allow an injured limb or an extremity which has just had surgery to hang down, it begins to swell. Once that swelling gets out of control, it is really hard to reverse. The more you can elevate the extremity from the get-go, the better.

Many of my patients manage all their pain with R.I.C.E. They might take their pain pills for only a day or two. Think R.I.C.E. instead of pain pill.

Tuesday, November 2, 2010

Pain Pills- part two

Post provided by Barbara Bergin, MD

Last time I mentioned that prescription pain pill abuse was a national health issue. It’s really a difficult problem for doctors and patients. We don’t want any of our patients to get addicted to pain pills, but we also don’t want you to suffer unnecessarily after an injury or surgery. There’s a fine line between relieving the pain and overusing pain pills and it’s different for every patient.

Following a minor operation one patient might not take any pain pills at all, and another patient might take 8 hydrocodones a day for 2 weeks. The second patient might really be suffering from that pain more than the other patient. Their tolerance for pain might be less. But they might also be conditioned to taking lots of pain pills. They might require more because their system is used to taking narcotics. And then, as much as I hate to say it, there is the patient who just wants to get more pain pills. They want to save them for a rainy day. Or they might be sharing them or even selling them to friends and family members. It’s nearly impossible for a physician to know which one they’re prescribing pain pills to. Trust me; we try to figure it out as soon as possible.

But let’s assume you’ve just broken your first bone or you’ve just scheduled your first surgery, and you don’t want to take too many pain pills. But you also don’t want to suffer. How do you know how many pain pills to take, when to take them, and when to stop using them?

The prescription bottle might say to take 1-2 pills every 4-6 hours as needed for pain. At first you will probably take a couple every 4 or 5 hours. Generally speaking, the first couple of days after an injury or surgery are the worst. So after that, start cutting back on the numbers of pills you take. Just take one instead of two. Or start increasing the amount of time you wait before taking your next dose.

You could start taking non-narcotic pain relievers like Tylenol, Aleve or Advil, in between doses, with the plan that eventually you’ll completely switch to the non-narcotic stuff and toss the rest of the pain pills.

I’ve got some other ideas you can read about in a couple of days. I also want to talk about pain pill use in children.

Monday, October 25, 2010

Pain Pills - part 1

Post provided by Barbara Bergin, M.D.

In my line of work, I get a lot of requests for pain pills. The majority of patients who need them have either just had surgery or an injury, like a fracture. And most people stop taking the pain pills as soon as they feel they don’t need them. Sometimes they wean themselves off of them by lowering the numbers of pills they take, or gradually increasing the interval of time in between the narcotics. Sometimes they supplement the pain medications with non-narcotic pain relievers.

But sometimes patients continue to take pain pills. Weeks and even months go by, and they continue to request large doses of pain pills. It’s really hard for some of our patients to gauge how many pain pills they should be taking or how to wean themselves off of them. They start getting into a habit of taking the pills. Maybe they think that if they are experiencing any pain at all, they should go ahead and take the pain pill. Sometimes they use the pain pills to help them sleep at night. And sometimes they use them in order to be able to function without pain during the day. These are all problematic ways in which to use pain pills.

In my opinion it is best to stop taking pain pills as soon as possible. Pain doesn’t actually “hurt” you. It’s a sensation; like hunger or itching. Just because you are hungry, it doesn’t mean you absolutely have to eat. And you don’t have to scratch when you have an itch. You don’t have to relieve pain every time you feel it.

Addiction to prescription narcotic medications is a serious national health problem. In my next blog I’ll talk about some things patients can do to minimize their use of pain pills.

Wednesday, October 6, 2010

Return of Football Season Brings Attention to High Injury Rates and Need for Prevention

Post provided by The American Academy of Orthopaedic Surgeons (AAOS)

According to U.S. Consumer Product Safety Commission:

- The 2009 football season saw over 1.2 million football-related injuries
- Such injuries resulted in more than $2.8 billion total medical costs from treatments in hospitals, doctor's offices, and emergency rooms

"Traumatic injuries to the knee and shoulder as well as concussions are the most common types of injuries we see on both the professional and youth levels," said orthopaedic surgeon Matthew Matava, MD, team physician for the St. Louis Rams and spokesperson for the STOP Sports Injuries campaign and the American Academy of Orthopaedic Surgeons. "Overuse injuries, especially in the beginning of the season, are another big issue with kids pushing themselves too far and too fast without proper conditioning."

The STOP Sports Injuries Campaign was launched in the spring of 2010 by a coalition of leading healthcare organizations to expose the growing epidemic of youth sports injuries related to overuse and trauma.

Because most football injuries can be prevented, the American Orthopaedic Society for Sports Medicine and American Academy of Orthopaedic Surgeons encourage the following easy strategies for parents, coaches, and athletes:

- Have a pre-season health and wellness evaluation to determine ability to participate

- Warm-up properly with low-impact exercises like jogging that gradually increase the heart rate

- Consistently incorporate strength training and stretching. A good stretch involves not going beyond the point of resistance and should be held for 10-12 seconds

- Hydrate adequately to maintain health and minimize cramps

- Play multiple positions and/or sports during the off-season to minimize overuse injuries

- Wear properly fitted protective equipment and do not modify equipment

- Cool-down properly to gradually lower heart rate with exercises like light jogging or stretching

- Don't play through the pain. Speak with an orthopedic surgeon who specializes in sports medicine or athletic trainer if you have any concerns about injuries or tips on injury prevention

Monday, September 13, 2010

You Kick Like A Girl

Post provided by the American Academy of Orthopaedic Surgeons.

Significant differences in knee alignment and muscle activation exist between men and women while kicking a soccer ball, according to a study published in the Journal of Bone and Joint Surgery. Data reveals that males activate certain hip and leg muscles more than females during the motion of the instep and side-foot kicks - the most common soccer kicks - which may help explain why female players are more than twice as likely as males to sustain an anterior cruciate ligament (ACL) injury.

Prior research shows that females are more prone to non-contact ACL injuries than males and though many theories exist, a direct cause for the disparity is unknown. "By analyzing the detailed motion of a soccer kick in progress, our goal was to home in on some of the differences between in the sexes and how they may relate to injury risk, " said orthopedic surgeon Robert H. Brophy, MD, study author and assistant professor of orthopedics, Washington University School of Medicine in St. Louis. "This study offers more information to help us better understand the differences between male and female athletes, particularly soccer players."

The study found that male players activate the hip flexors (inside of the hip) in their kicking leg and the hip abductors (outside of the hip) in their supporting leg more than females. "Since females have less activation of the hip abductors, their hips tend to collapse into adduction during the kick, which can increase the load on the knee joint in the supporting leg, and potentially put it at greater risk for injury, " Dr. Brophy said.

In 2008, the Centers for Disease Control and Prevention published a study that found a new training program called the Prevent Injury and Enhance Performance (PEP) program, was effective in reducing ACL injuries in female soccer players. Developed by the Santa Monica Orthopedic and Sports Medicine Research Foundation and supported by the American Academy of Orthopaedic Surgeons among other medical and athletic associations, PEP is an alternative warm up regimen that focuses on stretching, strengthening and improving balance and movements and can be conducted during regular practice time and without special equipment. "Programs focusing on strengthening and recruiting muscles around the hip may be an important part of programs designed to reduce a female athletes' risk of ACL injury, " said Dr. Brophy.

Monday, August 30, 2010

Anterior Cruciate Ligament Tears: An Ounce of Prevention is Worth a Pound of Cure

Post provided by Scott Smith, MD

I saw my first surgical reconstruction of a ruptured ACL in 1981. I began studying ACL's in 1991. I performed my first ACL reconstruction in 1992. Since starting my practice in Austin in 1996 I have performed over 400 primary recontructions. The essential techniques remain basically unchanged. A graft of some sort is strung through the knee to "reconstruct" the anterior cruciate ligament. This process takes roughly six months to form a "new" ligament.

Wouldn't it be easier to just not have an ACL tear? YES! Prevention is worth a pound of cure. Until recently no one really considered that prevention was possible. It may not be. This point is argued in multiple disciplines: orthopedic surgery, physical therapy, sports medicine. No one knows. What is state of the art in 2010 is core training, jump training, hamstring fitness, proprioception improvement and flexibility.

Every orthopedic surgeon knows that anterior cruciate ligaments fail more frequently in female competitors. Why remains a mystery that is discussed wherever knees are contemplated. Do women jump differently? Do they land funny or have too straight a knee at contact? Do hormones play a role? All valid questions without certain answers.

There are many theories and lots of reseach being done. No conclusive findings regarding the difference between men and women have been found yet. There are many prevention strategies also with unproven results. I feel that there probably is some protection provided by these programs. I am also sure that athletic performance is enhanced by improved muscle strength and flexibility. I have been using these techniques with the teams that I coach for the last six years. I can't say that I've prevented any tears but we haven't had any. I continue to look for more effective proven regimens and solutions.

Friday, August 20, 2010

Round Rock Open House & Ribbon Cutting

Round Rock Open House & Ribbon Cutting
Thank you to all those who joined us at our Round Rock Open House and Ribbon Cutting. The Round Rock office is located at 2120 North Mays Street, on the IH 35 access road just north of Highway 79. Doctors Scott Smith, Marc DeHart, and Christopher Danney will be seeing patients at this location.

Monday, July 19, 2010

Carpal Tunnel Syndrome, Part 2

Post provided by Robert Foster, MD

In the last post we discussed how CTS is diagnosed and nonsurgical treatment. Part two discusses the surgical treatment for carpal tunnel syndrome.

Surgical carpal tunnel release remains the standard of care for severe carpal tunnel syndrome or when conservative treatment modalities have failed. Unfortunately, there still seems to be a great deal of fear and misinformation surrounding carpal tunnel surgery. Today carpal tunnel surgery can be performed with local anesthesia, with the patient wide awake, eliminating the need for fasting or an I.V. Many patients who have local anesthesia will come to surgery alone and drive themselves to and from the surgery center. For those patients who are still anxious about being alert during surgery, oral and I.V. sedation can still be made available.

Mini-incision carpal tunnel surgery is performed with the patient lying flat on their back with a small tourniquet on their forearm to prevent bleeding during surgery. A small half inch incision is made at the base of the palm and through this incision the transverse carpal tunnel ligament is divided in half, essentially opening the roof of the carpal tunnel and removing the pressure on the median nerve. Once the ligament is divided, the incision is closed with only one or two stitches. The entire procedure usually takes only 10 to 15 minutes. Following surgery, a light, soft dressing is applied, with no splint, and is worn for four to five days. Once the dressing is removed, a simple band-aid can be used to cover the incision to protect the stitches. After surgery patients are encouraged to move their wrist and fingers frequently and use their hand as tolerated. Many patients return to work and normal activities the day after surgery, although a couple of days of rest and light duty are not uncommon. The stitches are removed 10-14 days after surgery and most patients have significant improvement of their symptoms by the time they are seen for the post-op appointment. Once the carpal tunnel is released, recurrence of carpal tunnel syndrome is rare.

Today both surgical and non-surgical treatment of carpal tunnel syndrome is relatively safe and simple. Surgical treatment has a very high rate of success and patient satisfaction with a low rate of complications and risk. Non-surgical treatments, while not a permanent cure, can provide significant relief of symptoms. If you are one of the millions affected with carpal tunnel syndrome, talk to your doctor about your options or get an opinion for a specialist.

Wednesday, July 14, 2010

Carpal Tunnel Syndrome, Part 1

Carpal Tunnel Syndrome
Post provided by Robert Foster, MD.

In 2009 over one million people sought medical treatment for carpal tunnel syndrome (CTS). It is estimated that carpal tunnel syndrome affects nearly three percent of the population, or over 8 million people in the United States alone. Despite simple and effective treatments, many people continue to needlessly suffer with symptoms of CTS.

Carpal tunnel syndrome is caused from compression of the median nerve as it passes through the carpal tunnel at the wrist. The median nerve is responsible for supplying sensation to the thumb, index finger, middle finger, and part of the ring finger. Compression of the nerve causes slowing of the electrical signal that can result in a multitude of symptoms, such as numbness, tingling, burning, aching, weakness, and radiating discomfort up the arm.

Carpal tunnel syndrome is not caused from working on the computer or repetitive key stroking. In fact, most cases of CTS do not have an exact identifiable cause. However, repetitive motion activities, such as typing on a keyboard, can aggravate carpal tunnel symptoms in those who have it. Conditions frequently associated with or cause an increase risk of carpal tunnel syndrome include pregnancy, obesity, trauma, smoking, diabetes, hypothyroidism, rheumatoid arthritis, and kidney disease.

Treatment of carpal tunnel syndrome can be conservative or surgical. Conservative treatments include splinting, therapy, oral medications, and steroid injections. Splinting and steroid injections are the most common and effective conservative measures. Splinting is effective because it prevents excessive flexion of the wrist, which can increase pressure on the median nerve within the carpal tunnel space. Steriod injections into the carpal tunnel space decrease inflammation and swelling, which relieves pressure on the median nerve and improves blood flow to the nerve tissue. While usually not a permanent cure, steriod injections frequently can improve symptoms for a prolonged period of time and are often used in conjunction with wrist splints. Physical therapy and oral medications are less effective for the long term treatment of carpal tunnel syndrome. Other therapy modalities such as laser therapy, heat therapy, and chiropractic care seem to have less or even no effect.

Wednesday, June 2, 2010

Adult Repetitive Strain Disorders, Part Two

Post provided by Barbara Bergin, MD

In the last post we discussed what repetitive strain disorders are, why we get them, and what you can do about them. Today's post continues with getting back to what you love after getting better and how to prevent repetitive strain disorders.

Once I get well can I go back to doing things like I was before?

- Probably not. Most people get these disorders because they are somehow anatomically predisposed to getting them, or because they are not put together to participate in certain activities. Frankly, most human beings are not put together to perform certain sports activities on a regular or high intensity basis. Our joints just will not tolerate repetitive strain for extended periods of time. Sometimes it is just a matter of conditioning ourselves to participate; like building up to run or swim long distances. But most of the time we get repetitive strain disorders because we are just wearing out our parts. We must make permanent changes. Again, that can mean minor alterations of the way we do things around the house, but it can also mean changing the way we participate in a sport or even discontinuation of that sport. I'm sorry to say this, but it's true. Most of these repetitive strain disorders occur in people who are 40+. I just don't see them in twenty year olds. If you refer to an earlier post, "Having Peace with Your Pain, " you'll understand a little more about my thoughts on that subject.

- Treating these conditions is kind of like treating hypertension. If your doctor says you have to take an anti-hypertensive medication, do you think you can just take that for a short period of time and your hypertension is cured? Can you stop taking the pill? Will your hypertension come back? Are you ever truly cured of hypertension? No. Occasionally there are people who will make major lifestyle changes and can lower their blood pressure but most people have to continue taking the medications for the rest of their lives. This is the same with most of these repetitive strain disorders. They will come back if you go back to doing things exactly the way you were doing them before. If you make 90% of the modifications permanent, you might be able to continue to enjoying some of the activities which previously caused you pain! You can live with that!

How can I prevent repetitive strain disorders?

- Some of them might be unavoidable, but general principles can always be applied: maintain a healthy weight, exercise in moderation, avoid extremes of high impact and high intensity exercises as you age, and maintain flexibility. It's also important to recognize repetitive strain pain and address it early, either by seeing your orthopedic surgeon (that's me) or your primary care physician, or by making the modifications yourself. It's common for people to try to "work through" the pain, thinking that it's better to work it than rest it. This kind of approach to pain probably stems from the idea that you have to "work through" the conditioning pain of getting into a higher intensity exercise like running. The first time you run a half mile, it hurts; your lungs, your feet, your legs. But as you continue to run and run longer distances, it gets better. This is not the philosophy to take with the pain you experience in a tendon or joint as the result of a certain activity or after that activity. Learn to recognize the difference and address it. Rest it. Ice it. Take Aleve or Advil (if your doctor says it's okay). Then modify it!

Wednesday, May 26, 2010

Adult Repetitive Strain Disorders, Part One

Post provided by Barbara Bergin, MD

Why do we get repetitive strain disorders?

- Because our bodies wear out and we do a lot of repetitive activities. As our population ages we're seeing more and more of these disorders. I see a different set of repetitive strains in younger aged individuals, mostly related to participation in sports. Of course an older person can get repetitive strain disorders from playing sports, but they can also get them from hanging up clothes in the closet and getting milk cartons off the top shelf of the refrigerator. Just because you go out and throw a ball a little, doesn't mean the milk carton wasn't the culprit. And just because your grandson can throw the ball to you all day, doesn't mean you can return it all day.

What are repetitive strain disorders?

- There are some very common disorders. They include:

- impingement syndrome: a disorder of the rotator cuff tendons. I also group shoulder bursitis and rotator cuff tears (partial and complete) with impingement syndrome.

- greater trochanteric bursitis: a disorder of the fluid filled sac that is on top of that prominent bone on the side of the hip. I see this more often in woman than in men. It's related to the shape of our pelvis and the way we move.

- plantar fasciitis: a common disorder of the foot, also seen more commonly in women. It results in pain on the bottom of the heel and is commonly called a heel spur. It's not due to an actual heel spur.

- lateral epicondylitis: Also known as tennis elow.

There are many other, less common repetitive strain disorders involving just about every tendon and muscle in the body.

What can I do about repetitive strain disorders?

- Rest: This doesn't always mean putting it in a splint, cast or brace. It usually means modifying the painful activity. As soon as you notice pain due to some repetitive activity and you can reproduce the pain by doing the activity, you should modify it. That might mean bracing the extremity involved. It could mean stopping that activity altogether. More often it means changing the way you do the activity; lessening the number of times you do it, decreasing the intensity of the activity, modifying the way you do it. For example, if I have pain in my shoulder when I get a large milk carton out of the top shelf of the refrigerator, I will start buying 1/2 quart containers and lower the shelf on which I put the larger bottles!

- Anti-inflammation: This can range from the application of ice to prescribing medications.

- Exercise: This might include some stretches or some strengthening exercises depending on the condition and the level of pain you are experiencing.

Friday, May 21, 2010

Austin Medical Relief for Haiti has a website!

Check it out and please send to anyone who would like to know more about what we do, who we are, and how we are helping restore hope and health to Haiti. We are in need of donations for our continuing medical projects in Haiti. Currently we are working with MOH to build a hospital on MOH property. Donations will be directed towards the completion of the hospital and the hiring of medical workers in the US and Haiti to help staff and run the hospital. Spread the word!

Check out the new video, courtesy of Seema Mathur!

Tuesday, April 27, 2010

New Prosthetics Lab

Friday, April 23, 2010

Peace with your Pain

Post provided by Barbara Bergin, MD

I’ve been an orthopedic surgeon in Austin for 23 years and as my practice and I have aged I have come to believe in a different set of rules and expectations for both me and my patients than I had when I first hung up my shingle. Here’s the bottom line: humans weren’t meant to last as long as we do. As an organism we just weren’t put together to stay around for 80 years. The average age of death for Americans is over 80.

Look at the archeological record. No one is finding fossils of old cavemen and cavewomen. Women died in childbirth. If a man sprained his ankle he was dinner for a bigger predator! People died when they were 20. We see these documentaries on octogenarians who run the Boston marathon or some little group of Japanese mountain people who look like they’re 40 when they’re 100, and we think we should be able to be like that. But what they don’t show you are the 10,000 people who tried to train for the Boston marathon and couldn’t because of stress fractures, iliotibial band syndrome and degenerative meniscus tears.

So, what’s my point here? Do I just not want to see any patients? No, I love to see patients. It’s what I do! But the point is…we’re hunter-gatherers, and were made to last about 20 years.
I find myself giving this lecture over and over to my many patients who suffer from degenerative disorders of their bones and joints, as well as those patients who suffer from repetitive strain disorders.

No cave man/woman ever lived long enough to suffer from greater trochanteric bursitis, shoulder rotator cuff impingement syndrome, plantar fasciitis or degenerative meniscus tears.
If it’s frustrating for me to treat some of these conditions, it is certainly frustrating for my patients to have them. I’ve personally experienced many of these repetitive strain conditions. Frankly we have to learn to have a certain level of peace with them. We have to look at pain from a different perspective. We’re lucky to have lived long enough to experience these conditions. If we are fortunate enough to be treated and saved from a heart attack, we may live long enough to experience some other disease. It could be a rotator cuff tear. It could be cancer.
Sometimes my patients ask, “Why am I having these problems? My grandparents and my parents didn’t have them!” There are several reasons for this:

-We may not inherit the same set of genes each of our parents had. Just as your eyes or your hair might not look exactly like either of your parents, your muscles, tendons and joints may not be the same either.

-We live differently than our parents and grandparents. As a whole, we are more active than our parents were. We started playing organized sports at a younger age. We do some crazy, harmful exercises our parents didn’t even think to do. We continued playing sports late into life. As a whole we are larger and heavier than our ancestors. And we live longer so unfortunately, we have longer to suffer!

-Our expectations are different than our forefather’s were. Our grandparents did not have an expectation of being treated and “cured” of their aches and pains. So why complain? Why go to the doctor? Everyone tells us that we can be cured. There is treatment. And there is! But because of that, we have an expectation of wellness and therefore we complain.

You will most certainly be able to think of a situation which contradicts my analysis. My parents are both in great shape and they’re out tango dancing without an ache or pain. Well, in my most educated opinion…that’s just good luck…for me and for them!

Wednesday, April 21, 2010

Prosthetics Update in Haiti

We are borrowing a computer from a missionary couple here on site so I have to type quickly and my thinking will most likely be a bit choppy...

Haiti is amazing. The country is beautiful and the people are very sweet. The amount of destruction due to the earthquake is hard to wrap my brain around. Last night the lead doctor on site told us her earthquake story. We have heard many things since coming down that I wish I did not have in my head. I know it helps to understand the level of need and the people we are working with but much of it is beyond horrible.

We currently have 5 legs in the works. I have taken on the role of prosthetic technician and Tim is teaching me alot. Yesterday the lead Haitian orthopedic surgeon brought 5 amputees to our lab and we spent the afternoon making casts and taking measurements for prosthesis. The surgeon had removed 3 of the patients legs using a saw. The level of trauma the Haitians have experienced is overwhelming. It is impossible to talk with someone and not break down as the tell you their earthquake story. Everyone here has been effected.

Today we drove an hour and half to the border of haiti and the Dominican republic to another orphanage/clinic where 47 amputees are being held while they wait for prosthetic teams to come by and make them legs and arms. We saw one woman who is missing her left arm and right leg, a 10 year old boy who is missing half of his foot, a dozen men and women missing an arm or a leg, two 5 year old girls who both lost a leg, and more I cant remember right now. It was overwhelming to know all of these 47 people lost their limbs due to the earthquake. Many were still experiencing phantom pains as they continued to adjust to life without their leg or arm.

On the way to the Love a Child clinic we drove up on two men who had just been hit by the local taxi truck (called a "tap tap"). One was slowly regaining consciousness and the other was not moving. A woman dumped a bucket of cold water on both of them to see if they would wake up. The first man walked dazedly to the side of the road and the second was not moving. The RN and PT who went with us jumped out to help and very quickly realized a large crowed was beginning to form and we needed to move on before anything more exciting started. It was hard to drive by knowing their was no medical help for miles but we had no other option. Just another day in Haiti...

It has rained the last two nights which has been exciting considering we are in a tent. It is also incredibly hot and humid which is wearing. We are working with a group of 50 from Canada as well as smaller groups from Ohio and Michigan. Everyone thinks its really cool that we are from California :).

There is alot of work to do and only a few more days to do it. We are trying to set up a system to pass along the current projects to the next prosthetist who will be coming next week. Since the prosthetic lab has only been open for 2 weeks, its all new for everyone.

Dinner is in about 30 minutes and we are going to walk down to the mid-week worship service going on at Church of Hope on site.


Tim and Amber

Monday, April 12, 2010

Team 12 in Haiti

Orthopedic surgeon: Frederic H. Pollock, MD (Charleston WV)
Family Practice: Myron Rosen, MD (Baylor, Dallas TX)

Joan Vega, RN (Scott and White Austin, TX)

Julie Manning RN (Austin TX)

Paramedic: Curtis Rhodes (Oklahoma)

Paramedic: Evalina Kadic (Canada, Halton EMS)

Paramedic: Ron Sonada (Canada, Halton EMS)
Supply/Med Student: Gabriel Pollock (Charleston WV)

PT: Helen Day (UK, Mercy Ships)

Prosthetist: Paul Morton

They will be joined by medical staff from Fallsview Church and Chapel Group.

Picture: Dr. Fred using a glove as an incentive spirometer on "Broken Man" in the ward

Thursday, April 8, 2010

4/7/10 - Team 11, Day 6

Update from John Morrow, MD:

It is Wednesday and the first half of the week has flown by. When we arrived, there was a large dome tent that had just been set up and was full of supplies. It is now a functioning hospital with a 26 patient census. Multiple orthopedic cases have been done and there are some patients that have been admitted and waiting for their procedures. There are several recent automobile injuries that are being treated.

Our first day of clinic, a staff member of Mission of Hope was involved in a major accident, fracturing her femur, tibia, and wrist. She was resuscitated and taken to the OR by a truly talented surgical team. Diana Adams is the OR nurse, her husband, Dr. Adams, along with Dr. Chardack are the surgeons, and Dr. Aaron Ali is the anesthesiologist. They have worked tirelessly all week. The work they are doing is not only very technical, but in this environment , very physical. There are some very tough post earthquake related cases that are surfacing.

The work here by Mission of Hope is major to say the least. One example – they have a generator that powers this entire facility which makes a large portion of this work possible. Laurens van der Mark is in the site manager and is basically in charge of the physical plant. You will just have to come here to see what all this organization is capable of doing on 70 acres on the side of a rocky hill in Haiti.

There has been much said about the hymns and songs of the Haitian Christians. They sing at the beginning of clinic and we all have to wipe our tears away each and every morning. Through their song, they are teaching us a lot about developing a relationship with God.

Picture: View of the ward on the walk down from the guest house. The clinic is on the other side below.

Wednesday, April 7, 2010

First prosthetic patient & new ward

Picture #1: Dr. Chase Brown and our first prosthetic patient
Picture #2: New ward

Tuesday, April 6, 2010

4/5/10 - Team 11, Day 4

Update from Jennifer Kinman:

Ward has 15 patients in house. 3 are pre-op rest waiting for surgery. Dr. Adams doesn't think we can take any more patients this least not until we get through these cases. 4 tough ortho cases today. "Broken man" (he was the bilateral upper extremitiy fractures, external fixators on his lower extremities, and critically low blood count) was transferred to Miami in error. He will come here tomorrow. 4 cases posted already some from today and some teed up by Rosie (Ortho Resident from team 11) and stayed at CAM (clinic down the road from MOH). 2 patients came for prosthetics clinic today. Lovely transhumeral that we have blogged about before and Malene a below the knee amputation. Both very sweet women. Brad Johnson(owner and operator of MOH) is back & thrilled about the lab. We cleaned it up really well and Chase Brown, prothetists, started on Malene's leg. She will come back Wednesday & stay until Friday.

I got to drive the ambulance today as we went up & down the hill for supplies. I also visited the circus tent. What a disaster. Tomorrow Sever, Max & I will tour ALL of the supply nooks & crannies. Dr. Hong saw a patient in clinic with nausea & vomiting...ultrasounded her & she is pregnant. He was so excited to have ultrasound & eager for the tech from Canada to set up the protocols.

Big case today was an employee of Brad & Vanessa in a bad motorcycle accident on her way to work. I dont have the specific injuries, I think mid femur & tibia fracture, but need to confirm. Powerful for Dr. Cheryl & Vanessa to pray over this woman who is a huge part of their families. Most cases we are doing are a result of the earthquake...needing external fixators removed & better fixation. 120 pts seen in clinic today. Lots of the same stuff..malaria, scabies, diarrhea. Wound care very busy & she is placing some vacs this week...please to to find someone...also talking more with Cheryl tomorrow at LEAP...they will probably be able to cover that need.

Monday, April 5, 2010

4/4/10 - Team 11, Days 1-3

Updates from Jennifer Kinman:

Friday, 4/2/10- Spent the day cleaning out the ward half of hoop barn. It is awesome but supplies are unorganized. Unfortunately when they moved them from the school they didn't totally keep order. We will be busy in there this week. Going to use the wire racks to separate the ward from supply hall.

Got to tour the clinic. It closed yesterday at noon, but had a head laceration arrive at the front gate today. Dr. Gueramy, Dr. Haas and Dr. Curtis got him all stitched up.

Tomorrow they will go to General to evaluate a bilateral femur fracture patient. Possible surgery tomorrow if he is medically stable.

We washed down the donated hospital beds & mattresses with soap & water then bleach. Half of the beds left to go tomorrow. The kids (MOH staff kids) piling up the mattresses & playing trampoline.

Saturday, 4/3/10- Dr. Morrow, Dr. Adams & team are stuck in Miami. Got lots done on the new supply ward & we are almost ready for our patients to arrive tomorrow. Bilat femur fracture surgery scheduled tomorrow.

Sunday, 4/4/10- Very good day...all of our team arrived. Ward is beautiful...OR sterilized. Problem with anesthesia machine, only works with small O2 bottles. We have connected with Miami to get more o2 & hopefully biomed. I went to town with Dr. Gueramy, Dr. Haas, Seema (Journalist) & Vance (Photographer). A guy with 2 femur fractures also has bilateral upper extremitiy fractures is coming tomorrow. Probably have to amputate..hand not salvageable. He had crit 15. Hgb 5.5 so getting blood before they transfer him. Found delightful femur fracture patient with external fixature on femur needing fixation....from the earthquake at Miami. Seema interviewed her with Miami ortho doc. He was fantastic & one of his partners is coming April 10. If we could round up OR staff & anesthesia we definitely have surgery week (and use all those team nurses)....very good possibility. Miami surgery said there is plenty of work. 4 surgeries scheduled tomorrow...all 4 spending the night. One guy is a femur fx...walked into miami.

Picture: Dr. Gueramy negotiating with UN- they were trying to bring us 5 patients in ambulance. Our clinic was closed & we didn't have our nurses yet.

Team 10 Final Update

Update from Ann Soo, MD:

Today is Good Friday and the clinic is closed. We spent the day moving out medical supplies from the school to the tent barn and hoop barn to help prepare the school to re-open. It was physically exhausting, however it had been raining recently and so the weather is cooler. It was as if God knew we needed some relief from the heat. Re-opening the school is vital in Haiti. Education is the best way for Haiti to break their poverty cycle. Mission of Hope schools 1200 children and education is their best hope for a better life.

There is a a rugged road that leads from Port au Prince to Mission of Hope. Along the road, there is a mass burial ground where more than 200,000 bodies are buried. Near the top of the burial site, a large cross has been built. If you stand near the cross and turn around, there is a a beautiful sweeping scenic view of the beach. It is quite eerie when you first walk on the site but in a strange way peaceful.

Sometimes I wonder why great tragedies happen in life. The earthquake that hit Haiti on Jan 12th brought devastation on top of a country that was already struggling. The people of Haiti need love, compassion and hope during their season of suffering. If you feel led to come here, this experience will stretch your faith and deepen your compassion. As we celebrate Easter this weekend, just remember God can do amazing things from tragedy – just look what He did at Calvary.

PS- Ortho clinic needs C-arm paper, pediatric crutches, and emla cream.

Medical clinic would like IV Zofran, IV benadryl, muscle relaxants (SOMA, flexeril, or robaxin), migraine medications (imitrex, relpax, or zomig), azithromycin, otoscopes with extra ear speculums, and Elimite for scabies.

Friday, April 2, 2010

Team 11 making their way to Haiti

This is a big Haiti Team, maybe our biggest yet. Here is the list of names and specialites who are traveling down today and tomorrow. Our prosthetics lab and clinic will open on Monday.

Orthopedic surgeon: Bradley Adams, DO, Austin: Texas Ortho
Orthopedic surgeon: Michael Chardack, MD, Trauma center, Salt Lake City, UT
Anesthesia: Aaron Ali, MD, Austin: Capital Anesthesia
Family Practice: Dr. John Morrow, Austin: ARC
Rehab/wound care: Dr. Jean Deleon, Dallas: Baylor

OR RN: Diana Adams, RN, Austin: NW Surg Center
ER RN: Jean Nations, RN, Austin: SNW
Wound/Rehab RN: Adora Lucius, RN, Dallas: Baylor
Pedi RN Elizabeth Stephens, Austin: Dell Children’s

Prosthetist: Chase Brown, San Antonio: MK Prosthetics & Orthotics
Prosthetist: Mark Kirchner, San Antonio: MK Prosthetics & Orthotics

Journalist: Seema Mathur, Austin
Photographer: Vance Holmes, Austin

Paramedic 1: Curtis Rhodes , Oklahoma (2nd trip to MOH)

Supply/Aid: Max Chardack

Prosthetics Admin: Jennifer Kinman, Austin: Texas Ortho

We have the privilege of having 3 of our Austin Medical Relief for Haiti leadership doctors joining us for the weekend, helping kick off the prosthetics week among other tasks!

Orthopedic surgeon: Tim Gueramy, MD, Austin: Medical Park Ortho
FP: Tracey Haas, DO, Austin: ARC
Anesthesia: Will Curtis, MD, Austin: Austin Anesthesia

Our team will be joined on the ground by medical staff with Mercy Ships:

Radiologist serving in general medicine capacity: Kuhn Hong, MD-Mercy Ships
ER RN: Kelly Belley, RN
ICU RN: Debbie Coons, RN
med/surg RN: Beth Studenroth, RN
med/surg RN: Joyce Wright, RN
Paramedic: Brenda Sine
PT: Helen Day

Thursday, April 1, 2010

Team 10 update/Smider & Job update

Update from Ann Soo, MD:

These clinic days are busy. Lot of patients getting IVF's. Seeing typhoid, malaria, GI and respiratory bugs, headaches, asthma, HTN off meds, STD's, newly diagnosed HIV and suspected Tb. All the pregnant patients I've seen have not had any prenatal care at all and many patients have never seen a doctor before. The Haitian people are resilient, grateful and proud. Many come into the clinic nicely dressed just to see us. For the majority of them, Mission of Hope is their only chance to receive much needed care and medications. Praise God for his ongoing compassion and love.
We had a chance to visit a homeless shelter and an orphanage outside of Mission of Hope yesterday. The living conditions at the homeless shelter was atrocious. The kids in the orphanages are living in tents. They appeared somewhat happy playing with each other and did not appear emaciated. Today after clinic, some of us went to Port au Prince on a tour. There is so much devastation and work to be done. Tent cities everywhere. Poverty and chaos. Much more help and many more prayers are needed for Haiti.
Team 10 is great - the doctors, nurses, PT's and paramedics. We just work so well together. It's wonderful to be around each other and supporting each other. It's amazing to see how God selects people with different skills, backgrounds and experiences and places them together to serve. Many have been on numerous medical mission trips before and their stories are truly inspiring!

Update on Job and Smider from Ashely Hurt:

I saw both boys today and they look wonderful. Such improvements in a day and a half. Smider has gained almost and ounce and a half in one day. he was 6lbs 7oz when he arrived. He had his first encounter with a mirror and have a full on coversation with himself. So cute! He's rolling over from back to belly and very alert and active. All boy.

Job went and had his eye cleaned out and repacked today. While sedated they cleaned his teeth and he has a gorgeous white smile! They must have also cleaned off a lot of his scabs cause he was looking much more handsome. They did a scrapping of his good eye and found two infections. No wonder the grafts didn't take. He's on heavy duty anitbiotics and they suspect a full recovery. He marvels at all the lights and surroundings here in America. He such a sweet boy. I'll be sitting with him tomorrow for a couple hours till lunch time. I'll have more pictures of the boys then.

Picture #1: Smider
Picture #2: Job at Dell Childrens

Monday, March 29, 2010

Ashley Hurt's update from Haiti

Dr. Joel Hurt and his wife Ashley, champions of the Austin Medical Relief for Haiti efforts, are leaving PAP today to return to Austin. Here's an update from Ashley:

We are so sad that we are leaving today. It has been a full three days and flown by so fast. Life here is different and wonderful. Church was amazing! The singing is beautiful and the Haitian people really get into the music. Yesterday we oriented the team to the clinic and did a major overhaul on supplies. Trying to get organized and situated. There are A TON of supplies. A blessing and a curse. There is a cirus tent full of supplies that are spilling out of. The school house still has tons of supplies in it, a huge hoop barn that was set up for supplies is now half way full and we have central supply room in the clinic stocked with supplies. It is a daunting task and we will now staff people on our weekly teams just to be a head of it and master it. Supplies are expiring and now unable to use simply because we don't know what we have. What a waste.

AC and water pressure are two things I miss. Our shower drips and is often filled with cockroaches at night...ugh, gross. I kill them and then do an icky dance before I'm able to pick them up and flush them. Last night I was greeted by a mouse when I entered the room. EEK was truly my response. I couldn't see a hole in the wall so I'm pretty sure he slept in our mattress with us.

The sun rises at 5 am daily. By 530 it is bright! Sets around 630. This is pretty much unchanged year round. We went into a local city near MOH for lunch yesterday. It was good Haitian food and they people were lovely.

Yesterday we changed Job's dressing and found his skin graft on his orbit to be necrotic so we removed it. Poor guy has two skin graft sites on his thighs with nothing to so for it. This is the second failed graft. We decided to sedate him to do the procedure which was much easier on everyone. He left this morning for Dell in Austin. Smider the baby with hydrocephalus was on the same flight. We put a lock, IV, in Job yesterday so we could give him a sedative for the flight. I went down at 645 to check it. It's patent and working. His "mommy" was bathing him and getting him dressed in his church clothes. He looked so handsome and was so proud. He's never worn anything like this before. He had slacks and a long sleeve yellow shirt with shiney black shoes that were probably 2 sizes too big. He jumped down and did a little dance for us in his new shoes. All the kids from the orphanage came by to see him off. We took a picture. Please pray for his flight home. Two amazing men, middle aged, no medical training, will be flying with Job and Smider to Austin. They tried to get Joel and I on their flight but it was full. The mommies are so sad to see their babies go and asked to bring them new babies to care for. They loved Job and Smider but understand this is the best for them.

Sunday, March 28, 2010

3/28/10 - Team 10 is on the ground!

Team 10 is on the ground at MOH today!
Tom Jackson, MD - emergency physician - Austin
Ann Soo, MD - internal medicine, retired - Austin
Sara Khanzadeh, PT - wound care - Austin
Rosie Wustrack, MD - orthopedic surgery 4th yr resident - San Francisco

Joined by Mercy Ships team of nurses - Melody Phelps, Mary Cade, Denise Piper, and Judy Teague, paramedic Bonnie DiSalvo, physical therapist Helen Day (UK-week 2!).

This is Dr. Nathalie Fiset's (Canada) last week at MOH.

Bob Kertcher, paramedic with Halton Medics in Canada will join the team Tuesday.

Lastly, this weekend marks the first rotational weekend of our leadership physicians. Dr. Hurt and Ashley Hurt arrived at MOH this past Friday to assess current needs and help form the ongoing strategy for medical services at MOH. They will return to Austin tomorrow.

Monday, March 22, 2010

We Live in Good Times

Post provided by Barbara Bergin, MD

It’s really amazing to see all the external fixators being used in Haiti. That surgical procedure has revolutionized the treatment of open fractures (broken bones which have penetrated through the skin or have had something penetrate the skin to contaminate them).
I can remember in my residency (early 1980s) we were treating open fractures in traction or with casts. We would cut big holes in the casts so we could have access to the wounds in order to clean them. We had to fashion little doors out of the cast material so we could get to them a couple of times a day. The little “doors” were needed because if you just left a hole in the cast, the injured skin and muscle would swell up into the hole, like rising bread, and then you’d have a bigger mess on your hands.

I can tell you that there were a lot less open fractures back then. We just didn’t see the number of high energy trauma cases we see now; motorcycles and high speed car accidents were not as common. We also did a lot more amputations! Without external fixators, we just couldn’t take care of the wounds like we can now! External fixators were in the making though. Orthopods are tinkerers and we would put big pencil-sized pins through the bones above and below the break and then hold them apart by making outriggers of twisted plaster over wire, or whatever interesting polymer we could find around the operating room or the mechanical room in the basement of the hospital.

While I did my rotations at the Veteran’s Administration hospital, I saw many veterans of WWII with chronically infected wounds they received while fighting in the European and Pacific fronts. Sometimes, instead of having amputations, they would opt to keep their legs, but the exposed bone would have become infected. If the bone healed, despite the infection (most of the time infected bones won’t heal) then they would just spend the rest of their lives with pus draining out of their leg. They would walk around with big dressings covering the hole in their leg in order to absorb all the liquid that poured out! It was really quite incredible. Our veterans were in their 60s then! Imagine young men suffering those wounds in their 20s and living with them that long. They would keep that leg along with all its problems, rather than have an amputation.
Then to add insult to injury, chronically infected wounds are susceptible to getting a form of skin cancer, so we always had to check them for that. By the 80s, those veterans had been walking around with their wounds for about 40 years!

Now just because we can put external fixators on the unfortunate folks in Haiti, it doesn’t mean they’re all going to get to keep their legs. Nor does it guarantee them to be free of the potential for infection, but it sure gives them a better chance than if we weren’t using them. We do live in good times.

3/21/10 - Team 9, Day 1

Update from Sheryl Lucier, PA:

Good evening from Team 9 MOH Haiti. We arrived late today, after getting in to San Juan at 3am!! But we were so glad to be at the mission. Lindsey gave us the tour of the compound at 3pm, so we are hoping for a good night sleep so we are ready for a busy clinic tomorrow. There seem to be an abundance of supplies….but a lot of organizing, inventorying needs to be done. There is no formulary, so we will just have to ask tomorrow to see what is available. There is a very small group here this week compared to past weeks…but more will arrive during the week.

The city of POP is much less congested as compared to before the earthquake, due to so many deaths, and people leaving the city to live in tents because they lost their homes or they are afraid to be inside them, or because that is where the food comes.

On Sunday afternoon the children from Hope House come to the guest compound to play ….so there are many children around tonight.

Sunday, March 21, 2010

3/21/10 - Team 9 is on the ground!

Team 9 marks a transition in Mission of Hope post-earthquake medical care. Going forward, our operative weeks will occur once per month, followed by a week of recovery for inpatient care and finishing the month with a focus on primary care and community health.

Team 9 volunteers arriving in Haiti include:
ER physician: Ashley Kumar, MD (Austin-Dell Children's)
Physician Assistant: Sheryl Lucier, PA (Georgetown-Dermatology)
Ann Parsons, RN (San Antonio-Home health)
Dawn Hallock, RN (Virginia-ER nurse)
Helen Day, PT (UK-coming with Mercy Ships)
Nicky Chovaz, paramedic (Canada-Halton Medics)
Dave Ryckman, paramedic (Canada-Halton Medics)

They are joined by Team 8 team members who are staying on at Mission of Hope for another week:
Nathalie Fiset, MD (Canada)
Bridget Russell, RN (Austin-St. David's NICU)

Friday, March 19, 2010

Refuge in the Haiti Hills

Poem by Maggie El-estwani, RN:

Early morning solitude in the hills -
earth browns, ochre reds, limestone white
and dotted with dusty shrub and grasses.

Cradling coffee mugs and
sitting in companionable silence and low voices at breakfast.
Some in prayer and meditative reading.

The bright sun rises over the hills.
The wind blows mimosa branches briskly
in the stone courtyard.

Through the quarter-open gate,
wilderness and a glimpse of the city and sea,
and our EMS ride Haiti One.

And I remember why we've come,
this Lent to join a mission of hope
to Haiti after the quake.

Intertwined white and fuchsia bougainvillea
are splayed over the simple wrought iron fence,
backdrop to aid worker tents.

Later in the morning the children will fly kites
and mount wild ponies
to scramble on the rocky paths;
And at the ward and clinic,
the women will break into song.

The hills join in chorus -
gather your strength, your inner joy and deep faith.
Morning breaks again.

-Tintayen, Haiti
March 2010

Thursday, March 18, 2010

Just How Do You Fix a Broken Bone?

Post provided by Scott Smith, MD

Orthopedic surgeons treat many types of problems with the human body. One of the most common is a fracture commonly known as a broken bone. In Haiti or any where else for that matter; when a rock house falls on a leg, bones are going to break. A large part of the work done by physicians in Haiti has been "fixing " these fractures. Well just how do you "fix" a fracture?

Bones have an inherent capacity to heal. Typically this occurs more predictably and faster if the fractures are stabilized or held still. The most effective pain relief for a broken bone is to prevent it from moving. There are many ways to do this. We all know about a cast. This is some sort of rigid material (plaster or fiberglass) wrapped around the arm or leg to provide the support needed. This works great for hand and foot or ankle fractures but not so great for thigh or arm fractures. Also if a bone is displaced or aligned incorrectly then it must be reduced or replaced and held there. Casts can't always do this. If the bone has broken through the skin, or if there is skin damage then a cast is less then ideal as it does not allow access to clean and care for the wound.

At this point frequently an external frame is assembled and used to stabilize the bones. Essentially the external fixation entails using large (5 milimeter) pins or screws and drilling them into the bone above and below the fracture. Then attaching a metal bar external or outside the skin to the pins. This frame acts as a new skeleton to stabilize the broken parts. It also allows the skin wounds to be cleaned and dressed without destabilizing the fracture. Another advantage is that no further "damage" is done to the soft tissues by actually cutting around the fractures to expose the bone for the placement of plates and screws directly on the bone also known as internal fixation. The advantage of internal fixation is the bones can be precisely aligned but open incisions must be made to do so. This is sometimes not advisable due to the risk of infection and problems with open wounds.

Another older technique is traction. Just like it sounds, traction is a method of fracture stabilization where a pin is placed through a bone and a weight is hung from the pin to provide a pull on the bone holding it "still". This is a rarely used technique in modern medicine, but still has its place in some injuries.

In Haiti, due to the type of injuries (crush) and difficult living conditions (high infection risk) many fractures were treated with external fixation. These frames will probably stay on for >3 months and then be removed. Hopefully with most of the fractures healed. If they have not healed, reconstructive surgery with bone grafting will be necessary.

Each fracture has its own personality. Each orthopedic surgeon has their own "style" or preference for fracture management. There is always more than one way to get the job done . God has designed a pretty good system for healing injuries so usually function can be restored by these techniques.
Picture: Drs. Hurt, Le, Smith and Joseph putting on an external fixator