New Prosthetics Lab

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!

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.


Blessings,

Tim and Amber

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

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.

First prosthetic patient & new ward

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

Picture #2: New ward

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 week..at 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.