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Texas Orthopedics, Sports & Rehabilitation Associates

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