This Saturday’s Mayo Clinic Medical Edge Weekend will feature Mayo Clinic orthopedic surgeon Dr. John Sperling talking about shoulder injuries.

The program will be recorded from 9-10 a.m. CDT on Saturday, Jan. 2. During that time, you may listen live on the Web here.

If you would like to submit a question in advance, you may leave a comment below, send an email, or simply “tweet” your question on Twitter.com using #mayoradio.

Here is some video of Dr. Sperling from Mayo Clinic’s YouTube Channel.

We look forward to hearing from you on Saturday!

URGENTLY REQUIRED….

Dear Students,

Treat musculoskeletal trauma, sports injuries, degenerative diseases, infections, tumors, and congenital conditions… Make your career in PG Program of Medicine with Orthopedics @ Niche International.     

Orthopedics?            

Orthopedics is the medical specialty devoted to the diagnosis, treatment, rehabilitation and prevention of injuries and diseases of your body’s bones, joints, ligaments, tendons, muscles and nerves.

Orthopedic surgery or orthopedics (also spelled orthopaedics) is the branch of surgery. Orthopedic surgeons use both surgical and non-surgical means to treat musculoskeletal trauma, sports injuries, degenerative diseases, infections, tumors, and congenital conditions.    

What is the job of Orthopedic doctor ?

People often think that Orthopedic Surgeons just do operations. This is not the case. A large part of Orthopedic practice is the non-operative management of musculoskeletal conditions.

An Orthopedic surgeon is a medical doctor with training in the diagnosis and treatment of the musculoskeletal system.

People of all ages may need the care provided by an orthopedist.
Orthopedists may practice general orthopedics or specialize in treating the spine, hand, sports related injuries, foot, hip, knee, shoulder, pediatrics, or trauma. 

The specialty of Orthopedic surgery is devoted to the care for all ages, from newborns with birth defects through to senior citizens with arthritis and fractures. Sports injuries are also an important part of Orthopedic surgery.

What are the most common Orthopedic-Related Symptoms?

Orthopedics disease symptoms can include:—-

  *   Pain, swelling or stiffness in joints
  *   Difficulty using or moving a joint in a normal manner
  *   Warmth, bruising or redness in an injured area
  *   Obvious deformity in an injured area

There are many more reputed institutes in India and abroad imparting expertise in the field of Orthopedics! But to acheive the depth of the course you needed a good institute and highly experianced counsellers.

Where do you find the best guidance for Orthopedics career course and PG (Post Graduate) program in Medicine? At Niche International!

Niche International is leading career couselling international company for overseas career.

Procedure to become Orthopedics

Orthopedic Surgeons make a good salary and their work doesn’t go unnoticed.
Orthopedic Surgery is not an easy career path to take but for those willing to make hard work and medicine a huge part of your life, it is the perfect career path.

Where to study Orthopedics?

PG Program in Medicine at Niche International:

4-7 years PG Program in Medicine (POST GRADUATE MEDICAL SPECIALITIES IN THE FACULTY OF MEDICINE AT THE “OVIDIUS” UNIVERSITY) at Niche International includes following Courses:

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   -   Laboratory
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   -   Internal Medicine
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   -   Pediatric Surgery
   -   Infectious Diseases and Epidemiology
   -   Ophthalmology
   -   O.R.L.
   -   Family (General) Medicine
   -   Psychiatry
   -   Clinical Genetics
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   -   Oro-Maxillo-Facial Surgery
   -   Orthodontics

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You will get all the information about Career counseling and information, Document preparation and admission, Bank loan assistance and Pre visa assistance and airline ticket booking.

So R U Ready to Fly abroad for PG Program In Medicine? Do book your seat at Niche International for more PG Program In Medicine courses details today.

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Most of the time when people hear about joint replacement or other orthopedic surgery, they think of the elderly. Unfortunately however, there is a group of young children that suffer from joint pain and other painful bone and joint diseases. There is hope for these children through orthopedic care. Treating children is much different than treating adults so there a lot of precautions that doctors must take.

There are a lot of different causes of pediatric joint pain that include normal development, inflammatory disease of the muscles and joints, activity-related pain or endocrine abnormalities. Many times pain is called simply “growing pains” and most of the time this really is the case. It is important however to monitor the child’s symptoms to see if it could be something more. Children typically experience growing pains between the ages of three and seven and they are caused when the bones grow and their covering stretches.

Some children with chronic pain could be at risk for juvenile arthritis. Some signs to look for that could possibly mean juvenile arthritis is morning stiffness, walking with a limp and joint inflammation. Many times, juvenile arthritis comes in waves and could be more painful some days than others so it is crucial to watch for the signs and make a journal of what you observe. Notes and in depth information can really help the doctor diagnose a child’s pain.

While pediatric joint diseases can occur to anyone at any age, there are some patterns to be aware of. Juvenile arthritis strikes children before the age of 15. A disease like lupus affects females a majority of the time while Ankylosing spondylitis occurs more often in boys. The most important thing when it comes to pediatric joint pain is to monitor symptoms and make notes about what you observe. A doctor is the only person who can diagnosis a pediatric orthopedic disorder but they are also the ones who can provide the care your child may need.

Carly Lamont

A thirteen-year-old girl with epilepsy, cerebral palsy, and a spinal deformity known as scoliosis, is embroiled in a dispute between two orthopedic surgeons and the wishes of her parents that has resulted in a delay in surgery that could correct her posture.

The girl, Carly Lamont, is one of 150 B.C. children that was put on a waiting list for what is deemed “non-emergency” surgery in February of 2008. At that time her parents, Susan Watson and David Lamont, were shocked to find out that the waiting list could be as long as 18 months. This August marked the passing of the 18th month that Carly would have been on the list. But her surgery was never performed, and her name was removed from the waiting list, stemming from a disagreement among the orthopedic surgeons and the parents.

Scoliosis, from the Greek word meaning “crooked”, is a medical condition in which the patient’s spine is curved like an “s”, and can be very painful. It is usually classified as congenital [vertebral anomalies present at birth], or as a neuromuscular symptom of a secondary condition such as cerebral palsy, which is what Carly has.

There are only two doctors in British Columbia qualified to do such an operation on children, while there are only four in neighbouring Alberta. One of the doctors, Dr.Firoz Miyanji, met with Carly Lamont and her parents back in October of 2007. Before that they had been seeking treatment in Portland, Oregon, for her condition, but were not satisfied with the results. Hopeful to find a better solution, they contacted the BC Children’s Hospital Spine clinic for more options.

After meeting with Dr.Miyanji, the parents agreed that it would be prudent to go ahead with the surgery, and they were accepted under the condition that they would meet with the doctors recommendations. Since the surgery would provide a great improvement in the quality of life for their daughter, the parents agreed.

But shortly after joining the list, they were told of an 18 month wait time. The parents were horrified. Nobody had indicated there was any wait time for the surgery in previous consultations. Although her doctor agreed that the list was long, the hospital officially reported that Carly’s spine curvature appeared to be stable, and that if her doctors felt her organs or her life were in danger, they would expedite the surgery.

That wasn’t good enough for Carly’s mother. She began a petition online, wrote protest letters to the Prime Minister and the Premier, health ministers and hospitals, and spoke to the media. Ms.Watson felt very strongly that children shouldn’t be asked to wait a year and a half for necessary surgery.

“I was looking out for the interests of my daughter, first and foremost,” says Susan Watson. “I was afraid that her condition would worsen while we waited.”

Premier Gordon Campbell made mention that “if wait times for a specific surgery or procedure become unreasonable, B.C.’s health system would need to shift resources to meet patients’ needs.” But nothing specific was done to help Carly. And while others have expressed sympathy for Carly Lamont’s situation, the wait time remained at 18 months.

In May of 2008, the parents went to B.C. Children’s Hospital to meet with Dr.Miyanji and the department head of orthopedic surgery, Dr.Chris Reilly. From the outset, Ms.Watson said that Dr.Reilly, whom she had never met before, was hostile and aggravated toward her. They recommended that Carly take off her back brace, arguing that it would let her bones and muscles settle into a position that would make the surgery easier. But with surgery still over a year away, Carly’s parents asked if she could be fitted for a new brace to wear for half the wait list time because she was undergoing physical changes and puberty at the time. That request was denied.

At this point Dr.Reilly said he was displeased to hear Ms.Watson speaking to the media and the government, and asked her to remove her petition site. The meeting concluded. Two months after hearing nothing more from the hospital or the doctors, they were suddenly informed in August that Carly had been removed from the waiting list, and was told to seek help in Alberta. The letter read:

“We have reviewed in detail all of our correspondence and our detailed notes. It is clear that you are not in agreement with some of our medical recommendations.”

“There have been many communications regarding Carly’s care both through our offices, the hospital administration and also public media, including newspapers and the recent website.

“We feel that we have not been able to establish a therapeutic relationship with your family that will allow us to care for Carly.”

The letter was signed by Dr.Reilly and Dr.Miyanji. The hospital said they would not be providing further treatment for Carly Lamont, except on an emergency basis.

One more meeting was set up on December 4, 2008, with a mediator, in the hopes of coming to an understanding. But according to Susan Watson, Dr.Reilly merely told her that to be reinstated to the waiting list she must agree to all recommendations, stop talking to the media and the government, and delete her petition website. Ms.Watson refused, she says, to be be bullied.

In an interview with Susan Watson last week, she said that it is now November of 2009, and nothing has changed to ameliorate the situation. The parents have travelled to Alberta for consultations, but they are still upset that they can’t get the treatment they need for their daughter in the province in which they live. Visits to orthopedic care in Alberta has confirmed that Carly’s spinal curvature has deteriorated. Worse still, the situation has strained the family to the point where Susan Watson and her husband, David Lamont, have filed for divorce after 18 years of marriage.

Now Ms.Watson wants an apology from the hospital, and to have her daughter reinstated to the waiting list. While her ex-husband has been granted access to the orthopedic department of B.C. Children’s Hospital this past June to do check ups on Carly, Ms.Watson is not allowed to attend, she says. Her husband doesn’t want the surgery to be done in Alberta, and would not let Ms.Watson put Carly on a waiting list in that province.

Now she just wants the impasse to end and have her daughter receive the surgery she needs in B.C. She says she never wanted to queue-jump the waiting list, nor embarrass the orthopedic department of B.C. Children’s Hospital, but only to bring awareness to the long waiting times for non-emergency surgeries for children.

As the months pass by without the surgery, Ms.Watson becomes increasingly despondent. And just recently in Vancouver, B.C. Children’s Hospital had a breakthrough surgical technique with an 18-year-old patient named Carmen Stolk to correct her Scoliosis. The new, less invasive surgery which reduces the trauma done to the patients’ back, allows them to get up and start walking the very next day. Carmen was the first patient in B.C. to receive the new technique.

As Carly’s parents argue over getting their daughter the surgery she needs in Alberta, a less invasive procedure awaits right here in B.C. Now they want a reconciliation with the hospital, an end to disagreements, and to get Carly up and walking like any other 12-year-old girl.

Dr.Firoz Miyanji and Dr.Chris Reilly were unavailable for comment for this article.

Susan Watson’s petition site can be signed here.

So I spent a little time watching a unicompartment knee replacement with one of the new custom knee replacements units. First let me say that the fit and installation ease with these appears to be superior to off the shelf units. Each unit is custom built for the the patient using a 3d CT scan and comes with custom guides for installation, way cool. Toward the end of the surgery there was a practice that’s becoming more common and is being shown to help with post operative knee replacement recovery and pain management, injection of a cocktail of drugs into the joint capsule and surrounding tissue during the operation. For you orthopedic reps out there this represents an opportunity for you to bring your doctors another one of those informative tidbits that differentiate you from the competition.

Generally the cocktail will include a numbing agent, anti-biotic, morphine, and an antiinflammatory steroid. Studies have indicated marked post-op improvement in function, mobility, and patient satisfaction.  Examining the components in the cocktail, the improvements don’t come as a big surprise. I’ve included the link to the surgery as well as a short article on eOthopod about. I encourage you to do a little more research and bring something extra to your orthopedic surgeons today.

Video of a custom knee replacement

eOrthopod article

by Ward Sieben

A novel form of treatment is now available in India for patients with early stage avascular necrosis of the hip. This treatment is based on regenerative medicine.

Avascular necrosis of the hip is a condition of unknown origin affecting many young and middle aged patients. Steroid intake, alcoholism, Sickle cell diseas, hypertension, decompression sickness are some known causes. Moderate to severe disease is treated by hip resurfacing whereas core decompression is offered to the first stage of the disease. Grade II A disease is an intermediary stage between the two extremes and has no definite treatment options. There is controversy on the appropriate treatment. Hip replacement is perhaps too drastic an operation for this early stage of the disease. Core decompression has limited success rate. Left to progress it leads to deterioration and hip arthritis.

For this stage, a biolgoical option is now available. This is based on the potential of stem cells to heal the avascular bone. Stem cells are drawn from the patient and cultured in the lab. A few weeks later, they are injected back into the affected portion of the femoral head along with a core decompression. In a core decompression the surgeon will drill a tunnel in the hip bone leading into the affected area. The regenerative bone cells are injected into the affected area. The bone forming cells called Osteoblasts synthesize new bone in the dead area. This leads to healing and hence a biological cure. The technique is called Ossron.
For advanced stages of the disease resulting in hip arthritis, Hip resurfacing is offered at the same center by experienced Orthopedic surgeon India

This process is avaiable in India for a reasonable cost.

E mail- drvenkat@kneeindia.com

Watch story of American patient who had a Birmingham Hip resurfacing surgery in India.

E mail-drvenkat@kneeindia.com

My legs have been bothering me so badly lately that I am forced to take the Requip twice a day, every day for over a week. I take it with my morning meds AND with my night meds. So, why is this happening?

One thing that I can put together is the fact that my knee replacement has been horribly wrong for over a year now and aches (no, is excruciatingly painful) more and more every day. I remember that after I had the knee replaced, the RLS became really bad too. Can you imagine a leg that jumps around and is already in serious pain from surgery.

Dear PHD who replaced my knee,

Although you were really nice and caring, I am thinking that perhaps you should go back to school or maybe even have your own knee replaced and not use the Continuous Passive Motion Machine! I believe that your exact words were “There’s nothing that machine can do that your own body cannot.” Ha!

Don’t think that I will ever recommend you to anyone.  Good luck in your venture though!

Sincerely,

Unhappy patient

OK, with that rant out of the way. I wonder if I am more stressed out about the fact that my knee hurts so bad that I can barely get up or down the stairs half of the time or that I am looking into having the whole procedure done again?

Today, I learned that one thing that causes the RLS to become worse is stress. That’s why warm baths are suggested. By the way, how am I supposed to sit in a warm bath when my legs are jumping all over the place? I can’t even stand to not pace the floor? So many questions, so little time. My husband and I are going to be sleeping in separate beds before this is all said and done. A lot of the time,  I cannot rest because I am so afraid that my legs are going to become possessed at any time that I cannot think about anything BUT my legs. I know that I subconsciously make it even worse. That has to be the case since it never fails. It’s The Secret!

Dear God,

Can you please help me with this situation? I love to be able to help others and I will but a little less jumping would be greatly appreciated!

Thanks!

Like your knees and hips, your shoulder is another joint that there are replacement options for. Many people don’t think about shoulders when it comes to replacement surgery. Shoulder replacement surgery is relatively new compared to hip and knee surgery. Doctors began replacing shoulder joints in the 1950’s and they were used mainly for shoulder fractures. Now, approximately 23,000 people have shoulder replacement surgery each year. That is a relatively low number compared to the 700,000+ people who have knee and hip replacement surgery.

Similar to your hip joint, the shoulder is a ball and socket joint. The ball is located at the top of the arm bone and the socket is found in the shoulder blade. The shoulder is one of the joints where people have an incredible range of motion. This large range of motion can wreak havoc on the cartilage within the joint over a period of years.

Anatomy of the Shoulder

Over time, the ball part of the joint rubbing inside the socket can cause the cartilage to wear down which can result in pain. If the cartilage wears down too much and the pain becomes too severe, your doctor may recommend replacement surgery. When the shoulder is replaced, the ball part of the joint is removed and replaced with a metal implant. The implant is shaped sort of like a half moon and attached to a stem. The stem is inserted down into the center of the arm bone. The socket portion of the joint is shaved out and replaced with a plastic socket that is cemented in for stability.

Shoulder Joint Replacement

Recovery from shoulder replacement surgery is fairly manageable for most patients. Easy physical therapy can begin the day after surgery. Simple tasks like eating and dressing can usually be accomplished about 2 weeks after surgery. Most patients need continual assistance for about 6 weeks after surgery. During and after that time, physical therapy continues with stretching and strength exercises. This therapy helps the patient regain their range of motion, but this time without the pain.

About 9 years ago, I tore my ACL (Anterior Cruciate Ligament) during a routine run down the blue square trail in Vail, Colorado.  Upon further inspection by the orthopedic surgeon, it was clear that I needed surgery and fast.  I had completely destroyed the most important stabilizing structure in my knee, and although a future in professional sports was not my goal, the road seemed daunting.

At that time, I had been an avid runner. I ran about 6-8 miles four times a week for four years, and had come to rely heavily on my routine as a way to maintain my fitness and sanity.  This being my freshman year at NYU, I was thrown through a loop at the prospect of not having my run to ground me in this new and sometimes intimidating environment, but unbeknown to me at the time, my casual relationship with yoga that had begun as mere curiosity would come to serve me in immeasurable ways.

My injury occurred in the spring, surgery in the summer and a long road of recovery followed.   Luckily, I regained range of motion and flexibility quickly, but unfortunately hastiness and overambition hindered my progress.  My therapist encouraged me to take my healing slowly, but  I was eager to get done with physical therapy and resume my regularly scheduled programming.  I refused to wait the recommended 6 months of strength training before attempting a run, and jumped back on the treadmill 3 months into my rehab.  I didnt see why this should be a problem since even my doctor was impressed by the speed in which my recovery was progressing.  Needless to say, over the next few years I accumulated a variety of knee related injuries while pursuing my runners high (hamstring pulls, hip misalignment, psoas strains, and ankle instability), eventually resulting in a second ACL repair surgery in the spring of 2006.

Throughout the 7 years chasing my pre-injury body, I had cultivated a dedicated yoga practice which essentially saved me from myself.  It may seem hypocritical to practice a discipline that speaks to patience and non-harming while so blatantly doing the opposite, but this is the beauty of the yoga.  It works on you.  No teacher can tell you the lessons yoga teaches, they can only guide you so you can come to learn them on your own, through your own experience.  Once you come to know this, the sweetness can be tasted and the fruits of the effort manifest in your life.  For me,  injury has come to be my most valuable teacher to this day, continuing to teach me non-attachment, compassion, patience, and balance.

Last winter, a few months shy of the 3 year mark since my last surgery, I decided to give running another shot.  This time, committed to starting slow, I maintained a steady 16 minute mile walk gradually adding some elevation and speed over time.  Whenever I began to feel the impulse to “see if I could do it faster”, I came back to the vinyasa, watching my breath and slowly putting one foot in front of the other, confident that my body would let me know when it is ready to advance further.  As I got stronger and started adding some interval runs, I could always count on my valued teacher to resurface as a pull or a strain if I needed a good helping of humble pie. Luckily, this time around, I am receptive to its teachings and have been better for it.  Almost a year into my treadmill yoga project, I am 5 miles strong (9-10 minute mile) and counting.

See you on the trails…

Yoga tips for running:

Here are some tips I have integrated into my running routine;

1.  Pull your belly in and breathe into your diaphram. Keep your chest lifted and feel your ribs expand as you inhale through your nose and exhale through your mouth to keep your body cool.

2.  Think light feet as you land on the ball of your foot and use your inner thighs and outer hips to press your leg back as you stride. Some people find lifting the knees helps lessen the impact upon landing.

3.  Maintain a straight torso.  Torso should be aligned over the pelvis to ensure equal weight distribution and proper muscle development of the leg, in addition to helping avoid knee, ankle strains and shin splints.

3.  Keep a steady gaze and an equal inhale to exhale ratio.  If you find you are holding or having trouble equalizing your breath, decrease the speed or walk for a few minutes to regain breath control.

4.  Enjoy and be safe!

-Alana

Time passes so fast, when there’s a lot going on in your life.  Every time I turn around, I realize that it’s been two or three days since I’ve updated folks on my father’s condition.

Dad’s recovery post-op was very fast.  He was off of the ventilator in under two hours this time.  The orthopedic surgeon implanted a long rod in his femur and then ran a screw through it an into the ball of his hip joint.  Interestingly, when you have this kind of work done, you don’t wait for the bones to knit.  Apparently the titanium hardware can carry all of your weight.  You don’t really need your bones to stand anymore.

I have a cyber-dad.

He was on his feet the day after surgery, sitting in chairs and walking with carefully managed support.  He’s making good progress, and little is said about his lungs anymore.  But then, he’s been moved to the orthopedic floor.

And lemme tell ya something about orthopedic nurses.  They’re kinda . . .  abrupt.

That’s not to say that they lack empathy or compassion.  But it’s clear that when you’re a veteran of orthopedic medicine, you have learned the following:

“I’m sorry.  But there’s nothing we can do to make this suck less.  And no amount of physical, mental, or spiritual preparation on your part is going to make this suck less.  So we’re going to do this now. So quit stalling.”

He’s in a lot of pain.  He also doesn’t like to feel fuzzy-headed.  As a stroke victim, he’s already only running on about five cylinders, and doesn’t like pain killers or anything that makes his brain any less effective than it already is.

This leads us to a situation where he’s unhappy that he’s in pain.  Or he unhappy that he’s doped up.  He wants out of bed, out of the hospital, and to be independent.

And I don’t know if he can do that any more.  If he can fall and hurt himself that badly just be getting out of bed, he’s too fragile to be living alone anymore.  And I don’t know what to do.

Latest update:  the orthopod is coming in from Johnson City and will operate to repair the hip this afternoon.  There are two cases ahead of him and the charge nurse has warned me not to expect any real movement until after 3:00 PM.

When he was speaking to one of the doctor’s, he said he had a crazy dream:  he dreamed he needed his oxygen, and couldn’t reach it.  Then he woke up on the floor.  He was ON supplemental oxygen at the time, so he was definitely hallucinating.  My wife and I will be headed over there this afternoon.

Y’see, while the pulmonologist has given his blessing to surgically repair the hip, Dad’s lungs are so bad that they want me around just in case hard decisions have to be made.  Even a relatively healthy person takes a small risk when going under general anesthesia.  But Dad’s lungs are very bad.  I’m told not to worry.  Nobody expects any problems, and my presence is just to help him relax, and “just in case.”

Bleh.

New video, new post. This week, I’m putting up this video about Drea Dorrow, which is really my first profile piece that I’ve ever done.

I completely improvised everything with this project.  I didn’t have a camera, microphone, or lights for this video, so I ended up borrowing a camera from a friend, a microphone from an office, and used Drea’s desk lamp for the lighting.

Coach K

When we hear about a celebrity going under the knife, it’s usually for a face lift, liposuction or other cosmetic procedure. You might be surprised to learn however, that celebrities sometimes need surgery that actually improves their quality of life. The rich and famous aren’t immune to the plagues of old age, like arthritis and many celebrities have had to have joint replacement surgery.

One very well known actress by the name of Elizabeth Taylor had hip replacement surgery in 1995. She pulled through the surgery and was once again able to get around without a cane. Another popular actor, Michael Douglas had knee replacement surgery in 2009 and it has allowed him to keep up with his 6 year old daughter. Joint replacement surgery has made such huge strides that recovery is now much shorter and can truly improve the patient’s life, allowing them to once again enjoy activities they may have thought were lost to them forever.

Some other household names like Mary Lou Retton, Mike Krzyzewski and Eddie Van Halen have also all had joint replacement surgery. Mary Lou Retton had both of her hips replaced at the very young age of 37. She had a condition called hip dsyplasia and was the cause of constant pain in her hips. After having both hips replaced, Mary Lou keeps up with her 4 daughters and maintains a high level of physical activity without any pain!

Mary Lou Retton

Duke basketball coach, Mike Krzyzewski had his hip replaced in 2002 after realizing the pain was keeping him from making those runs up and down the sidelines at the Blue Devils games. After making a full recovery, “Coach K” is as energetic as ever, bounding up and down the sidelines like he is in his 20’s. Another name you might recognize, Eddie Van Halen, also had his hip replaced in 1999. The pain he was experiencing from a degenerative disease became too much to bear. Now, the 54 year old rocker can rip on his guitar onstage and put on a show without having to push through intense pain.

Michael Douglas

It’s easy to see that joint replacement surgery is an option for even those people who live highly active lifestyles. In the end, it can even let you live a MORE active lifestyle than before the surgery. Take a lesson from these celebs and learn how joint replacement can improve your lifestyle too!

Whether I want to believe it or not, and I don’t, summer vacation is officially over. With Princess Girl’s surgery keeping us house bound for several weeks and having experienced the coldest July on record it hardly seems like we have had a summer at all. But cheer practice starts this week. School starts next week. Of course, that means that the temperatures are finally rising.

This past weekend was our last hurrah. On Saturday we went swimming at a friend’s house. Swimming is normally a common summer activity for us, but this was the first time either of us had gotten to swim this year. Princess girl was in a cast and then physically unable to enjoy this common pass time until this week. I felt guilty even thinking of swimming when I knew she could not go. We both love the sun and the water; the lack of water activities was a major disappointment this year. It makes the prospect of Princess Girl having to have surgery on the other leg next year depressing on so many levels.

 I need to remember this week to ask her surgeon if he is going to write about her for a journal article. She was the first case of her kind he had ever seen. She had spent an entire year in pain with the peroneal tendon of her left ankle popping up over the ankle bone every time she moved her foot.

We went the least invasive route of treatment first with a cortisone shot in the tendon and an immobilizing boot for four weeks. I was not entirely happy with this option, but if it would allow us to avoid surgery I could not turn it down. Unfortunately, it did not solve the problem. The orthopedic doctor was amazed that the tendon continued to pop over the ankle bone while wearing the boot. The next option was surgery.

We all thought he was going in to do a surgical repair on an injured tendon. When he opened the incision, he did not find a tendon issue. What he found was a calf muscle that extended abnormally all the way down to the lower tip of her ankle bone. This additional muscle was in the way of the tendon and not allowing it to function properly. He removed approximately three inches of muscle. The tendon then fell naturally into its expected position.

Princess Girl spent the next three weeks in a non-weight bearing cast. The first of those weeks was spent almost totally immobilized with her leg elevated over her heart. I have never seen someone so inept at crutches. She never did get her balance. After getting the cast off, she was put back into the immobilizing boot. Thankfully we had that several week reprieve. The boot had begun to smell very ripe after the first go-round. She had taken to spraying it down with Febreze on a daily basis. Once the boot was on she was able to bear weight, and start physical therapy. Except for the horrid oozing rash that covered her entire lower leg the day after her cast came off, lasting a week, her physical recovery has been astounding. She has had almost no pain while working on regaining the strength in her ankle and calf. And last week she was released for normal activity as tolerated. YAY!

The tendon on her right ankle is visibly bulging out of position. It is starting to pop over the ankle bone on occasion. I’m afraid I know how we are going to spend next summer…

image, http://www.saifeehospital.com/DSports_S.html ; Fibularis longus is the muscle at issue.

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• William Stanfield, MD, Is First Cleveland-area Orthopedic Surgeon to Perform OtisKnee Custom Fit Knee Replacement (prweb.com)

from the annual meeting of the Society for Pediatric Dermatology in Philadelphia

10.    Neurofibromatosis

9.      Progressive Osseous Heteroplasia

8.      Epidermolytic Hyperkeratosis

7.     Recessive Dystrophic Epidermolysis Bullosa

6.     Junctional Epidermolysis Bullosa

5.     Hemangioma

4.     PHACE Syndrome

3.     Netherton Syndrome

2.     Fibrodysplasia Ossificans Progressiva

1.     Harlequin Ichthyosis

Image courtesy of Wikimedia Commons

*It was really hard to rank these.

—Kerri Wachter (@knwachter on Twitter)

Photo courtesy of WHO

from the annual meeting of the Society for Pediatric Dermatology in Philadelphia

Never doubt that a small group of thoughtful, committed, citizens can change the world. Indeed, it is the only thing that ever has.

Margaret Mead

This morning I listened to Dr. Fred Kaplan, an orthopedic surgeon at the Hospital of the University of Pennsylvania, Philadelphia, talk about Progressive Osseous Heteroplasia–or POH–a rare genetic condition, in which the body produces bone inside skin, subcutaneous tissue, muscles, tendons, and ligaments. In patients with this disease, nodules and lace-like webs of extra bone extend from the skin into the subcutaneous fat and deep connective tissues, and may cross joints–leading to stiffness, locking of joints, and permanent immobility.

Researchers now know that POH is caused by heterozygous inactivating mutations in the GNAS gene.  They know this thanks to some high school students, who raised more than $100,000 on behalf of a fellow student stricken with the disease.  The money allowed Dr. Kaplan and his colleagues to fund a couple of fellows to work on the genetics behind the disorder.  They found the GNAS mutations.

The story is similar to that of Portia Iverson, whose son was diagnosed with autism.  In order to help researchers study possible genetic components of autism, she put together a team that traveled the country collecting blood from families with at least two autistic children.  The resulting DNA bank is helping researchers identify candidate genes through genome-wide association studies that compare DNA of autism families with that of healthy controls.

Both stories point to how much power motivated patients, family, friends, and community really do have to make a difference in medical research.

—Kerri Wachter ( @knwachter on Twitter)

According to our own studies, the number of centenarians in Guadeloupe could cross the 4 thousand mark by 2050.

Although approximately 40 percent of centenarians are functionally independent, they are among those at the highest risk for disabling arthritis and not so frequent, here,  fractures due to osteoporosis.

With increasing age, the safety and desirability of performing hip and knee replacements (arthroplasty : one thousand/year by 2016 in Guadeloupe ?) may be questioned with the idea that health care resources should be spent on those who can potentially benefit from them the most, and such procedures may be too hazardous for elderly patients.

However, there have been few studies on joint replacement among patients older than 90.

Our own study find that hip and knee replacements are very infrequent among this age group, but that they should not be denied to these patients solely because of short-term life expectancy.

My study is the largest to date of hip and knee replacements among French West Indies nonagerians and centenarians.

From 1983 to 2009, I identified only one total hip replacement in patients aged 104 and one total knee replacements in patients aged 97.

This relatively low frequency of elective surgery might be due to physician and patient judgment that these individuals are at high risk for poor outcomes and that the risk is not offset by the perceived benefit in light of the relatively short life expectancy..

Centenarian who underwent hip replacement is at a higher risk for in-hospital mortality than nonagenarians.

Among centenarians, however, hospitalization for hip replacement compared to other causes of hospitalization is associated with a lower risk of death.

Although frailty is known to increase with age, I believe that with better medical care only the extremely elderly are suffering its effects.

I  point out that centenarians live to the century mark by delaying or even avoiding many age-related diseases, and that among those suffering from such conditions, many appear to do so with better functional status than younger patients.

As to the question of whether centenarians and nonagenarians are able to reap the benefits of a new hip or knee, my study also indicates that at least one-quarter of the nonagerian and centenarian population are cognitively intact and they appear to sustain their mental status over time.

Our study find that nonagenarians treated for hip fractures do not have an increased risk of postoperative complications.

Given the increasing trend of joint replacements over the last decade in the French West Indian Guadeloupe and the growing centenarian population, such procedures are likely to become more commonplace in the elderly population.

I conclude, “My 1983-2009 study provides data that suggest arthroplasty need not be denied to centenarians solely on account of age and the concern of high in-hospital mortality risk.”

Photo courtesy of Interplast under Creative Commons license.

From the American Surgical Association annual meeting.

When Dr. Paul Farmer says there should be a Global Fund for Surgery, people know he’s an expert on the “global” part. But surgery?

Dr. Farmer was one of the instigators behind the Global Fund to Fight AIDS, Tuberculosis and Malaria, a public-private partnership that’s now the main source of financing for programs to prevent and treat those diseases. His pioneering work in developing community-based treatment strategies in poor nations earned him a MacArthur Foundation “genius” award in  1993, and many awards since.

He was a founding director of Partners in Health, an international charity organization providing care to people who are sick and living in poverty in Haiti, Latin America, Africa, and elsewhere. Farmer was the subject of the best-selling book in 2003 by author Tracy Kidder, Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, A Man Who Would Cure the World,  and he’s written some of his own, including Pathologies of Power.  

 Here’s the thing — in all those limited-resource areas where it’s so difficult to get medical care, it’s even harder to get surgery. But Dr. Farmer has a “secret plan” for improving global access to surgery: focus on maternal mortality. The half-million women who die in childbirth each year largely die of “surgical disease” like postpartum infections and Cesarean-related problems, he says.

Before his speech to the American Surgical Society, Dr. Farmer chatted with me about his secret plan and how the issue of maternal mortality can bridge the artificial, historical gap between public health and clinical care, and get more people under the knife who need to go there. Take a listen:

Interview with Dr. Paul Farmer

—Sherry Boschert @sherryboschert

From congressional hearings, press briefings and other health reform goings-on, Washington, D.C.

Gooooooooooooooooooooooooddddddddddddddd Morning, Washington!

Photo by Alicia Ault

OK, it’s mid-morning here, but it’s still morning on the Left Coast.  While ya’ll are enjoying your cafe au lait and beignets and Congress is off home to play, the hard-working staff here at the International Medical News Group has produced yet another scintillating update on the health reform drama that continues to fuel special-interest-paid expense account lunches and dinners  across the Nation’s Capital.

Take a listen to the latest two-and-a-half minutes that may just change your life:

Policy & Practice Podcast 6/29

Or, continue to eat those sugary fried confections.  See where that gets you.

If you do give a listen, let us know what you think. Useful? Boring? Too long? Too short? Juuuuuust right?

– Alicia Ault (on Twitter @aliciaault)

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