Texas Orthopedics

Welcome South Austin Orthopaedic Clinic to our Team!

2011-12-19T15:44:00.009-06:00

Texas Orthopedics is proud to welcome South Austin Orthopaedic Clinic to our team effective January 1, 2012.

Doctors J. Clark Race, David Savage, Robert Blais and Greg Westmoreland will see patients at our South Austin office located at 3755 South Capital of Texas Hwy., Ste. 160. Their current location on Westgate Blvd. will close.

Shoulder Pain

2011-12-08T15:51:00.005-06:00

Post provided by Dr. John McDonald

Many active patients are disappointed that while trying to stay fit by working out, exercising with a trainer, or playing weekend sports, they actually can develop pain in the shoulder. This type of pain can be a debilitating problem for many recreational athletes. There are several common causes that force even fit people to cut back on their activities. The most common cause of pain in these patients is a combination of rotator cuff tendinitis and impingement syndrome.

There is a small fluid filled sack called a bursa above the ball and socket shoulder joint but underneath the acromion (bone you can feel at the top of the shoulder). Everyone has these bursa sacks almost anywhere in the body where there is a bony prominence, but they do not get inflamed unless a trauma is sustained. The rotator cuff is a group of tendons that attach the small muscles in the shoulder to the humerus (upper arm bone). When active people constantly do things above shoulder level (weight lifting, aerobics, throwing a ball) often this bursa and these tendons can be pinched between the acromion and the humerus. This phenomenon can be worsened by a narrowed space for the bursa due to the shape of the acromion. Repetitive overhead activities cause the bursa to fill with fluid and become inflamed and painful. The pain is typically in the front and side of the shoulder and can radiate to the upper arm. Often, patients have difficulty even with daily activities including washing their hair, reaching for something in the cupboard, or reaching behind their backs.

There are many effective treatments which include physical therapy for rotator cuff strengthening, icing, and anti-inflammatory medicines. Occasionally, a steroid injection can calm down the inflammation in the bursa which can improve the outcomes of physical therapy. Arthroscopic surgery is sometimes necessary if the symptoms fail to resolve. It can be done through several small incisions with the use of a camera. The inflamed bursa is removed and the underside of the acromion is removed to create more space for the rotator cuff. The rehabilitation from surgery typically allows for return to full activities by 6-8 weeks.

The key for recreational athletes is not to ignore shoulder pain. Impingement can become a nagging problem and can significantly affect not only your recreational sports but also your daily life.

FREE joint replacement seminar

2011-11-28T08:24:00.004-06:00

Learn more about non-surgical arthritis treatment options as well as total hip and total knee replacement surgery at Arthritis Camp! Refreshments are served. Bring your friends and family!

Date: Thursday, December 1st
Time: 5 PM to 7 PM
Location: Northwest Austin, 4700 Seton Center Pkwy, Ste. 200, Austin, TX 78759
Speaker: Marc DeHart, MD

Please RSVP by registering online or call 439-1100.This FREE informative seminar is held the first Thursday of every month so if you can't make it this Thursday, plan to attend our next seminar on January 5th!

Happy Thanksgiving!

2011-11-23T09:39:00.002-06:00

Texas Orthopedics would like to wish everyone a happy and safe Thanksgiving! We will be closed on Thursday and Friday. Normal business hours will resume on Monday, November 28th.

FREE joint replacement seminar this Thursday

2011-10-31T09:44:00.002-05:00

Learn more about non-surgical arthritis treatment options as well as total hip and total knee replacement surgery at Arthritis Camp! Refreshments are served. Bring your friends and family!

Date: Thursday, November 3rd
Time: 5 PM to 7 PM
Location: Northwest Austin, 4700 Seton Center Pkwy, Ste. 200, Austin, TX 78759
Speaker: Tyler Goldberg, MD
Please RSVP by registering online or call 439-1100.

This FREE informative seminar is held the first Thursday of every month so if you can't make it this Thursday, plan to attend our next seminar on December 1st!

Texas Orthopedics partners with Bikes for Kids

2011-10-18T09:07:00.006-05:00

Each year Texas Orthopedics employees donate to an Austin charity during the holidays. This year we have partnered with JB and Sandy's Bikes for Kids to be a community donation site. Anyone can stop by any of our 5 Austin area locations to donate money to help children receive a bike, helmet and bike lock for Christmas! We have locations in Northwest Austin, Central Austin, South Austin, Cedar Park and Round Rock!

Over the past 14 years, JB and Sandy's Bikes for Kids program has reached an amazing milestone; over 11,000 bikes donated and more than $1.1 million raised. Join Texas Orthopedics in providing children the experience of getting a brand new bike, helmet and bike lock for Christmas. Stop by and donate today!

FREE Joint Replacement Seminar this Thursday

2011-10-03T14:43:00.001-05:00

Learn more about non-surgical arthritis treatment options as well as total hip and total knee replacement surgery at Arthritis Camp! Refreshments are served. Bring your friends and family!

Date: Thursday, October 6th
Time: 5 PM to 7 PM
Location: Northwest Austin, 4700 Seton Center Pkwy, Ste. 200, Austin, TX 78759
Speaker: Marc DeHart, MD

Please RSVP by registering online or call 439-1100.

This FREE informative seminar is held the first Thursday of every month so if you can't make it this Thursday, plan to attend our next seminar on November 3rd!

Stretching Before a Run Does Not Prevent Injury

2011-09-19T13:11:00.005-05:00

Post provided by the American Academy of Orthopaedic Surgeons

According to a study presented at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons, stretching before a run neither prevents nor causes injury.

The study also found that the most significant risk factors for injury include:

- history of chronic injury or injury in the past four months
- higher body mass index
- switching pre-run stretching routines (runners who normally stretch stopping and those who didn't stretch starting to stretch before running)

"The more mileage run or the heavier and older the runner was, the more likely he or she was likely to get injured," said Daniel Pereles, MD, study author and orthopaedic surgeon. "Although all runners switching routines were more likely to experience an injury than those who did not switch, the group that stopped stretching had more reported injuries, implying that an immediate shift in regimen may be more important than the regimen itself," he added.

Total Knee Replacement Patients Functioning Well After 20 Years

2011-09-12T15:20:00.006-05:00

Post provided by American Academy of Orthopaedic Surgeons

A research study revealed at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons shows that more than 90 percent of individuals who undergo total knee replacement (TKR) experience a dramatic reduction in knee pain and a significant improvement in the ability to perform common activities. Most patients who undergo total knee replacement are age 60 to 80.

The study evaluates patient functionality 20 years after knee replacement. Although aging may cause a gradual decline in physical activity, a remarkable functional capacity and activity level continues 20 years or more after TKR.

John B. Meding, MD, study author, said "this research refutes any perception that the importance of a well-functioning TKR diminishes over time because of an overall declining functional status. Elderly people are using their surgically replaced knees for fairly active lifestyles many years after surgery."

Patients considering knee replacement should talk to their orthopaedic surgeons about the implant's life expectancy.

Free Joint Replacment Seminar this Thursday

2011-08-29T08:34:00.003-05:00

Learn more about non-surgical arthritis treatment options as well as total hip and total knee replacement surgery at Arthritis Camp! Refreshments are served. Bring your friends and family!

Date: Thursday, September 1st
Time: 5 PM to 7 PM
Location: Northwest Austin, 4700 Seton Center Pkwy, Ste. 200, Austin, TX 78759

Please RSVP by registering online or call 439-1100.

This FREE informative seminar is held the first Thursday of every month so if you can't make it this Thursday, plan to attend our next seminar on October 6th!

Taking Care of Your Neck

2011-08-08T11:10:00.004-05:00

The key to taking care of your neck is good posture of the neck always! The correct posture for you neck is when looking at the neck from the side you should have a slight inward "C" curve called the cervical lordosis. Your head should be directly over your shoulders.

Forward head posture is one of the most common cervical alignment problems. Your head should not be forward of your shoulders, tilted to one side and your chin should not be tilted up.

Here are a few tips to taking care of your neck:

- Computer/desk: The monitor should be directly in front of you witout you having to look down or up to see it. You should sit with your back against the back of the chair with support for your low back. Your forearms should be supported on armrests and your feet should touch the ground. Your keyboard should be at an appropriate height to maintain good alignment with your forearms. Standing up every 30 to 60 minutes to stretch is good for your entire body. Set up a pop up reminder on your computer to help you remember!

- Telephone: Do not talk on the phone with your head bent to one side and your shoulder elevated to hold the phone. A headset or speaker phone is a better alternative.

- Driving: The back rest should allow you to sit up straight. The back of your head should be 2 to 4 inches from the back of the head rest. The top of the head rest should be as high as the top of your head.

- Reading: Sit in a chair that promotes good alignment of the entire spine. Keep your forearms supported on armrests or pillows at an appropriate height to avoid slouching. Hold the book so you do not have to lean your head forward. Place a pillow in your lap if needed. If you like to read in bed sit with your back supported with pillows, place another pillow in your lap to support the book and another pillow under your knees. It is ok to read in a sidelying postion as long as your head and neck are level and not tilted to one side.

Free Joint Replacement Seminar this Thursday

2011-08-01T11:16:00.001-05:00

Learn more about non-surgical arthritis treatment options as well as total hip and total knee replacement surgery at Arthritis Camp! Refreshments are served. Bring your friends and family!

Date: Thursday, August 4th
Time: 5 PM to 7 PM
Location: Northwest Austin, 4700 Seton Center Pkwy, Ste. 200, Austin, TX 78759
Speaker: Marc DeHart, MD

Please RSVP by registering online or call 439-1100.

This FREE informative seminar is held the first Thursday of every month so if you can't make it this Thursday, plan to attend our next seminar on September 1st!

New Physicians Join the Team in August

2011-07-15T16:43:00.005-05:00

Dr. Koval will see patients starting August 1st at the Cedar Park and Northwest Austin locations.

Robert J Koval, Jr, MD, is board certified in Internal Medicine and completed Fellowship training in Rheumatology in 2011. Dr. Koval graduated from the University of Texas at Austin with a degree in Biology, after completing high school in Laredo, Texas. He graduated from the University of Texas at Houston Medical School, where he was accepted into the prestigious Alpha Omega Alpha (AOA) Honor Society, graduating near the top of his class.

After completing his internship and residency in Internal Medicine at the University of Colorado in Denver, Dr. Koval worked for a year in hospital medicine at Denver Health Hospital. He then returned to the
University of Colorado for Rheumatology specialization training. He has a special interest in autoimmune disorders, arthritis, and osteoporosis. After moving to Austin to join Texas Orthopedics, Dr. Koval will be starting an infusion center to assist in the treatment of various Rheumatologic diseases. He is a member of the American College of Rheumatology and the International Society for Clinical Densitometry.

In his spare time, Dr. Koval enjoys spending time with his wife Erin and young son Joshua. He also enjoys watching and attending sporting events (Hook 'em Horns!), traveling, and many outdoor activities.

Dr. McDonald will see patients starting August 22th at the Northwest Austin and South Austin locations.

John E. McDonald Jr., M.D. is a native of Houston, TX. He graduated cum laude from Georgetown University in Washington, DC where he played NCAA Division I tennis for the Hoyas. He went on to attend medical school at UT Southwestern Medical School in Dallas where he was named to the Alpha Omega Alpha Honor Society, an honor given to those graduating in the top 10% of their class. Dr. McDonald completed his residency training in orthopaedic surgery at UT Southwestern and Parkland Hospital in Dallas. After being selected as one of two Chief Residents, he spent time overseas in Norwich, England where he worked exclusively with knee and shoulder surgeons and learned a tremendous amount about cost effective medicine.

In order to further specialize after his training, Dr. McDonald was selected to attend a one year fellowship in sports medicine and arthroscopy at the prestigious Steadman Clinic and Steadman-Philippon Research Institute in Vail, Colorado. While in Vail, he trained directly under many of the world's top experts in the field of orthopaedic sports medicine and hip, shoulder, and knee arthroscopy and reconstruction. Additionally, he had the privilege of providing care to numerous professional athletes from the NBA, NFL, MLB, NHL, PGA tour, and professional tennis as well as collegiate, high school, and recreational athletes. He served as the team physician for the US National Snowboard team at the 2011 World Championships and was one of the team physicians for a local high school in Colorado.

Throughout his clinical training, Dr. McDonald has been involved in research in the field of orthopaedics. He has been published in peer-reviewed journals including the Journal of Bone and Joint Surgery and has co-written several book chapters and review articles on a variety of topics including hip arthroscopy, multi-ligament knee injuries, and traumatic should and hip injuries. He has presented his research at multiple national meetings.

Dr. McDonald specializes in hip, knee, and shoulder arthroscopy and orthopaedic sports medicine. A sports enthusiast all his life, Dr. McDonald encourages a team approach with each of his patients. When patients, their families, physical and occupational therapists, and physicians all work together, the patient can achieve a quicker recovery and the success that they desire through both surgical and nonsurgical means. Patients enjoy his friendly, open, and personalized approach to care. He encourages questions and always takes the time to get to know his patients and thoroughly understand their concerns.

Currently, Dr. McDonald is a team physician for the US Ski and Snowboard teams. He is a member of the American Academy of Orthopaedic Surgeons, the Arthroscopy Association of North America, and a candidate member of the American Orthopaedic Society for Sports Medicine. In his free time, he enjoys running, golf, hiking, skiing, and basketball. He is joined in Austin by his wife, a University of Texas alumna and dermatologist, Halliday (Hallie) McDonald, MD, and their daughter.

Texas Ortho doctor speaks at national orthopedic meetings

2011-07-12T09:00:00.005-05:00

John McDonald, Jr., MD, who will join Texas Orthopedics this August, has been busy giving presentations at national orthopedic meetings this summer. He was selected to give a podium presentation at both the 2011 Annual Meeting of the Arthroscopy Association of North America and the annual meeting of The American Orthopaedic Society for Sports Medicine. The presentations were focused on findings related to two recent studies of elite athletes who returned to play quickly and at a high performance level following arthroscopic microfracture surgery of the hip. To learn more about Dr. McDonald, visit his bio on our website!

Free Joint Replacement Seminar this Thursday

2011-07-05T09:23:00.002-05:00

Learn more about non-surgical arthritis treatment options as well as total hip and total knee replacement surgery at Arthritis Camp! Refreshments are served. Bring your friends and family!

Date: Thursday, July 7th
Time: 5 PM to 7 PM
Location: Northwest Austin, 4700 Seton Center Pkwy, Ste. 200, Austin, TX 78759
Speaker: Marc DeHart, MD

Please RSVP by registering online or call 439-1100.

This FREE informative seminar is held the first Thursday of every month so if you can't make it this Thursday, plan to attend our next seminar on August 4th!

Texas Orthopedics Celebrates 25 Years of Providing Orthopedic Care

2011-06-27T08:59:00.006-05:00

Founded July 1, 1986 by two orthopedic surgeons and one physical medicine and rehabilitation specialists, Texas Orthopedics has grown into the largest provider of orthopedic services in Central Texas, now comprised of twenty-one physicians and six locations.

We'd like to thank all of our loyal patients and referring physicians for letting us care for your orthopedic needs over the last 25 years. We look forward to continuing our relationship with all of you!

Congratulations to our doctors listed in Super Doctors!

2011-06-20T10:10:00.004-05:00

Nine Texas Orthopedics physicians have been named by his/her peers to the Super Doctors list.

- Bradley Adams, DO
- Barbara Bergin, MD
- Donald Davis, MD
- Robert Foster, MD
- Peter Garcia, Jr., MD
- Tyler Goldberg, MD
- Richard Lutz, MD
- Scott Smith, MD
- Archie Whittemore, MD

To learn more about the physicians at Texas Orthopedics, click here!

Be Kind to Your Hands

2011-06-13T10:24:00.005-05:00

Post provided by Barbara Bergin, MD

Here are some tips on how to ease the load on your hands. Follow these recommendations and maybe I’ll be seeing less of you!

1) Invest in a nice electric can opener. It’s hard to open cans and once you get arthritis, it’s nearly impossible. So why not start using the electric can opener before you get it? I used to hate electric can openers because of that greasy, black coagulum of old tomato juice and pork and bean gravy that collected in its little gears. But now you can remove that piece and wash it! Using an electric can opener will spare your thumb a lot of stress over the decades.

2) Use jar opening gadgets and bang the lids on the counter top before trying to open them. Spreading your hands out and doing something as strenuous as opening large jar lids and tight bottle tops really strains those delicate joints. Again, once you have arthritis, you won’t even be able to try. Don’t wait until you have pain to start using these handy little devices. I also like to use those little rubber pads.

3) Notice how you grab the steering wheel in your car. Do you hold it with your four fingers wrapped tightly around the wheel and your thumb hyper-extended like a hitch hiker? Try to relax your hands on the wheel. This position puts a lot of pressure on the base of your thumb also. Many of my patients have pain when they drive. I encourage them to wear driving gloves and even to put a sheepskin cover on the steering wheel. You can grab tightly while using these items, but they’ll create a subconscious reminder to loosen your grip.

4) Get smaller milk cartons, or the cartons with a handle instead of the big square half gallon cartons. Again, that wide grip is the perpetrator of harm to your thumb.

5) Same goes for big books, notebooks, dictionaries, and family Bibles. Don’t just grab them with one hand from the shelves. Lift them with two hands; one pulling from the top and the other supporting the bottom of the book.

6) Use an electric toothbrush rather than an old school brush. Again, that grip with the thumb hyper-extended should be minimized. You grab an electric toothbrush with your fist and you don’t have to manually move it up and down like you do with the old school brush. Cavemen didn’t brush their teeth.

7) I’m going to pull my first plug against pushups and I know I’m going to get loads of hate mail, just like I did when I came out against squats. I love the idea of pushups. It’s a cheap, easy way to get a full body workout. You can do it when you’re out of town and have no access to a gym. You can do it if you don’t want to go to a gym or buy your own weights. You can use them to help count scores at a football game, even when the scoreboard works just fine. They’re just fun! But I see tons of patients who have injured their hands and wrists doing pushups. I know someone will ask about using pushup bars. Yes, they help reduce some of the stress of pushups by loading the wrist in a more biomechanically advantageous way, but there are other issues to be further discussed later. Remember, our little hands and wrists evolved away from being weight bearing structures to being dexterous structures; best used for delicate manipulations. So don’t go four-legged on me.

8) Use gloves when doing dirty or heavy work; weight lifting, gardening, construction. They protect your hands from injury and infection, but also allow you to loosen your grip.

9) Don’t try to carry 10 bags of groceries from your car to the kitchen. I used to sling one bag on every finger, two on some if the bag was light. Believe it or not, I’ve seen patients develop finger tendonitis and “tennis elbow” from doing just that. Take your time. Frankly, taking your time is a good adage in general. Often we injure ourselves because we’re in just too dang much of a hurry.

10) Don’t persevere with any activity that causes pain in your hands, thinking you can just work through it. Give it a rest. I’m thinking of my patients who spend an entire day cutting paper or fabric with scissors, all the while developing a numb spot on the side of their thumb. That can cause permanent damage. Stop. Use different scissors. Rest. Get some gloves. Let someone else do it for awhile.

11) Always try to negotiate with others by using your words and not your fist. The fist almost always loses against teeth, walls and windows. It sometimes wins against noses and tummies.

Dr. William Taylor helps underserved patients needing orthopedic care

2011-06-09T16:18:00.005-05:00

Read Dr. Taylor's article in the Austin American Statesman

Read Dr. Taylor's bio!

Transitional Stretching

2011-06-06T16:28:00.007-05:00

Post provided by Barbara Bergin, MD

One of the most common complaints I hear from patients is that they experience pain in transitions; going from sitting to standing, standing to sitting, getting out of chairs, getting out of bed. Now let me say, I never hear that complaint from 20 year olds. I only hear it from those over forty.

As you age your soft tissues get toughened, thinned and stiff. They’re in a state of degradation. So my recommendation is that you begin to develop a habit of doing a little stretching before transitioning from one position to another. After forty. Now look, you don’t have to do some thirty minute Jack LaLane stretching program every time you get out of your car or out of bed. Just make sure the joints are ready for it.

Bend and straighten your knees and your back. Just a covert movement. You don’t have to pull your ankle around your neck or do a sun salutation. Just bend and straighten your knees. Make sure they’re ready to go there.

When I’m riding my horse, going around in circles or whatever, I never just take off and make a big sliding stop with my horse. I sort of introduce his body (and his mind) to the fact that we’re going to start making big stops. I do a slow gentle stop first. Then bigger and bigger. That seems logical, doesn’t it?

Frankly, when you’re 60 and you’ve been sitting for an hour, you’ve got to introduce your body to the idea that you’re going to be standing up in a few seconds. And getting out of bed is a major culprit. People are always so surprised that they hurt when they get out of bed in the morning! Think about it. You’ve spent the whole night horizontal to gravity. Most of the night you’ve been curled up in some variation of the fetal position. Now you want your body to just jump up and stand. Hello disagreement.

And you can actually hurt yourself getting out of bed. That’s the beginning of the curse of plantar fasciitis for many people. It’s the movement that results in a degenerative meniscus tear for others. So introduce your body to the fact that you’re going to be standing up now. Again, this doesn’t have to be a thirty minute program.

-Roll over onto your back.
-Bend and straighten your knees and hips.
-Rotate your hips in and out.
-Stretch your feet up and down.
-Then turn over on your side, curl up a little and push yourself up into a seated position. This is important. Most of us use our legs and weak abdominal muscles to kind of yank ourselves from a face up position in bed to a seated position. This really aggravates the muscles and joints in your pelvis and back.
-Now wait for a few seconds. Stretch your feet and knees again.
-Then stand.

If you get into the habit of doing this when getting out of bed, I promise it will improve the quality of your rising!

I know that if you try to do more of this kind of quick stretching, and I frankly wouldn’t even go so far as to call if officially stretching… more of an introduction or preparation for what is to come…it will improve the experience of going from one position to another and lessen your likelihood of suffering pain…not all pain…but some.

Free Joint Replacement Seminar this Thursday

2011-05-31T09:01:00.005-05:00

Learn more about non-surgical arthritis treatment options as well as total hip and total knee replacement surgery at Arthritis Camp! Refreshments are served. Bring your friends and family!

Date: Thursday, June 2nd
Time: 5 PM to 7 PM
Location: Northwest Austin, 4700 Seton Center Pkwy, Ste. 200, Austin, TX 78759
Speaker: Scott Smith, MD

Please RSVP by registering online or call 439-1100.

This FREE informative seminar is held the first Thursday of every month so if you can't make it this Thursday, plan to attend our next seminar on July 7th!

More on Plantar Fasciitis

2011-05-24T15:24:00.003-05:00

Post provided by Barbara Bergin, MD

Let me say first off, that if you’re not the kind of person who would floss their teeth to prevent tooth decay, you probably won’t be interested in this or most of what I have to tell you.

Why is the morning a time when we often experience pain and stiffness? Think about it. Name one other time when you spend several hours in basically the same position. It’s particularly so for the feet. There is not one single moment during the night when you bring your feet to a neutral position or a dorsiflexed (pointed up) position. Your foot is pointed down ALL NIGHT LONG. And honestly, it’s not just pointed down in a relaxed pose. It is POINTED down. Sometimes when people wear splints or casts to bed at night, they get numbness in their toes. Sometimes they can even get blisters. The toes want to point down and the muscles are actually pulling them down. So after 6-8 hours of that, you go and immediately stand up…well, sometimes the feet balk a little. Give them a break. Stretch them. Say “good morning” to your feet. They’re at the bottom of your body and over a lifetime they take a lot of abuse. Give them a little TLC.

I also recommend that you stretch the bottom of your feet before standing up after you’ve been sitting for awhile. Many of my patients complain of plantar foot pain in the morning when they first wake up and less so after they’ve been sitting awhile. Once again, notice where your feet go when you sit, especially if you’re sitting for an hour or more; like while you’re watching a movie, or in church. They relax and they point down. The plantar fascia begins to seek its shortened position. When you stand up, you strain it with the pressure of your body weight bearing down on that tender band. So make it a habit to wiggle your feet up and down a little. Push your feet back against the floor, as if you were trying to stretch your Achilles tendon. Cross your leg and push back your big toe, like I described for your morning stretch.

Plantar Fasciitis

2011-05-18T09:16:00.007-05:00

Post provided by Barbara Bergin, MD

Stretch your feet every morning before you get out of bed.

I see at least one woman every day in my office with this problem. I have 19 partners who collectively probably see similar numbers of patients with plantar fasciitis every day. Do a little extrapolation and you can begin to imagine the amount of plantar fascial pain out there and then the cost of treating that pain. And with a couple of simple preventive measures, I really believe this pain could be eradicated. I’m looking for a Nobel prize here.

I know you were probably thinking I’d tell you about some life changing vitamin or some extract that would put cartilage back in your knees. Maybe I have a special exercise that will keep you from tearing your ACL. This foot stretching thing is so…mundane. So uncomplicated. But let me tell you that I’ve been doing it for about 10 years. I started the morning after the first morning I woke up with the dreaded heel pain. And I never experienced a second morning of waking up with heel pain. But don’t wait until you have heel pain to start stretching your feet in the morning.

I think there are a lot of preventive measures we can utilize which don’t affect the quality of our lives and may keep you from experiencing pain and some disease. It just so happens that foot stretching to prevent plantar fasciitis is a great example; a very simple example of that kind of preventive measure. It takes about two minutes to stretch your feet and there’s really no downside to it. I love that kind of prevention. Lots of potential benefit…little downside.

Let’s compare it to a mammogram. Now there’s a test with lots of potential benefit, but it comes with some downside. It’s uncomfortable. A complete stranger has to grapple with your breasts. It takes at least four years to get a little used to it. There’s a little radiation exposure. Plus it takes a couple of hours out of your day and you can’t put on deodorant that morning. You see where I’m going with this?

Let’s compare it to taking a baby aspirin every day. There’s a preventive measure with potential benefit, but in some people taking a baby aspirin can cause ulcers. If you are taking aspirin, it could be risky to take other anti-inflammatories like ibuprofen or Aleve, Celebrex or Lodine.

As you begin to realize that full wakefulness is imminent, begin to wiggle your feet up and down. Don’t be too aggressive. No need to wake anyone up. Take hold of the top of your flat sheet and gently pull it snug. Then press your toes against the firm sheet, using the sheet to assist in stretching the bottom of your foot. You’re trying to stretch the plantar fascia.

Okay, now there’s your 30 second stretch with a lot of benefits and few to no side effects or diminished quality of life. But if you want to take it one step further, and I would recommend that you do, then sit up and swing your feet around to the floor. Take one foot and pull your big toe backwards, just to tolerance. Don’t try to dislocate the joint.

While doing this you’ll be able to feel a little band on the bottom of the foot. It will feel like a bowstring. Some of that is your plantar fascia; the thing that gets so tight and causes so much misery. Massage it with your other hand. Do the same thing on the other foot. Then put your feet on the floor. If you feel pain in your heel, then start over with the stretch and massage. Repeat as needed.

What I’m really hoping for is prevention. If you already have heel pain, this might not make it go away instantly, but these stretches are an integral part of the treatment regimen for plantar fasciitis. Just keep doing that every morning before you get out of bed. If you do this before you have pain, in other words, you use it as a preventive measure, you will likely never experience the misery of heel pain.

You Can Prevent Osteoporosis Related Fractures: Part One

2011-05-11T11:02:00.000-05:00

Post provided by Marc DeHart, MD

Osteoporosis is a growing problem in our maturing population. It is the most common bone disease in humans. It is commonly confused with osteoarthritis because it starts with the greek prefix “osteo” which means “bone”. Osteo-arthritis is the wear and tear arthritis that loudly announces itself with achy sore joints. Osteo-porosis is the word used to describe thin or porous bones. Osteoporosis is known as a “silent disease” because it has no warning symptoms. The underlying problem in osteoporosis is the decrease in the amount of calcium structure in the bone. When looked at through a microscope, bone looks a lot like a sponge with many tiny bridges forming the stuff of bone. Bones with osteoporosis have fewer bridges and thinner bridges. As a result, thin bones are at risk to fail when overstressed. Osteoporosis is responsible for more than 1.5 million fractures annually, including 300,000 hip fractures, and approximately 700,000 vertebral fractures, 250,000 wrist fractures, and more than 300,000 fractures at other sites. What starts as a “silent disease” can lead to major life altering fractures of the hip, spine and wrist. After a hip fracture only half of patients return to the same level of performance. Fractures are certainly not limited to a major joint like your hip. Fractures are even more common in the bones of your back – the vertebrae. Osteoporotic fractures of the spine can lead to height loss, round back deformity, chronic pain and death.

Fractures of the wrist come from attempts at breaking the fall using your hands. Wrist fractures can lead to deformity and arthritis that make the routine daily activities of the hands painful and difficult.

It is clear that as we all become “less young” the amount of calcium in our bodies goes down. As our bones’ density decreases the risk of fracture climbs exponentially. This is much more of problem for women. As women go through menopause, their bones can lose as much as 3% of their calcium per year. Overly thin women have less bone to lose and are at even higher risk.

Dr. Goldberg Speaking at International Orthopedic Meetings

2011-05-05T13:10:00.006-05:00

Tyler Goldberg, MD, will travel to Stresa, Italy in the coming weeks to speak at the International Hip and Knee Symposium. Following his lecture, Dr. Goldberg will teach an anterior hip replacement course to fellow orthopedic surgeons in Paris.

In June, Dr. Goldberg will be in London speaking at the International Society for Computer Assisted Orthopaedic Surgery on MyKnee, a patient-specific cutting block that allows the surgeon to realize his pre-operative 3D planning based on CT images of the patient's knee.

An innovator, designer, and educator, Dr. Goldberg is involved in many professional organizations for advancement of technology intended to benefit patient care. To learn more about Dr. Goldberg, click here.

Free Joint Replacement Seminar this Thursday

2011-05-02T09:19:00.003-05:00

Learn more about non-surgical arthritis treatment options as well as total hip and total knee replacement surgery at Arthritis Camp! Refreshments are served. Bring your friends and family!

Date: Thursday, May 5th
Time: 5 PM to 7 PM
Location: Northwest Austin, 4700 Seton Center Pkwy, Ste. 200, Austin, TX 78759

Please RSVP by registering online or call 439-1100.

This FREE informative seminar is held the first Thursday of every month so if you can't make it this Thursday, plan to attend our next seminar on June 2nd!

Tips for Fitness Goals

2011-04-20T09:47:00.003-05:00

You went out to the local court over the weekend and played a few of your best pickup games ever. Now it is Monday, and your shins are stiff and painful, your back is aching, and your knees are starting to swell. If this scenario sounds familiar, then you have experienced what I call an “under fit” injury. I do not like to call them overuse injuries because that implies you should not use the muscles. “Under-fit” means you were not prepared for whatever activity you engaged in. You played three games of basketball instead of one. Basketball is an excellent sport for overall conditioning. It offers intense aerobic workout while strengthening muscles throughout the body. But it can also cause finger and ankle injuries, sprains, tendinitis, back spasms, and knee problems. Here are some tips on how to get the gain without the pain.

• Know your body’s limits. “Do not go out and try to ride like Lance Armstrong unless you have been training for a decade,” says Dr. Smith. “Gradually build up to your goal level. That might take six to 12 months, depending on your age.”

• Resist being a weekend warrior. Exercise some during the week as well, even if it is just a brisk, 30-minute walk. “The problem is we are episodic exercisers,” says Dr. Smith. “We tend to ping-pong back and forth between activity and inactivity rather than having a baseline.”

• Warm up. Begin with low-intensity aerobic activity before getting into the heat of the game. Stretching, however, is only recommended after playing. Stretching beforehand can actually make muscles weaker by fatiguing them.

• Use the right gear. Make sure shoes fit properly and offer the right support. If you have had wrist, knee, or ankle injuries before, it might be helpful to wear a brace. If you do feel you have overdone it, remember the acronym RICE — rest, ice, compression, and elevation. If pain persists, increases significantly with activity, or causes swelling, limping, or limited range of motion, see a physician immediately.

Your Fitness Threshold: The Key to Injury Prevention

2011-04-04T10:41:00.005-05:00

Post provided by Scott Smith, MD

Many patients come to the doctor with aches and pains that “started out of nowhere” apparently without an injury. They have experienced a stress to their system that was above some undefined threshold and resulted in an injury.

Everyone has heard the term overuse. I don’t like it because it implies that there is something wrong with using our bodies. Our bodies are built to be used. I prefer to think more in terms of underfitness, meaning that the activity performed was above the fitness threshold resulting in damage to some part of the musculoskeletal system. In every case there are two options. One option would be to stop or limit the activity performed. This is not only no fun it’s unhealthy. The second option is raise the fitness threshold such that it is never surpassed and no injuries are incurred. This would be great except that it is unlikely that anyone can obtain and more importantly maintain their perfect maximum fitness level. Therefore it is inevitable that we all will have some aches even if we have a high fitness threshold.

These aches should be very mild, short lived and self limited. In fact most will resolve if the body is allowed to repair itself. Daily or at the very least weekly physical activities to “stress” your system will strengthen it. As the fitness level increases so will the amount of activity required to cause pain.

The inertia of being out of shape makes it extremely difficult to make any significant commitment to exercise. By exceeding our threshold in our first few workouts we become sore or even painful where we can no longer perform. This stops us in our tracks physically not to mention what it does to our mental outlook. The next re-initiation of a workout program is more difficult and less likely to succeed. A more gradual approach is much more effective. This allows the body to repair the “damage” from a work out and stepwise progress toward healthy fitness is made. If significant soreness is present don’t stop workouts just decrease intensity and persists at a lower level. Then make slower progress as the discomfort subsides. If problems persist seek professional help.

Specialists Who Treat Back & Neck Pain

2011-03-22T14:44:00.006-05:00

There are many types of health practitioners that care for patients with spinal conditions, and each has a slightly different role. Selection of the most appropriate type of health professional—or team of health professionals—largely depends on the patient’s symptoms and the length of time the symptoms have been present.

There are three broad groups of health providers who treat back pain:

Primary care providers are often the first port of call for patients when back pain strikes:
Primary care physicians (Family practice doctors, Internists, Pediatricians)

Chiropractors

Doctors of osteopathy

Spine specialists have a specific area of expertise in diagnoses and/or treatments for back pain:
Spine
Physiatrist
Surgeons (Orthopedic surgeons and Neurosurgeons)

Anesthesiologists

Neurologists

Rheumatologists

Therapists for back pain or psychological help for chronic pain:

Physical therapists

Clinical psychologists

A Physiatrist is a Medical Doctor who specializes in Physical Medicine and Rehabilitation (PM&R). Essentially, physiatrists are nerve, muscle, and bone experts who treat injuries or illnesses that affect how you move.

Physiatrists diagnose and treat both acute and chronic pain and musculoskeletal disorders. They can order and interpret all types of spine imaging (x-ray, CT myelogram, MRI, bone scan) and perform specialized nerve tests (EMG and NCS) to help assess the location and severity of nerve damage. Typical treatments may include:

o Referral to Physical Therapy (e.g. exercise, stretching, heat/ice, TENS units)
o Prescription medications
o Electromyographic studies
o Interventional procedures (e.g. epidurals, joint injections)

Physiatrists treat a wide range of problems from sore shoulders to spinal cord injuries. Their goal is to decrease pain and enhance performance without surgery. Physiatrists take the time needed to accurately pinpoint the source of an ailment. They then design a treatment plan that can be carried out by the patients themselves or with the help of a team. This medical team might include other physicians and health professionals, such as neurologists, orthopedic surgeons, and physical therapists. By providing an appropriate treatment plan, physiatrists help patients stay as active as possible at any age. Their broad medical expertise allows them to treat disabling conditions throughout a person’s lifetime.

Texas Orthopedics has two physiatrist, Dr. Kenneth Bunch and Dr. Ai Mukai, that work closely with our orthopedic surgeons to provide comprehensive musculoskeletal care.

Back Pain

2011-03-08T09:00:00.005-06:00

Post provided by Ai Mukai, MD

What can cause back pain?

There are many structures in the back area that can cause pain. Some of those structures are:
• Muscle – muscle strain and sprain – usually achy, may have spasms
• Disc – usually sudden pain, can pinch nerve, twisting and bending makes it worse
• Bone – fracture of the back bone or smaller bony structure in back – usually constant, may be sharp or achy
• Ligament – strain or sprain, usually worse with movement
• Nerve – pinched nerve – can shoot pain to one side or another, feels like burning, shooting, tingling pain
• Joint – sacroiliac joint – near the base of spine and buttock area, worse with transitional movements like sit to stand
• Joint – facet joints – “knuckles” of the back, pain with bending backward or twisting.
• Coccyx – tailbone pain- worse with prolonged sitting, feels achy and inflamed

How do you figure out what is causing the pain?

X-rays can show broken bones or alignment issues. MRI is usually needed if soft tissue injury or cause is suspected like disks, pinched nerves, and ligaments. Information about how the symptom started, what it feels like, what makes it better or worse and physical examination can help narrow down the possibilities. Sometimes, there are multiple causes for the pain and one pain can cause another. Lab work can diagnose issues that may be preventing you from healing or causing more widespread pain and inflammation.

What are some possible treatment options?

Physical therapy is the key to improving alignment, taking pressure off areas of pain, and preventing future injuries. For the spine, McKenzie method and looking at the stabilizing the pelvis seems to give the best long term results. To help with the symptom relief of pain, different types of medications aimed at the different causes of pain (nerve pain medicine, muscle relaxers, anti-inflammatories) can be taken short term while undergoing physical therapy. For more severe pain or long term issues, non-surgical procedures such as injections into joints, epidural space (space where discs and nerves live), and muscles may help. There are more specialized procedures geared towards specific structures like radiofrequency ablation (burn the small nerves that supply joints) and spinal cord stimulators. Sometimes, the procedure can help diagnose the cause of the pain. Lastly, if all options fail, or there is something that needs to be addressed surgically, spine surgery is an option.

Texas Orthopedics Physical Therapist qualifies for Boston Marathon

2011-02-23T10:59:00.003-06:00

Amber Anderson, PT ran in the Austin Marathon with a final time of 3:39:56 placing 19th in her age group and 525 overall out of 4,796 finishers for the full marathon.

This was Amber's first full marathon! Congratulations Amber!

The Squat Debate

2011-02-14T10:16:00.003-06:00

Post provided by Barbara Bergin, MD

There were many negative comments regarding my “Do No Squats” blog. I wasn’t surprised because the exercise industry is very invested in that exercise form. One has only to read a copy of SHAPE magazine and see that about every 10 pages has a product to assist in doing squats or a program using squats as its staple exercise.

Squats are an efficient way to strengthen the quads and gluteal muscles. Because they are the largest muscle masses in the body, exercising them results in more sweating, caloric expenditure and a great burn.

But I honestly do believe that the world would be a better place without the squat as a form of exercise. I see patients in my office 3 full days a week and every week I will estimate that I see 4 people a day, therefore 12 people a week with injury related to doing squats, deep knee bends or lunges. If you extrapolate that number, minus a few weeks for vacation then you have about 600 people a year! I’ve been doing this for over a quarter of a century so I would say I’ve probably seen 15,000 patients with disease related to doing squats. Most of them are women but many are men. All ages are affected.

I cannot think of another single activity which so consistently sends people to my office with complaints of pain in one specific place (the knee). There are other issues which are frequently associated with orthopedic problems. Motorcycles, for example, consistently injure people in an unfortunately predictable way, and obesity, which is associated with all sorts of lower extremity and bodily disease. I will also someday blog away on those two subjects as well. But right now, I’m addressing squats again because that blog made a lot of people very angry.

Sure, squats can be done without caution by some people. Some healthy people. Who defines a “healthy person” before the deed is done. One could also say that healthy people can eat all the sugar they want or drink all the alcohol they want. But who preemptively defines a healthy person? Define the healthy knee before a person starts a squatting program. Who knows what a healthy knee alignment is…before the fact? Does that person have any patellar malalignment? Do they have chondromalacia patella already? Do they have a meniscus weakened by former injury, age or genetics?

There are people who can probably do squats with abandon. Men are more likely to be able to do them without issue than women. Young men better than older men. A person with no existing crunching or grinding under their knee cap would be better at them! A thin person more so than a heavy person. These are very general categories and if a person came to me to ask if they could start a squatting program, I might be able to make a generalized prediction, but I could never give the recommendation because there would be liability for me in that recommendation.

If one has to squat for a living, then one should be conditioned to squatting. But I have seen many plumbers, electricians, welders and computer repair specialists who must discontinue that line of work because of patellofemoral disease related to their squatting job description. And as for the comment regarding the need to strengthen the muscles in order to be able to get off and on the toilet…well, most of us have been adequately conditioning those muscles since we got out of diapers.

But if one doesn’t have to squat to put food on the table, then one should proceed with a squatting exercise program with caution. Be aware of the presence of pain during and AFTER the exercises. Be aware of the development of crunching under the kneecap and swelling of the knee. Make sure you follow good instruction with regard to the positioning of your hip, knee, ankle and foot, and the depth of the squat.

One comment suggested that doctors bug off with the prevention and stick to curing disease once it has manifested itself. Most doctors practice prevention every bit as much as the curing of disease and it’s the purpose of my blog. I want this information to go out to the public for the purpose of prevention as well as cure.

In blogging about a controversial issue there is always the possibility that what I say might cause some readers to seek advice elsewhere. That’s a risk I must take. If more business was what doctors were all about, we would encourage squatting, motorcycle riding and overeating.

Dr. Bergin honored as She! Women of Influence

2011-02-08T16:12:00.006-06:00

Dr. Bergin was recently honored as Women of Influence in She! a supplemental magazine in the Westlake Picayune and Lake Travis View. The magazine focused on women of influence in the Austin area. According to the magazine, these are the ladies that do it all, make a difference and change the world. Women who are devoted, engaged and striving to make themselves and their communities better.

Read Dr. Bergin's article!

Pictured above: Carol de Cardenas, Dr. Barbara Bergin, Susan Combs and Jerri Ward

Joint Replacment Seminar Rescheduled

2011-02-03T10:02:00.002-06:00

Due to the possibility of snow, tonight's Arthritis Camp has been rescheduled to Tuesday, February 8th at 5 pm.

Free Joint Replacement Seminar at Texas Orthopedics

2011-01-31T09:44:00.004-06:00

Please RSVP by registering online or call 439-1039.

This FREE informative seminar is held the first Thursday of every month so if you can't make it this Thursday, plan to attend our next seminar on March 3rd!

FREE joint replacement seminars this week!

2011-01-24T10:13:00.005-06:00

If you are interested in learning more about the advancements in hip and knee joint replacement, attend one of the following seminars provided by Texas Orthopedics physicians.

Tuesday, January 25, 2011 6:00 PM

Speaker: Tyler Goldberg, MD

St. David's North Austin Medical Center
12221 MoPac Expressway North
Austin, TX 78758
Room: Classroom B, 2nd Floor

New Advancements in Knee and Hip Replacement: Learn how new techniques, such as the anterior approach to hip replacement, are utilized to spare muscle tissue, providing a quicker recovery. Discover how we are using Computer Assisted Navigation for both hip and knee replacement to provide the least invasive surgical option.

Register today!

Thursday, January 27, 2011 6:00 PM

Speaker: Christopher Danney, MD

Cedar Park Regional Medical Center
1401 Medical Parkway
Cedar Park, TX 78613
Room: CPRMC Cafe

If hip or knee pain is keeping you from doing the things you love, find out about the advanced orthopedic treatsments at this seminar.

Register today by calling (512) 528-7100

Do Not Do Squats!

2011-01-21T09:50:00.003-06:00

Post provided by Barbara Bergin, MD

That’s a good New Year’s Resolution. If a bunch of folks could read this and follow it, I’d see a lot less of you because I can predict that I’ll see 2-3 patients every week this year for knee pain related to starting some kind of a squatting exercise program!

DO NOT DO SQUATS! Let me emphasize the point. DO NOT DO SQUATS!

And learn to recognize deceptive forms of the squat; the deep knee bend, the lunge and its particularly egregious variations, the weighted lunge and especially the forward-moving-weighted-lunge. I don’t know what it is called but I want to put a red circle with a cross hatch on those.

A lot of people are going to hate me, including most trainers, coaches and promoters of video training programs. I’ve got to admit that squats are a good way and maybe the best, most efficient and cheapest way to build gluts, quads and hamstrings. They utilize some of the biggest muscle groups in the body and so you can work up a good sweat and feel the burn. So doing them accomplishes a goal and maybe for football players, it’s the best way. But it’s dangerous for their knees, their cartilages and particularly their knee caps. There are some individuals who are biomechanically sound to do squats but they are rare and there’s really no way to identify those people and predict how long they can tolerate it. So, there are some people who tolerate smoking cigarettes just fine. But more of us can’t and so in general we say, “Don’t smoke.” And in general I like to say, “Don’t do squats!”

Here’s how it works. When you squat you put tremendous pressure on your knee cap since it’s the fulcrum through which you bend and straighten your knee. That puts pressure on the delicate cartilage that lines the knee cap. When you do a deep squat it also put tremendous pressure on the meniscus cartilage (the rubbery shock absorber cartilages between the two bones). Over a period of time (years for some…one squat for others) that can cause wearing of these delicate and important structures in the knee. Once that happens, arthritis begins to develop. And that can even happen at a young age.

For most of us, there are a lot of other exercises we can do to gently strengthen those muscle groups; straight leg raises, quarter squats, leg curls and extensions with low resistance, stationary bike, elliptical trainers, swimming, and the list goes on. I see so many patients with knee pain and in quite a few, particularly those with knee cap pain, I can elicit a history of doing squats…or one of its varieties. So when your personal trainer says he’s going to get your butt into shape…beware of the squat and just say “no.”

Diagnosis and Treatment of Arthritis

2011-01-17T13:01:00.004-06:00

Post provided by Marc DeHart, MD

In last week’s blog post we used a car tire analogy to help explain arthritis. This post focuses on the basics of diagnosis and treatment alternatives available for people who suffer from the pain, stiffness and loss of function that goes along with arthritis.

Diagnosis: Do I have it?

Most patients suspect they have arthritis when their joints ache and are stiff in the morning. Frequently their stiffness improves with gentle motion but may come back after they sit still for some time (“gelling” phenomena). Pain often improves with light activity but is usually gets worse later in the day after harder activity, walking long distances or standing for a prolonged time. Over months or years the ability to bend or straighten the joint (“range of motion”) may decrease. Joints may swell from fluid collecting in the joint or from the growth of bone spurs (osteophytes) as the cartilage wears away. Fingers and knees may become “knobby”. The most important finding is a major decrease in the function of the joint.

A simple x-ray is the first diagnostic test to prove arthritis of most joints. X-rays can show the bone spurs and decreased space between the bones that can be found with severe end stage arthritis. Lab studies are rarely needed to diagnose the most common types of arthritis, but blood tests are helpful in diagnosing inflammatory arthritis such as rheumatoid arthritis, lupus, or ankylosing spondylitis. A MRI study is the best diagnostic test for viewing the soft tissue of bones and joints. However, it is an expensive test that is useful only if x-rays don’t make the diagnosis.

Treatment: What do I do about it?

Experts in arthritis concede that although there is no known cure for arthritis, we can help manage the symptoms. The treatment of arthritis begins with exercise to keep the joint moving and to maintain the strength of the muscles around the joints. Experts in arthritis recommend continuous motion exercise beginning with 15 – 30 minutes each day. Fitness walking, low tension stationary biking, low angle treadmill walking and water aerobics are tolerated well by most patients.

Patients are often interested in medications to help manage the pain from arthritis. Acetaminophen (Tylenol) is a pain medicine that is a first choice drug for arthritis because it is available without a prescription and is safe when used at recommended doses. Anti-inflammatory medicines such as ibuprofen (Motrin, Advil) and naproxen (Naprosyn, Aleve) help many patients with arthritis.

When exercise and the usual drugs don’t adequately relieve pain, patients are often willing to try more invasive means to help. Cortisone injections have been used for over fifty years and can be a safe and effective way to temporarily reduce pain for most people. Newer injections made with hyaluronic acid are commonly used to decrease the inflammation and pain for knee joints. These shots are sometimes called “chicken shots” because hyaluronic acid is a protein found both in rooster combs and in normal joints.

Finally, if x-rays show end stage arthritis and other treatments fail to control symptoms, surgery for arthritis may be necessary. The most common surgery for arthritis is joint replacement (total joint arthroplasty). The procedure involves cutting out the destroyed cartilage and bone then replacing it with metal and plastic parts. Hips and knees are some of the most commonly replaced joints and over 90% of the patients who get them get rid of 90% or more of their arthritis pain and are able to maintain their range of motion and function for 10 to 20 years or more.

Treatment for your arthritis depends on the cause of your arthritis, your age, the severity of your symptoms and your willingness to accept the risks of the treatment. When picking a course of travel on new highways, having a good map helps guide your path. The best resources are your family doctor, rheumatologist or orthopedic surgeon. Schedule a visit so they can help get you back on the road!

Why Do I Have Arthritis?

2011-01-10T11:56:00.006-06:00

Healthy Knee

Arthritic Knee

Arthritic Hip (left) Healthy Hip (right)

Post provided by Marc DeHart, MD

If you have joints that are stiff, painful and have lost mobility, you are probably one of the 46 million Americans who have arthritis. Arthritis is the wearing out of the surface on the end of the bones and affects both large joints (hips, knees and shoulders) and smaller joints in the hand, feet and spine. Arthritis can come from injury and aging as well as specific problems with the soft tissues around the joints. Wherever it is found in the body and whatever causes the damage to the cartilage, it is the painful, swollen, and stiff joints which keep you from being active and moving on down the road.

All joints have a smooth white slippery covering called cartilage which acts as the bearing surface for movement. It is where the “rubber hits the road” for the movement of joints. There are over 100 various disorders which cause damage to the cartilage. The most common arthritis, osteoarthritis, results from stresses on cartilage that are greater than the tissue can withstand. This can be routine forces on weakened cartilage or from excess forces on normal cartilage. Researchers have found that an inherited weakness of the main protein in cartilage (collagen) frequently leads to early osteoarthritis. Hormones that help make women’s tissues soft, supple and more flexible for pregnancy may be a reason women have twice the osteoarthritis of men. It is easy to understand how the forces of direct trauma can damage cartilage and its underlying bone. Motor vehicle accidents, falls or severe sports injuries, especially those that tear ligaments, are well known causes of arthritis later in life. Using a tire example, driving recklessly over potholes or across sharp metal objects will clearly tear up your tires! Excess force on the joint over the long term can also wear out healthy cartilage.

People with crooked legs from bowlegs or knock-knees or from poorly healed fractures of the leg bones, wear out their cartilage on the high stress side of their joints. People with straight legs can also overload their cartilage with continuous loads that crush their cartilage. Participation in high level sports like soccer and football has also been associated with more frequent arthritis of the hip and knee. Occupations where heavy loads are lifted repeatedly, such as farming and ranching, can also lead to arthritis. Being overweight causes heavy loads across your joints with every step. Obesity is not only a common cause of hip, knee, and ankle arthritis, but it also makes your symptoms worse.

Other causes of arthritis are uncommon diseases like rheumatoid arthritis, psoriatic arthritis and lupus. These autoimmune arthritis disorders result when the body’s immune system goes awry and attacks its own cartilage. Using the car tire example, you can think of autoimmune disorders as a bad battery acid leak on the tires where the rubber slowly dissolves away!

Treatment for all arthritis is to decrease pain and improve the function. Treatment depends on the cause of your arthritis, your age, the severity of your symptoms and your willingness to accept the risks of the treatment. Avoiding high demand activities, weight loss, gentle exercises, canes or walkers, pills, injections and various surgical procedures can all be effective treatments. Your best resource for the diagnosis and treatment of arthritis is your family doctor who can refer you to a specialist should the need arise.

What Would a Caveman Do?

2010-12-27T09:19:00.005-06:00

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 http://barbarabergin.posterous.com/

Little League Parent Syndrome

2010-12-21T10:18:00.003-06:00

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.

Vitamin D Deficiency Common Among Orthopaedic Surgery Patients

2010-12-13T15:18:00.005-06:00

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.

Pain Pills- part 5

2010-12-09T12:01:00.003-06:00

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: http://www.fda.gov/forconsumers/consumerupdates/ucm101653.htm

New South Austin office opens Wednesday, December 1st

2010-11-30T08:50:00.005-06:00

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.

9 Texas Orthopedics Physicians Named Super Doctors by Texas Monthly

2010-11-29T10:29:00.005-06:00

Congratulations to our nine physicians who were voted Super Doctors by Texas Monthly magazine!

- Bradley Adams, DO
- Barbara Bergin, MD
- Donald Davis, MD
- Robert Foster, MD
- Peter Garcia, Jr., MD
- Tyler Goldberg, MD
- Richard Lutz, DO
- Scott Smith, MD
- Archie Whittemore, MD

Texas Orthopedics Employees Pick a Christmas Charity

2010-11-22T08:32:00.005-06:00

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.

Pain Pills- part 4

2010-11-15T08:56:00.002-06:00

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.

Texas Orthopedics volunteers at Race for the Cure

2010-11-10T13:37:00.006-06:00

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

Pain Pills- part 3

2010-11-08T08:45:00.004-06:00

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.

Pain Pills- part two

2010-11-02T08:12:00.004-05:00

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.

Pain Pills - part 1

2010-10-25T08:51:00.002-05:00

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.

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

2010-10-06T08:24:00.004-05:00

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

You Kick Like A Girl

2010-09-13T16:25:00.004-05:00

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.

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

2010-08-30T10:55:00.005-05:00

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.

Round Rock Open House & Ribbon Cutting

2010-08-20T11:05:00.005-05:00

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.

Carpal Tunnel Syndrome, Part 2

2010-07-19T10:12:00.004-05:00

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.

Carpal Tunnel Syndrome, Part 1

2010-07-14T15:51:00.007-05:00

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.

Adult Repetitive Strain Disorders, Part Two

2010-06-02T10:31:00.006-05:00

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!

Adult Repetitive Strain Disorders, Part One

2010-05-26T10:07:00.006-05:00

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.

Austin Medical Relief for Haiti has a website!

2010-05-21T11:43:00.005-05:00

www.austinhaiti.org

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!

http://surfacetoairstudios.com/haiti/haiti.html

New Prosthetics Lab

2010-04-27T10:20:00.003-05:00

Peace with your Pain

2010-04-23T14:13:00.003-05:00

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

2010-04-21T15:58:00.001-05:00

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

2010-04-12T14:22:00.004-05:00

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

2010-04-08T11:01:00.003-05:00

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

2010-04-07T17:40:00.002-05:00

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

Picture #2: New ward

4/5/10 - Team 11, Day 4

2010-04-06T08:38:00.002-05:00

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.

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

2010-04-05T08:06:00.004-05:00

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

2010-04-05T08:01:00.002-05:00

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.

Team 11 making their way to Haiti

2010-04-02T15:27:00.001-05:00

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

Team 10 update/Smider & Job update

2010-04-01T13:00:00.003-05:00

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

Ashley Hurt's update from Haiti

2010-03-29T08:59:00.003-05:00

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.

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

2010-03-28T22:15:00.002-05:00

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.

We Live in Good Times

2010-03-22T11:40:00.004-05:00

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

2010-03-22T08:16:00.000-05:00

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.

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

2010-03-21T05:55:00.002-05:00

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)

Refuge in the Haiti Hills

2010-03-19T08:15:00.002-05:00

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

Just How Do You Fix a Broken Bone?

2010-03-18T15:25:00.004-05:00

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

3/14/10 - Team 8, Day 1 & Day 2

2010-03-18T08:43:00.005-05:00

Update from Nathalie Fiset, MD:

Like it is so often the case, before I leave for a medical mission, all my patients wanted to have their babies before I got on my plane. As a result, I ended-up doing a full day of appointments and delivering 3 babies (the last one at 7:10 a.m. as I said I needed to leave at 7:00 for the airport) and have not slept at all. I am happy though that I got to be present for all my patients and I actually was able to change my seat and get a window on the plane so I will sleep.
At the airport, the clerk was nice enough not to mention anything nor overcharge me for my very heavy suitcases. Before landing in Haiti, I am inhabited by a sense of sadness by seeing all the devastation. Usually when you approach a city, you see the swimming pools from the air. Here what is apparent are the numerous blue tents next to most houses that are down in dust.

At the airport, there is no customs formality whatsoever and immigration asks nobody questions. Then, the chaos starts: there are no carrousel for the luggage so a few bellboys are doing their best to find the screaming crowd’s suitcases and boxes. The luggage also comes very slowly and is often broken or dirty. It gets even worst when we get outside as there is a screaming crowd and we have to work our way outside because the truck is stuck two streets away. I hold on tightly to my guides.

After getting in the truck, we basically are stuck in traffic as there are no roads and no traffic lights. We finally get moving after an hour and get on a dirt road. We pass in front of hills that smell very bad. I am told this is the burial ground for the people who perished in the earthquake. My guide tells me that more than 200 000 people died. I am overwhelmed by a sense of loss this nation has suffered. I set up my little tent and try to go to sleep but it is very hot and damp and my sleep is light.

Today I am scheduled to do consultation at the local clinic. The pace is very slow and after two hours, I still have not seen any patient. I am learning to take it easy. I see a teenager who is dehydrated, has a high fever and pneumonia. I am surprised to see that this clinic is so well equipped. They even have an ultrasound machine and labs. I am happy to see that most people understand my French and that I can guess Creole and communicate with people. My highlight of the day is when we had extra time and played with the cutest twins.

As we ask people how the earthquake affected them, some children mention that they are now afraid to be inside and would rather sleep in a tent as they saw buildings collapse and kill their friends and loved ones during the earthquake. This morning, one of the team affiliates brought his son Matthew, a Haitian little baby boy that he rescued from an orphanage a couple of months ago in a near death condition. He also mentioned that sadly, many of the clothing, food and toys donated to orphanages are either stolen or sold. People have to be very careful who they donate to and make sure that their donations make it to the ones who need it. After taking a nice shower I realize that all my make-up and my deodorant have completely melted. What do you know, it was hot today!

Update from Tammy:

The OR has not been too busy. Monday we did a 2 month old ankle fracture and an I&D of elbow and a wound change on Job. Tuesday no surgeries but myself and Joe, a cath lab nurse from California, spent the day cleaning, organizing and sterilizing. Basically seeing what there is to work with! Really pretty good. I hope we are making it better and easier for the next team coming in. Today we did 5 cases. 2 external fixator adjustments and 2 ex fix removals. 1 I&D. Have an early morning planned , a 7:00 am ankle fracture also an old injury. As before, I am totally impressed and in love with the people here. Their faith and spirit keep everyone happy to be here and really give everyone perspective. I feel blessed by being here.

Picture: Waiting to be seen at the MOH clinic

3/14/2010 - Team 8 is on the ground!

2010-03-15T09:00:00.000-05:00

Team 8 members from Austin include:
Matt Roberts, MD, Capital Anesthesia
Nick Nunez, MD, emergency medicine
Doris Robitaille, MD, family practice
Jennifer Allen, PT, wound care, Seton
Tammy Noel, RN, Texas Orthopedics
Bridget Russell, RN, St. David's
Tomorrow Laureano, RN

Joined by other team members from N. America:
Orthopedic surgeon from New Hampshire and his daughter: Brad White, MD and Margo White

A team from The Grove Community Church in Riverside, CA:
Michael Lance, PA
Jackie Bowier, PA
Joe Giron, RN
Vickie Schlone, RN
Dan Lamy, EMT
Chris Galletta, paramedic
Pastor Mike Barnes

Canadian team members:
Nathalie Fiset, MD
Agnes Hyma, RN

Cheryl Hoover, RN with the Indiana Purdue team

Week 2 for Hannah Warren from the UK with Mercy Ships!

3/12/10 - Team 7, Day 6

2010-03-15T08:07:00.002-05:00

Our brief visit draws to a close. Most of us just landed in Miami, tired, excited, our heads spinning. A handful of our nurses (Hannah, Sally, Agnes, and Lyn) are staying for a second week, so they will mind the patients in the ward today and through the night. Along with Brad, Grant, Lindsey, Dr. Cheryl and the rest of our new-found Haitian and Mission of Hope friends, a smooth and coordinated hand off of our patients to team 8 is assured. At least we won't fear for the well-being of that group of patients. They are in good hands at the Mission and will get the care they need. In fact, Dr. Glenn just told me that he gave report by phone on all the recovering cases to the oncoming Orthopedic Surgeon.

For our last full day on Friday, as with Thursday, the sun peeked over the hills across a nearly cloudless sky, and by 9 or 10 the heat was building. We had to remind ourselves to drink lots and lots of fluids, and even then, it was hard to keep up. The Team worked hard, with several very ill patients early in the day that made us a little slower than normal treating the more routine people. We had to transfer a young feverish man to a hospital over an hour away. He was most likely suffering from cerebral malaria. Another woman we sent to the local Obstetrics clinic. She was nearly due, had minimal, if any, prenatal care, and was having contractions. We were worried about her being in premature labor, complicated by severe anemia. We needed a bed for another elderly lady with congestive heart failure, whose lungs we're half full of fluid from chronic untreated hypertension, but she wasn't too uncomfortable sitting up in a chair, so that is where she stayed for treatment. We parked her next the bathroom after a large dose of diuretics. Thankfully, several visiting nurses from Wisconsin arrived and offered to help (I have no idea who they were but I do know they dropped in at just the right time, proverbial manna from heaven). One was kind enough to provide one-on-one care for several hours as the lady very slowly improved. Yesterday was our busiest OR day yet, and we ended the busiest operative week to date for the Mission. As a testament to the maturing capabilities at the Mission, most of the work is being referred from other hospitals in the surrounding area, including the University of Miami tent hospital in Port au Prince. Accordingly, the wards were filled with patients their families, translators, many of whom were operated on earlier in the week. One of our nurses, nurse Julie, gave her tent to one family to go away with. At least then they would have a home to take 'home' as they left, a shelter in which to care for their special needs child.

When Team 8 arrives, the members of the their team will need to look over as much of their work and supply areas as possible to quickly get an idea of what they have and where things are. When the doors open Monday morning, things will ramp up quickly! We are excited for them, for we know they will continue to provide much needed care. We now know, as prior teams have learned, and as future volunteers will as well, that we have received far more from the Haitians than they have from us. We know that the next team will come home wanting to go back. They will be reminded of how good it feels to bring together a large group of individuals, each with his or her own skills and gifts, for a common purpose, each one willing to focus only on the mission, the goal of helping just a few people who need our help. They will be reminded of how inspirational it is to be led by those who live their faith. And they will come home with hundreds of stories. Stories of horror and tragedy and struggle. And songs. So many songs. And they will see faith and resiliency and hope and love. In action. They will feel it and see it and smell it. And they, like us, will never forget, and will be forever grateful for being allowed to be part of this. Dr. Glenn and I were talking a few minutes ago, still trying to grasp the scale of it all. This afternoon, we drove for several hours through the streets of Port au Prince, a city of between 3 and 4 million people before January 12th, trying to make sense of whether our tiny efforts mattered.We remembered that we only saw 500 or so in the Clinic this week and only operated on about 30. Could this really amount to anything given the scale of the need? In the face of such obstacles? When what is needed is not just 21st century medical miracles eked out one at a time, but shelter, food, clean water, education, and opportunity? The answer is absolutely yes. If we do our part, and other teams do their parts, and the efforts continue, then after a year, 1500 will have had surgery, and twenty-five thousand seen, just in the Mission of Hope clinic. If 20 other missions and NGO's do what the Mission of Hope is doing, then after a year, 30,000 Haitians will have had surgery and half a million seen in the clinics. Together, each doing a little, we will have made a difference. Now is a good time to look at the calendar, and pick a week, and join this effort. Put your gifts into action. We are grateful we have, and look forward to having others join us when we return.

3/11/10 - Team 7, Day 5

2010-03-12T08:32:00.002-06:00

Text from Glenn Speigler, MD:

It Is just so amazing that a group of strangers could become such a team. Each of us a piece of a puzzle. The whole far greater than the individuals. Have been doing 7 wk old cases with levels of complexity that until now I would have thought impossible.. To date no operative infections. We feel that in many cases the care is equal to the US. Another full OR today. Will be doing overflow on Saturday. Have begun scheduling for next weeks team. They will be operating. Have become the referral center for facilities much larger than us. Lives depend on future teams. Please please please keep them coming. With great appreciation and respect.

Update from James Dudley, MD:

Just as I hit 'send' last night, our team found out what it is like to have the only 24/7 hospital in this area of 'Ayiti'. An important security official from a nearby town showed up with several armed escorts at the compound's front gate, requesting entrance; he was suffering terribly from a "belly ache, belly ache, fever, terrible fever". The guards radioed up to the ward where Dave, the flight medic, and Amie, our nurse practitioner were on duty, passing on their request. They talked it over, (well, maybe for about 15 seconds!), and soon, they were evaluating the gentleman. The call came up to the Guest House a few minutes later; orders were given and treatments started, and in a few minutes, as the 'on-call' doctor, I was on my way down to the ward. At night, the local populations of ponies seem to graze more freely, closer to the roadside than during the day. But, they remain skittish. Even though I expect them to move away as I approach, when they finally do bolt, I can't help but feel my heart race. I couldn't help feeling a kid's sense of grand adventure, as I made my way down the hill. The stars to the south were spectacular with constellations we from the north rarely get to enjoy. I had asked Dave to place our newest charge away from the other patients, partly out of deference to his status in the community and partly out of concern that should he be contagious, it wouldn't compromise the other patients, most of whom are post-operative patients. The Mission of Hope Hospital has one of the cleanest Operating Rooms on this side of the country, and it has allowed our pair of Orthopedic Surgeons and our Plastic Surgeon to take on very complex, professionally satisfying, and meaningful work. They are giving significantly injured patients a wonderful chance to return to normal or near normal function, but it is essential that we be vigilant to prevent wound infections. Dave and Amie had come up with the perfect solution. The officer was appropriately placed at the far end of the ward's central hallway, away from the others, on a mattress with fresh linens. Along with the IV fluids and medications he had received, they had also done the hard work of reassuring him and his wife as well as his comrades. Our able, if sleepy, translator, along with the patient's high level of education and ability to give precise details about his illness made my job easy. We decided to allow him to rest in his relative privacy until one of our Haitian physician colleagues, Dr. Alix, could weigh in on the situation in the morning.

The waning crescent moon was just rising over the mountains as I made my way back toward the Guest House around 2 AM. However, another patient, a 5 year old trauma patient, came in around 5 AM. He was on a small motorcycle with his dad and another young man, headed to the clinic to have a rash on his hands evaluated when his bare foot slammed into a cinder block wall. A large cut on the inside of his ankle was just the tip of the iceberg. Again, Amie and Dave did all the right things. The IV Morphine eased his pain, and the first dose of IV antibiotics began infusing within an hour of his injury. They reported he never whimpered as the line was started. n the way down to check on him, as I rounded a curve and emerged from a clump of trees, I saw a small figure sitting on a boulder playing what looked like the guitar from a few nights earlier. Jean Marc, about 14-16 years old, sat facing east as the sun rose from behind the hills and lighted his face. There was no one within a hundred yards of him. Jean Marc is the daytime translator for us on the wards, and his shift hadn't yet started. We chatted as he strummed away and after a bit, I asked him if he sang or just played. "Oh, yes, I like to sing" and added his warm voice to the easy rhythm of the chords. he antibiotics were finished by the time I made it the ward. The boy with the injured ankle required not only orthopedic work, but the transfer of a nerve by Dr. Matt, our Plastic Surgeon. This nerve is to take the place of the nerve on the inside of the ankle that was avulsed by the wall. Without this nerve, sensation in the foot is lost, and in the harsh environment of Haiti, inevitably he would end up an amputee, probably after years of progressive disability.

The whole team is really coming together to make a difference here. As we share stories at day' s end, one concern we all have is who is going to step into our respective places once we leave. The need is not just now, it will be for years. Mission of Hope is working, as are many groups, to build this as a sustainable venture. This is the essence of the work we were all called to do when we set out on our careers. For any who are able, this is an opportunity of a lifetime.

3/10/10 - Team 7, Day 4

2010-03-11T09:47:00.002-06:00

Update from James Dudley, MD:

It is nearly midnight, and the camp-style singing, tonight a gift of our college colleagues, continued until nearly 10. I don't know if the guitar lives here, awaiting the next player, or if one of the others brought it. It definitely seems that college aged men and women definitely have more energy this time of day compared to some of us middle aged doctors and nurses. They have probably done a lot more hard physical work today than we doctors and nurses, but most of our group has turned in while many of them are still giggly. Ah, to be so carefree. Mission of Hope-Haiti lies above the northern shore of a large horse-shoe shaped bay that is also ringed by mountains on the south and east. The opening of the bay faces west, and the south eastern edge of Cuba lies fewer than a hundred miles away. The Mission property sits on the foothills, no more than a few miles from shore, probably about five hundred feet above sea level. Its views of the Caribbean are spectacular. The 70 acres are basically a large narrow rectangular of land with the long borders running more or less in a south to north direction, up the hillsides. The gates of the compound are at the downhill, southern edge, and it is there, at the gates, where the queue forms each morning. The Guest House, where we stay, lies well up the hillside, probably a half mile up from the gates. The rocky road winds up the eastern side of the property. As one travels north, up from the gates, the large church, which holds hundreds of worshipers, sits to the left, or west. It has a large low-pitched A-framed roof and only posts hold up the roof and its trusses; its walls are open. Beyond the church is the cafeteria for the schools and to its west, a substantial concrete two-story rectangular High School. Each floor has a long central hall with classrooms on each side. After the earthquake, the school was needed for medical purposes and now it houses a hospital ward. There, our nurses, two at a time, around the clock, staff the downstairs ward, where patients are arranged up to four in a room. Family members stay with each patient. Tons of supplies are packed into the upstairs classrooms, but these temporary quarters have to find a new home soon, since the Haitian government expects school to reopen in April. In one of the store rooms is a box labeled "Tents for discharged patients". A hundred yards up the hill from the ward is the Clinic, and as the doctors and the day shift nurses walk down for rounds and change of shift in the morning, the gates open and several hundred people of all ages, a few at a time, wind their way up the hill. It is a sight to behold, a quarter mile line of people, hurrying as best they can the first in line.The Operating Room team heads directly to the clinic, and finishes their last minute preparations. As the patients gather outside the clinic one of nurses greets those assembled and matter of factly leads them in song. This morning's hymn was a beautiful Creole version of "Praise God from Whom All Blessings Flow". The conviction the Haitians expressed as they embraced the message in those words left me shaky. Following the hymn was a prayer. The rhythm seemed vaguely familiar as the phrases, some long, others shorter, rolled into the clinic from the waiting area, but its Creole words were lost on my untrained ear. The nurse told me later it was the 23rd Psalm, about walking through the valley of death. We have no time to dwell on those moments as the pace of the day's work overtakes us. Each person has a story to tell, or a hundred stories, and we each gather bits and pieces as we do our respective work. The team comes together a little more smoothly each day. The medics transport patients up from the ward to Pre-Op then triage the masses. The ER fills and treatments begin on the sickest of the group. The exam rooms fill and we move as many as we can as fast as we can, trying not miss those who are truly acutely sick, and not simply exhausted, hungry, burdened by parasites or lingering grief. Then, as before, almost suddenly, they are gone except for the late OR cases, and those awakening from surgery. In some ways, we all struggle to regain our bearings. So, at the end of the day, to share food and stories and music, brings peace and closure and allows us to drift off without worry.

3/9/10 - Team 7, Day 3

2010-03-10T08:15:00.002-06:00

Update from James Dudley, MD:

Good evening from the Mission of Hope. The crickets are chirping the team to sleep in their respective bunks and tents, as things wind down on Tuesday evening. The evening after dinner brought lots of pleasant conversation and excitement about the work done today and the challenges facing us tomorrow. One of the highlights today was the work of the orthopedists. The team did a very difficult repair of an unstable fracture of the tibial plateau - the broad top of the shin bone. The fracture had been set at the time of the earthquake but was still unstable even though some bone repair had started. They were able to put the fragments back in good position, using a plate and screws to stabilize everything. The patient has an excellent chance of regaining full use of his leg. Each morning, there is along line winding its way up the hill to the clinic. By the time the gates open, many have already been in the queue for several hours. Our Paramedics triage the sickest to go to our small 3-bed Emergency Room for giving IV fluids, and monitoring. Three other doctors and their translators work steadily to see the many others Meanwhile, our Physical Therapist stays very busy, between therapy sessions with the orthopedic patients on the hospital ward, and wound care in the clinic. One of the interesting cultural aspects we have noticed is that when a Haitian undergoes surgery or a serious injury, it is common for them to stay in bed, waiting to get well. It requires significant education and encouragement to convince them of the benefit of early and sustained mobilization following surgery. Even in the few days on site, we are seeing them make gains from those efforts.Today's musical moments we're varied and mostly spontaneous. Anyone, anywhere is liable to break into song, and although the words are in Creole, the hopefulness conveys in a universal language. And when one starts, others join in. The Haitians seem to express themselves in song as easily as in conversation. The singing starts early in the morning, on rounds in the wards and in the waiting area outside the clinic, and goes well into the evening. Around sundown today, the large open-walled church was full of worshipers, singing full force, sending echoes several hundred yards up the hill to the hospital wards. There, patients and their families, who stay with those hospitalized to feed and help care for them, heard the singing. Within a few notes of hearing each new song, they have joined the chorus. And it feels like real healing is taking place.

3/8/10 - Team 7, Day 2

2010-03-09T08:33:00.001-06:00

Update from James Dudley, MD:

Hello from Titanyen, Haiti! It was a beautiful day here, warm but breezy. It feels tropical and the pace of life seems like what one would expect in the islands. As many know, the length day in the tropics doesn't vary much with the seasons, and so sun-up is a few minutes after 6 in the morning, and sunset 12 hours later. Haiti is very mountainous and our compound is situated on the southwestern slopes of a mountain range, so the sunrise is delayed just a few minutes more. Most people in the area where we are seem to rise and set with the sun.

Last night was breezy and quite comfortable and it was easy to get going this morning. After rounds on the 6 orthopedic patients in the hospital, we walked up the hill to the clinic. It was about 8:30 and there were at least two hundred people in the queue, some with minor issues, some more serious. We met Dr. Jennifer and later Dr. Alix, our Haitian hosts who staff the clinic on a regular basis and to whom we could run anytime when we had questions about local practices and more importantly, the spectrum of disease we were facing. We worked as fast as we could to take care of all the patients, sort out the really sick from the not so sick, the acutely ill from the chronically ill, or malnourished. The range of needs, medical and social and spiritual was significant; challenging and exciting. In some ways, I felt like a medical student on the first day in the wards. Almost without warning, the mad rush was over. I went to find Dr. Jennifer, my new-found mentor, but she had gone. Early in the morning, she and I had talked about Wigans, the young man we had worked on feverishly just we hours earlier. Dr. Jennifer had been his primary doctor for the last two years and she had made huge efforts to care for him, even traveling to Cuba to arrange medical care for him, and staying with him at Christmas last year, acting as physician and mother for him during another hospitalization. His death overnight hit her especially hard, as it did many of those who work in the clinic. They all knew Wigans and knew the struggles that had been made for him. This evening, as grace was said before dinner, a prayer was made to bring healing to those suffering in the wake of his passing. It helped ease the pain, as did the wonderful music after dinner. There are two groups of college students here, about two dozen in all, and they provided a beautiful chorus for the pastor who played the guitar and sang with clear rich tenor. A good night's rest will bring a renewal of energy for the work tomorrow.

All are well here and send their love and greetings to family and friends back home.

3/7/10 - Team 7, Day 1

2010-03-08T08:01:00.001-06:00

Update from James Dudley, MD:

Today, we have tried get oriented, organized, and ready for tomorrow, when our real work was supposed to begin. Unfortunately, just as we were finishing our inventory of supplies a young man was brought, sweaty, pale, and clammy. His family brought his medications; a small Walmart bag with five cardiac meds. He had undergone cardiac surgery in Indiana a year ago and was fragile even before he became ill yesterday with a fever, diarrhea and abdominal pain. He was critically ill, probably with sepsis. He required vigorous resuscitation, including a central line and intubation, as well as transfer to the field hospital near the airport that has been set up by the University of Miami. There they have ventilators and Intensive Care Units, all in tents. If anyone is looking for an adventure, ride in the back of ambulance, lights and sirens blasting, through the unlit streets of Port au Prince at night, crowded with tens of thousands of people on foot and bicycles. So our real real work starts in the morning.

3/7/10 - Team 7 is on the ground!

2010-03-07T21:41:00.002-06:00

Team 7 members from Texas include:

Stan Rice, DO - Team Leader - ER (Brackenridge & Dell Children's ER)
Kurt Knauth MD - anesthesia (Capital Anesthesia-Brackenridge)
Maggie El-estwani, RN - OR (Austin)
James Grant, PT (Encompass Home Health)
Julia Chang, RN (Seton)
David Krussow, RN (Austin, Star Flight)
Kathy Bremer, RN (Austin Area OB/GYN)
Pam Rizo, paramedic (San Antonio, W-I10 Fire Dept)

Joining the team from other areas of the WORLD!
Glen Spiegler MD - orthopedic surgeon (Virginia)
Mike Mara, MD - orthopedic surgeon (Oregon)
Matt Shambaugh, MD - plastic surgeon (Indiana)
James Dudley, MD -FP/ER (Virginia)
Greg Schmitt, MD (Indiana)
Peg Kiester, RN-OR (Indiana)
Hannah Warren, RN-Mercy Ships (England)
Sally Greenway, RN (Canada)
Sandi Brock, RN (Georgia)
Agnes Hyma, RN (Canada)
Amie Mock, FNP (Virginia)
Suzanne Tolson CC-EMT (Virginia)
Lyn Westman-Mental Health, Mercy Ships

3/5/10 - Team 6, Day 6

2010-03-06T07:58:00.000-06:00

Update from Heidi Walker, RN:

It rained today! This is wonderful considering it has been sticky and hot all week. There is actually a nice chill in the air tonight.

The day started with two women going into labor at the clinic. Unfortunately, MOH is not allowed to deliver babies and therefore we loaded them up in the ambulance and took them into Port Au Prince. The two labor and delivery nurses were excited and ready to deliver the babies, but they did not get to show us their skills.

The surgeries went much better today. Each surgery we do should be a lot easier than they have been, but with the lack of vital equiptment and these adverse conditions, we have had to work a lot harder . With passing time, these older injuries are getting more difficult to treat. Thankfully we were able to fix a bad tibial plateau fracture, an acute gunshot wound to the hand, a fractured and dislocated elbow, and of course a debridement of an infected wound (we have seen a lot of infected wounds). We were going to wrap up the OR team tonight, but we decided to leave Haiti with a bang with one last above the knee amputation tomorrow. Dr. Brad will be losing his scrub partner, Dr. Greg, tomorrow to a flight back to Indiana, so he has asked Kristen to be his assistant in surgery.

The ER was hopping today as usual. There were all sorts of people in there, which is much like it is in the states. We saw a 17 month old baby only weighing about 10 pounds who was severely malnourished. Of course this baby pulled at all of our heart strings and we did everything we could to get some fluid down. We eventually shipped her out to a hospital in Port Au Prince. We can only pray that someone else will care as much as we do and will nurse her back to health. We also had a patient come in yesterday who fell out of a building or tree depending on who you ask (no one is sure of the exact story because things get lost in translation). Dr. Jon was able to diagnose a C4-C5 cervical fracture and we immobilized him and sent him to stay the night in our ward. We were supposed to have a helicopter come into the mission today to transport him to a hospital that takes 10 hours by car, but they cancelled because of the weather. A helicopter around these parts sounds pretty unbelievable to me, so I will have to see it to believe it. Hopefully tomorrow’s weather will be better and the helicopter will come for him. Rick, the Canadian paramedic, made him a short back board to travel on so that his flight will be as comfortable as possible.

All of the people on this team have been amazing. It’s such an eclectic group, but everyone has had something amazing to offer. It’s great to see people working until exhausted for the same common goal of helping these people. We forget how lucky we are sometimes and thank God for allowing us these experiences to remind us. Our team will be disbanding slowly over the next 3 days and I think we are all feeling it. We wish we could keep the team together forever, but we are also looking forward to getting back to our family and friends. There really is no place like home!

3/3/10 - Team 6, Day 4

2010-03-04T08:18:00.002-06:00

Update from Team 6:

The most exciting thing about today is the fact that Dr. Brad did the first ever, as we know of, hip hemiarthroplasty in Haiti. Actually, he did two! Way to go surgery team! And rumor also has it that there is a 19 y/o from the Dominican Rebublic who is wanting to come to the mission for his hip to be fixed as well, but there is no word on that yet. We are hoping to go international here at the mission by the end of the week!

It was a long day today as we were in surgery until almost 7 pm. As a matter of fact, I haven’t seen the recovery nurse yet so my guess is she isn’t back yet from the clinic. I think tomorrow might be another long day as well because we already have 2 femur fractures and 1 tibia fracture to fix as well as several wound debridement’s on our schedule and there is always a possibility of add-ons. We are going to sleep good tonight!

There was also some excitement on the ward with a pt that was dropped off yesterday for fever, nausea, and vomiting. His condition worsened today and it was determined that he probably had a ruptured appendix. Dr. Greg said he would have preferred not to take out his appendix in our OR, but he was standing there ready with scalpel in hand. Luckily we were able to transfer him to a place that the paramedics said looked pretty clean. I believe that he was taken to the OR for an appendectomy, but I’m not for sure on this.

Kim says nothing much happening in triage right now except that there are a lot of people coming through. Coincidentally, everyone in triage has the same complaints of fever, cough, n/v, and abdominal pain which they say have been present since the earthquake. Maybe it’s nerves. These people really have been through a lot.

Dr. Jon, the ER physician from Chapel, had a patient come in on Monday with a heart attack in progress. We treated him as much as we could and then sent him on to the University of Miami hospital. We have since then learned from his son that he passed away today. May God bless him and his family at this time.

From Dr. Greg: “I have had the distinguished honor of assisting one of the most brilliant orthopedic surgeons in the world doing the toughest arthroplasty that I have ever seen under extremely adverse conditions. In fact, one could say he was operating under the jaws of death.”

Text updates from Dr Parker via Chris Merrell:

Pts seen today:
2 hip replacements
hip spica on a 10 month old
2 endo prosthesis
debreided stump wounds
"lots of action"

Haitian orthos are up and running again

Still many malaigned fractures from earth quake

2 femurs and tibia tomorrow.
Lots of wound care surgery.
2 surgeries lined up for next week.

Still need RN's. Dr Parker feels ward will be full the next week.

Update from Haiti and our prosthetics team:"Chase just texted me that the meeting he had with the government, WHO/ICRC and Helping Hands went incredible!! The Government has not only give us a big green light, but they have asked Chase and MOH to help make the Prosthetics Standards for the NATION!!! WOW." So exciting!! Our prothestics clinic is scheduled to open April 3rd.

3/2/2010 - Team 6, Day 3

2010-03-03T08:34:00.002-06:00

Update compiled by Kristen Damery, PT from Team 6 members:

Our communication has been sparse secondary to a spotty connection with email and phones. We are all safe and busy! We are all going to contribute tonight!

Anesthesia system is pretty complete and we are able to take care of everything we need.
-Dr. Dave, Anesthesiologist

Ambulance needs some air conditioning! To his family, he misses you and is safe. Everyone is really great and a really good bunch of people to work with. I just hope my wife doesn’t have too much snow to shovel!
-Rick, medic

-Experience of a lifetime. Misses her family but not the snow.
-Denise, nurse

Can’t believe how great the OR team is. Met Dr. Greg, a retired thoracic surgeon, still demonstrating great surgical skills, a tremendous help. Have a new X-ray tech named Wicky (Haitian). Injuries are bad, we are able to help some but not all. Tomorrow morning we are doing wound cases and Haiti 1 is going to pick up fractures for tomorrow afternoon.
-Dr. Brad, orthopedic surgeon

Haiti one had a mishap in route yesterday, apparently the local population doesn’t recognize an ambulance.
-Pauline, medic

Very unique and rewarding experience. We have a great team that gets along together and works well except there are too many Texans. Haven’t been able to do any coronary bypasses yet, the TSA wouldn’t let me bring my bypass pump on the plane!
-Dr. Greg (cardiovascular surgeon form Chapel team)

Finally finding where everything is at in the OR. Have dish pan hands from washing instruments.
-Jeff, orthopedic tech

I really enjoyed working with Dawn from the Chapel team in post-op today. She is great to work with and we are thankful for the teams from Indiana and Canada (although we try not to talk about recent international hockey games). Despite searching very hard for a fax machine I was unable to locate one to fax the order to the pharmacy prior to giving meds. This was a huge bummer…NOT. Actually it is great to focus on patient care and being with the people here, they are very grateful and fun to be around. I also enjoy the random turkeys and goats that walk by the clinic. One baby goat actually walked in the clinic but we could not see anything medically wrong with it so we shooed it away.
-Eric, nurse

Today was a slower day for wound care so I was able to assist a little while in other areas which were fun to experience. Yesterday was madness, a steady stream of patients for wound care coming in all day. The Haitians were all so grateful. They are beautiful people. Our team is working well together, everyday is better than the day before. The patients are all so diverse; some are still recovering from wounds secondary to the quake. Their stories are unbelievable. They have experienced things that we can not comprehend. Miss everyone. Good things are happening here in Haiti.
-Kristen, PT

Melissa is currently working nights at the ward! What a blessing she is to the patients, unfortunately she is not here to contribute. She is an angel.
-Heidi, nurse

We had a new team from Austin today. Very happy to have them here. They are working on setting up a prosthetics clinic. When up and running many, many people will benefit from this service.

More on Amputations

2010-03-02T11:30:00.003-06:00

Post provided by Barbara Bergin, MD

We’ve all been talking a lot about amputations. It’s an operation that doesn’t get much attention in this country. It’s not very glamorous and it’s certainly not cutting-edge technology. We’ve been doing amputations pretty much the same way for a hundred years. In the United States about 40,000 below knee amputations (BKA) and 35,000 above knee amputations (AKA) are done every year! About 70% of those amputations are due to disease, the main culprit being diabetes. About 20% are due to trauma. Those statistics have been gradually changing over the past several decades because of advanced technology with regard to treatment of traumatic injuries of the lower extremities. We learned a lot about the importance of cleaning contaminated wounds in Viet Nam. Just getting a contaminated broken bone cleaned and temporarily stabilized with an external fixator (like the ones you see in the pictures from Haiti) has made dramatic increases in the number of limbs we save here in the U.S. and in other industrialized countries. But again, in Third World countries, amputation remains the mainstay of treatment for these kinds of injuries.

Now an amputation isn’t a simple operation. If not done properly, with adequate bone coverage and just the right amount of muscle padding, fitting and ultimate use of a prosthetic limb can be a problem. So a lot of planning goes into the performance of this operation. And when there is adequate, healthy skin and muscle, this can be done with a relatively predictable outcome.
But traumatic amputations are a whole different ball game. A limb smashing into pavement from a motorcycle accident or being crushed by a collapsed building, such as thousands suffered in Haiti, almost never gives the surgeon an opportunity to perform a textbook amputation. There is always some degree of contamination, torn muscle, stripped skin and exposed bone. This can leave the patient with thin skin and a poorly padded stump, which then can be difficult to fit into a prosthesis and will almost always result in some functional disability and pain. Surgeons want to make every effort to give a patient a BKA because of the energy requirements it takes to function with an AKA (see Dr. DeHart’s blog from 2/22/10). We will often do skin grafts and muscle transfers to cover a little stump of bone in order to give a patient a BKA.

This is doubly important in Haiti, where a BKA instead of an AKA could make the difference in a patient’s ability to work and support him/herself. Many patients are refusing to have second and third operations in order to make improvements to their stump. I can’t blame them. It’s a huge pill to swallow even under ideal circumstances.

Barbara Bergin, MD
Texas Orthopedics

3/1/10 - Team 6, Day 2

2010-03-02T08:03:00.001-06:00

Update from Brad Parker, MD:

Just got email. Things going great. Busy today and more people learning about MOH. Surgery working well. Massive thigh I&D, revision wound vac, fem nail revision, open shoulder for chronic dislocation.

Orbit debride on Job was difficult for all. Previous surgery failed for the little guy. Tomorrow, open tib fib, then osteo with questionable septic knee. Tell all that there were a large number of follow ups and I thought the previous surgical work was excellent.

Picture: Job traveling to USS Comfort

2/28/10 - Team 6, Day 1

2010-03-02T08:01:00.004-06:00

Update from Brad Parker, MD:

Internet has been down. First and mainly to let all the loved ones know everyone is doing great, no issues at present.

Quick Notes:
-uneventful day
-4-5 OR cases scheduled tomorrow-General wasn't aware there was another OR team coming this week so some pts got sent home. They plan to do more PR to get these pts to MOH this week.

Update from Dave Bryant, MD:

The greatest part of our long day of traveling was the flight from Miami to Haiti. On board was a native Haitian, King Wa Wa, that was returning home after being in the states for 10 years. He so happens to be a fantastic musician and had the whole plane singing as he played in the aisle! Unreal! Once we arrived in Haiti we hit the ground running. The Canadian nurses worked all night in the ward and this morning we began sorting through the supplies that people have so generously donated. We explored where all the supplies are kept and are ready to begin bright and early tomorrow morning. Dr. Parker got to travel on Haiti 1, our ambulance, with Pauline and Rick, our medics. We have our first case lined up for the morning but when he found out he was coming here to have surgery he turned up missing. So…an I & D of a thigh abscess that came from General will be our first case tomorrow and several more are set to come. It has been very hot today, lots of water and lots of sweat. I think we might have even gotten a sun burn. Haiti is beautiful. The people are beautiful and loving and most importantly grateful. We are surrounded by mountains and you can see the ocean from the mission. The resiliency of the Haitian people is amazing considering the stories we have heard just from the people here at the mission. Eric arrived today from Miami. We are so grateful to finally have the whole team together. Some of our team went into the city today and told us about the chaos of the living conditions. The streets are lined with tent cities and the roads are clogged with everything you can imagine. We just finished up with mac and cheese and hot dogs for dinner and the mosquitoes are out. You better believe we have gotten an ear full from the Canadians about their team winning. We are all looking forward to tomorrow and hope all is well there.

Picture: Kristen, King Wa Wa, and Heidi

2/27/10 Team 6 is on the ground!

2010-02-28T09:06:00.002-06:00

Team 6 arrived late in the evening on a 737, had a quick debrief with Team 5 and off to Mission of Hope!

Brad Parker, MD, orthopedic surgeon, Medical Park Orthopaedic Clinic
Dave Bryant, MD, anesthesiologist from Dallas
Jeff Benoit, OPA, Medical Park Orthopaedic Clinic
Kristen Damery, PT, Integrity Rehab
Heidi Walker, RN, Stonegate Surgery Center
Kim Walior, RN, Stonegate Surgery Center
Eric McNeil, RN from Denver, CO

We are also lucky to be joined by two teams this week, the Chapel group from Ft. Wayne, Indiana and Canadian nurses and paramedics!

2/26/10 - Team 5, Day 6

2010-02-28T08:55:00.008-06:00

From Alicia Michalz, CST

I write this with a very heavy heart, as our time has come to an end. Today is the last day to see our helpers for the week and the clinic is now closed. I can't even begin to tell you how most of our lives have changed. Dr. Bryan gave us our last debrief. It was warm and gracious and so spiritual. Tears were shed as we all realized we had come into a routine and are not ready to leave. Dr. Guy, who is Haitian and from the Bridge Team also expressed his thanks for helping his native country.

We have seen patients come and go but yet all of them have touched us one way or another. Again, I cannot say how precious and kind these people are. I believe that somehow they will never forget us either. Each time I give something, hug someone or smile I hear the same warm words, "God Bless you," I will pray for you. I would have never thought that I would have so many people praying for me. How lucky am I?

I believe there was a reason for me to be here. God lead me here and I have this strong feeling he will lead me here again. I have this urgency to continue this cause and make sure my precious boys that have spent the whole week with me are doing well and thriving.

I sign off for now so I can enjoy the company of my team and the stories they are sharing from today.

Pictures:
1. 14 day old in the clinic

2. Dr Bryan giving us our last debrief. We are going to miss him.
3. Expired supplies but great helpers!
4. The supply helpers, sitting still for once listening to a wind up radio that plays the story of Jesus.

2/25/10 - Team 5, Day 4

2010-02-26T08:16:00.006-06:00

Update from Alicia Michalz, CST:

It's the end of another long day. The Compound is somewhat quiet right now, many either getting ready for bed, or the night shift and the ward and Dr. Bryan, Pastor Dave, John PT and Chuck Paramedic just walked down the hill to transport a patient from recovery to the ward. They are transporting by foot which is often how it done here.

We have had some cute little babies come through the ER, not so much patients but their mamas. They were tiny little things and our nurses just loved on them. One of the mama's had the baby at 2 in the morning and had some complications. Paramedic Chuck and Heather transported them to MOH. Heather held the little one was just under 6 pounds.

My little buddy Job wanted me to pick him up, so I did and sang to him. He just laid his head on my chest and rubbed my arm. I just wanted to cry. He is so precious. All of my boys are. They are always helping and getting creative with all the little things that we find in the boxes we have been unloading. Sometimes they get a little crazy and I quickly get into mommy mode, they know that Madam Alicia's word is the law. They are always asking if they can have something and Elena always defer's them to Madam Alicia.

Wound Care has been hopping. Today they saw the first skin graft patients done this week and the wounds look great! There is a young guy named Gaby whose wounds on his legs have been active and festering for over eight years. He suffers from sickle cell anemia and is a frequent flyer to MOH. He is a special patient here and holds a little space in everyone's heart. Today he had skin grafts done to close his wounds and tolerated well! Very exciting news! Please include him in your prayers and hope that the grafts survive.

Let me tell you a little about the ward. They have goats and dogs that frequent the halls almost make their own rounds like our docs. The nurses have found being able to get close to the patient and their families is something special. The families are so much help and care so much about their family member. There are not too many patients in the states whose family empty their bed pans or bathe them. Not only that but they are so greatful for the nurses and constantly dote on them. Again, another example of the gifts we receive.

Dr. Bryan is wonderful and truly has been taking care of us. He makes notes daily and advocates us to the MOH on how our jobs can be more efficient. Towards the end of the working day it looked like it was going to rain. He radioed up to the compound to have someone close our tents so our stuff wounded ruin. How awesome is that?

Again, a great team, a great leader and another great day of work.

Picture 1: Clinic didn't want table paper but made for a great arts and crafts day.
Picture 2: A woman was dropped off at the clinic today lethargic and basically unresponsive. We learned that she had just delivered a baby a couple hours before and had been having seizures since the time of delivery. She was eclamptic. We were able to stabilize the woman and she finally woke up although very confused. In the midst of treating her, someone brought a tiny baby into the clinic, handed it to me and told me the baby was hers. I took him to the "ER" room and checked out the baby who was very healthy but weighed only 4 lbs. We ended up transferring mom and baby to General but we loved on the baby a little in the meantime. Here is a picture of Bryan, paramedic, and the brand new baby boy.

2/24/10 - Team 5, Day 3

2010-02-25T09:30:00.004-06:00

Update from Alicia Michalz, CST:

Today was HOT! Today was a busy for everyone. Seven cases today in the OR and plenty of woundcare too. There were 14 patients in the ward including a sweet 4 year old named Job. He has an allergy to the sun and has been very ill. He just came from the US Comfort. He lost one of his eyes to the condition. I was in the ward speaking to Amy and he walked by and swatted my backside and then ran off laughing! The supplies just keep coming and Elena and I thought we were going to lose it. But we regrouped and left with a smile. The orphans are great they are constantly finding supplies and playing with them. Today they made capes from U drapes and one had a special necklace he made. It was a foley catheter! They are so creative and easily pleased. A couple of docs and paramedics made it into town. Some bargins were made and patients secured for tomorrow at least 8 cases posted. So as you see we are still succeeding. Each day is a gift and we all haves been blessed in way or another .

Pictures provided by Rachel Feeler
Picture 1: This is Amy, RN with Rachele who has been here for a while. Amy and I taught her how to do pin care today and she was very excited to do it herself and make the pin sites clean. She did an excellent job and was transferred today to CAM down the road.

Sugar Cane Clinic

2010-02-24T09:31:00.002-06:00

Post provided by Barbara Bergin, MD

I spent the summer between my first and second years of medical school in Mexico City, working with an ophthalmologist who did some volunteer work for the sugar plantations. We saw some incredible stuff. The tolerance for suffering in people of Third World countries is extraordinary. Loss of an eye is common in the sugar plantation work. I guess they get stuck in the eye with part of the plant and it punctures the eyeball. So then they would schedule an appointment to see the doctor much like you or I would schedule an appointment for a routine eye exam. There was no emergency visit to some big eye center in Mexico City. They had a 9:30AM appointment just after the guy who was there to get a pair of second hand glasses. Then they would get scheduled for an enucleation (eye ball removal), which would also get done whenever the doctor had an available time on his surgery schedule! Their eyeball would look like a little raisin sitting in the socket. And the patient wasn’t there, screaming like I would be, “WOULD-YOU-LOOK-AT-THIS-EYEBALL-AND-FIX-IT-NOW!” These plantation workers would walk around with the little raisin eyeballs as if it were an errant hair on their brow.
Their family members could also come to the clinic and many of them had amputations. Once you have an amputation in Mexico as in Haiti, you become a ward of the state (whatever that means in Third World countries). There were no prosthetics, unless you knew someone who could make you something out of wood or you could afford to buy a used or stolen one at some market. Most people had ancient crutches, like the ones you see in old Civil War photos. They look like wooden t-posts. They had huge callous formations on the web space between their thumb and index fingers and I could tell by looking at their hands, many had lost the function of their ulnar nerves from leaning on the crutches for years. Their pinkies were numb and contracted.

We rarely see this kind of thing in the United States. If you lose your leg, whether you have insurance or not, a whole system of doctors, nurses, social workers, prosthetists and physical therapists go into action to get you a prosthetic leg that fits AND functions. And if it doesn’t fit and function, then you have an opportunity to go on disability! It’s amazing and because of this system you see people who can run and compete in sports with a prosthetic limb! The people in Haiti won’t have access to this kind of process. They don’t even know it exists. A young man or woman or a child with wooden t-post crutches could easily become the “poster child” for Haiti rather than a healthy, hard-working Haitian with a functioning prosthetic limb. I’m not sure I know the answer for this. Knowledge and understanding the problem comes first. No, getting the Haitians past their rainy season comes first. Then a whole ship load of crutches…

Barbara Bergin, MD
Texas Orthopedics

2/23/10 - Team 5, Day 2

2010-02-24T08:49:00.006-06:00

Update from Dr Lee:

11 surgical cases today: wrist fx, manipulated ex fixs, and mulitple skin grafts
6 cases planned for tomorrow
4 cases on Thursday and 1 on Friday as of now
Waiting on cases to mature from Mennonite clinic
ER and FP docs are working hard
14 ward pts. Difficult to staff at night with busy days
Supply organization staff sent with this team (Alicia and Elena) are a huge help
Univ of Miami and General Hospital in downtown PAP have both sent cases to them. Unsure of how busy they are.

Update from Alicia Michalz, CST:

The day as usual started early with a yummy breakfast of pancakes and papaya and yet another conversation of an earthquake at 1:30 a.m. The OR was full of cases today both Ortho and Plastic. I found out yesterday there were 300 patients seen in the clinic I am curious for the total seen today.

The wishes for supplies are starting to come in. Spinal Kits and a propofol pump for anesthesia. OR wishes for sterile OR towels, mini c-arm drapes and guide wires for IM rodding/Post op would like extension cords and surge protectors. PreLancets for sugar checks and D50 amps, linens and pillows for the ward. Funny how more simple, yet useful the requests.Dr. Dirk hooked us up with a couple of guide wires and are scheduled to be delivered to Texas Orthopedics. The Supply people (me) would love shelves, stackable bins and at least 2 people just assigned to supply next team. It is impossible to have anyone help, they are truly stretched.

Again, the people are so sweet and gracious. I actually had someone help me all day, totally under the assumption he was an employee. He also helped the ward nurses create pillows for patients out of tubigrip. Only to find out he is the husband of a patient in the ward who is status post BKA. He is a professor of mathmatics and speaks four languages. He asked me if I believe in Jesus and I replied "of course he is the one who sent me here." Shele is his name, and he prays everyday and gives thanks because he believes Jesus is capable of the impossible and is our Saviour. I have to agree. He was a pleasure to work with today. One of my 'little" helpers Roberto, was a little pistol. He would sneak pictures with my camera and put on tons of bandaids and hang on me like a monkey.

Elena and I walked down to the orphanage and gave out balloons. The kids came out of the woodwork. It was a joy!

Now that Elena and I have seen many supplies it is getting easier to meet immediate needs for the compound. It's either here or it's not but at least we know either way. I hope I continue to find little treats like saline flushes to put a smile on our great team. Everyone is finding their nitch. Dr. Lee is awesome! He is realistic, meticulous and helpful. He wears all shoes and this morning he helped Ms. Mona with the dishes. He debriefs us every night.

The end of the work day ended with Elena and I locking up our supplies, then sitting on the stairs of the ward watching the sun set and listened to service from a far. The praising was beautiful and there are no words to explain the song, just joyful.

Dinner was again a hit, red beans and rice and kabosh (sausage, cabbage and carrots with spices). The conversation quiet, as we discussed the day and all the special moments we had each encountereed, whether it be the orphans or patients or staff.

Picture 1: Two ward nurses (Melody/center, Laura/ right) and Shele.
Picture 2: Paramedics transferring a patient to the OR

2/22/10 - Team 5, Day 1

2010-02-23T08:03:00.006-06:00

Update from Alicia Michalz, CST:

The team's travel was long, picking up members along the way. Finally all 18 of us boarded the last plane headed for PAP. We took a quick stop into The Bahamas to refuel and came across tanned rested people, clearly not on their way back from Haiti.

The arrival was a bit hairy, actually dark is more accurate. Somehow the power was out at the private terminal we arrived and we were left with our luggage and some security guards. One phone call to Bob King and we were on our way to MOH. Mark found us and Ruben was our host for the night.

The streets were streaked with street vendors, colored homes and plenty of crowds visiting amongst each other. We watched colored trucks and vans weave in and out of traffic with people seated in the back, some were standing and hanging on for dear life. The very art decored vehicles are called "tap tap" (cuz you tap the top of the roof when you want to get off) which is a taxi to us.

Upon arrival to MOH, Vanessa Johnson greeted us and showed us to our quarters. She is "Mrs. President" of MOH. Soon after we settled to a much needed meal. Spaghetti and salad and french bread. It was great! Dr. Cheryl showed up shortly after and started debriefing the teams.

She gave us history on MOH, the day of the quake until present. I still am speechless at how everything happened and the devistation of this poor country. I helped Dr. Cheryl in the debrief getting questions answered for the team and then she kissed me on the cheek because I am here to solve her supply maddness. We walked down to the clinic and ward for a tour. I think we were all anxious to see were we will be working for the week. It was just short of midnight when we made the long treck uphill back to our quarters.

Elena and I opted to sleep in a tent outside, it was much cooler outside. We were awaken by a rumble in the ground. It was morning that we realized the a 4.7 hit us. We also had another little shift in the afternoon. Most of us were up at 600am and the consensus was we didn't get much rest.

We started at the clinic taking a look at supplies. Patients and their families were starting to arrive to wait in line for treatment. Dr. Jennifer came out and greeted everyone with a prayer and hymn. It was just beautiful, again another speechless moment. A gentleman who was weak and staggering showed up. I couldn't help but leave supplies to help him down and get him on a stretcher. Sometimes I am so torn with cleaning and wanting to be with the patients. They all have such a gentle demenour and greet each one of us as they walk by. The perfect patient.

Supply madness is an understatement, there are rooms upon rooms of stuff, for lack of a better term. Somehow after 10 hours of work we managed to clean, sort and organize one room. The surgical supplies, for me a important one. Dave a pastor from Indiana helped put some shelves together with Cevere, my assistant. He went up to the quarters for lunch and "brought" Elena and I some lunch. Really it was for our sweet little helpers, Samual, Schneider and Richardson, Blez and Linder. They worked very hard taking "pupel" (spelled wrong but is trash in creole) out for us. We took a quick break and enjoyed our time with them. Cevere is determined to make us Texans fluent in creole, we have him laughing at us all the time.

Aside from our day we heard constant walkie talkie conversations with STAT calls and request for Docs to the Ward or Clinic and it is with great saddness that I say we lost someone today in the ward. Vanessa said it well at dinner when she explained to her daughter that the lady in the ward went to be with Jesus. I am confident she is there.

Our night shift nurses told us when the 4.7 hit the ward up and evacuated themselves in a moments notice, for fear of the same devestation that now is 6 weeks out. Even Ruben showed up in a wrist brace because he fell running out of his home. No one feels safe hear, except of us Americans who have no idea what these people have been through.

Five cases in and almost 200 clinic patients the day has started to come to an end. There are 5 cases posted for tomorrow and 3 preops are in our ward now, ready for tomorrow. Some Orthos and many STSG for Plastics.

Dinner was served around 6pm with seasoned potatoes, corn, jello and chicken. Everyone is exchanging stories and discussing plans for tomorrow.

I think the most exciting for me was our C-arm finally arriving and working. A successful tibial retrograde nail ( glad Dr. Dirk agreed to do) and my one measly room done with a gift of new friends I did not expect to make.

5 cases today:
2 split thickness skin grafts
Closed Reduction under spinal with wound closure
Debridment with wound vac
Retro Tibal Nail

Went to Mennonite Clinc and picked up 8 pts, General sent 3 prep-op pts (wrist fracture, plastics face, "foot something"), Miami scouting for pts for MOH

Picture 1: Helpers in organzing supplies