Uganda Mission Day 9
August 26, 2011
DAY 9 – Monday August 22nd:
Monday morning started with shock and awe. Throughout the week Skumolski and Lieberman, like a Swiss train consistently opened the gym at exactly 5:30 am for their workouts. Occasionally Brian and Ilalov would wake early enough to get there as well. This morning however the exercise addicted duo were astonished that the girls, Ngozi and Jordan, sporting their morning faces, succumbed to the peer pressure and came to work out as well. The small gym was packed with team members working off the great food of the week.
Once showered and fed we started with the clinical day and visited our post-operative patients. P.T. , the 14 year-old girl with scoliosis and the elevated chest plate, was recovering well on the breathing machine. The second part of her surgery would have to wait until next summer. She smiled at the sight of her new teddy bear, one of several Sherron brought for our pediatric surgery cases. I.K., the 64 year-old ACDF patient from Saturday noted improvement in her leg pain, recovered speedily and was discharged today. A.W., the 15 year-old boy with cerebral palsy and kyphosis smiled at first sight of the team.
P.T. with her teddy named “Nice.” She is wearing the BPAP machine installed by Drs. Szkulmowski and Kusza.
Surgery at Case began at 10am. The patient B.A. was a 7 year-old girl with congenital scoliosis who was seen in the penalty box one week earlier. She had a T7-L3 instrumentation and fusion procedure, which involves the installation of screws and rods spanning 9 vertebrae and placement of bone chips to grow into and stabilize the spine. Drs. Lieberman and Ilalov strategically placed the Globus-supplied screws then contoured the titanium rods to match the contours of a healthy skeleton. Both would assert that surgery is just another word for “controlled violence.” This surgery went off without a hitch and at the end Dr. Ilalov patiently taught Jordan how to throw some stitches.
Dr. Lieberman and Dr. Ilalov work hard on the last case at CASE.
Having completed our sole case for the day earlier than expected, the team decided to relish in our early finish! We planned to drop off our stuff back at the apartment, then take a walk through the slums of Kampala. Key word: “planned.” Kirill, Jordan and Brian just had to make one quick stop at Mulago to pick up some instruments from storage for Tuesday’s Case case. The Mulago spine theater was locked so Brian called Sister Sarah, who said she would arrive in 30 minutes. Two and a half hours later, after Jordan had finished 3 daily blogs and Kirill had become a Ninja Fruit grand master, Sister Sarah finally showed up to unlock the room. We reminded ourselves, again that we were “on Uganda time.” When we finally got home, Lieberman jested:
“Sister Sarah strikes again!” We should be lucky she struck at all!
The doctor from whom we removed infected hardware was found to have a serious multi-organism infection, resistant to most available drugs, including the broad-spectrum antibiotics he was already taking. We all hope he can get a permanent intravenous line and the appropriate antibiotics. Luckily, he is a prominent physician in Kampala and has the means, the connections and the know-how to afford and self-administer the treatment.
Quote of the day:
“If I slow down my thoughts I speed up my productivity.”
Ngozi will have this patient walking around in no time!
How to Avoid Injury while Golfing
August 3, 2011
Dr. Michael Duffy, our orthopedic spine surgeon in Mansfield, took some time out of his practice on Tuesday to talk with Chris Flanagan from Good Morning Texas about how to avoid injuring your back pain when golf. Dr. Duffy actually played golf in college so this type of segment was right up his alley!
Dr. Duffy and Chris Flanagan.
Dr. Duffy and Chris having a good time!
Thanks so much to Mansfield Methodist for inviting us on the show.
If you have questions about back/neck pain, please come out to the BACK TALK event Saturday August 6th at 10am. 
Spring Cleaning
April 20, 2011
It’s that time of year again—time for spring cleaning.
We’re all brushing off the dust that’s collected over the winter, organizing cupboards and closets, and cleaning clutter from our garages. Before you get too far along, remember these tips to help protect your back. If you have boxes to move, be sure to test the load before attempting to lift it. Try moving it with your foot to get an idea of how heavy it is. Use slow, fluid movements, and keep your body facing the box. Twisting while lifting, can hurt your back. Be sure you have enough room to safely lift, and bend your knees to pick up the load. Keep your back straight while you lift.
Some things to remember
Right way to lift items:
It’s easy to run into trouble while reaching for items too. Try to minimize the amount of awkward reaching you need to do. Use a ladder, rather than straining to reach something overhead. Try not to work with items spread across the floor, as this can cause unnecessary strain on your back. Organizing items at a table where you can sit comfortably, or a surface that is waist-high while you’re standing.
Lastly, don’t get in a rush. Take your time, and take frequent breaks from strenuous lifting and reaching.
These few tips will help keep your back safe so you’re able to finish your spring cleaning!
Empire State of Mind…..Dr. Izzy at the NY marathon
November 19, 2010
As I’m sure you know the NY Marathon was just the other week.
Well, here at Texas Back Institute we had our ears and eyes glued on it. We followed it on the tv and online and we eager to hear the final results.
Why were we so interested in the race this year?
Because one of own doctors was running in it!
Dr. Lieberman finished in just under 4 hours and we were all so proud to watch him cross that finish line.
You may remember our recent blog post about Dr. Lieberman and the marathon but now we wanted to share some pictures and his results!
Coming in at 10,235 place with a time of 3 hours and 58 minutes is…..Dr. Lieberman!
Way to go Dr. Izzy!
Spine Health Day – October 16th
October 18, 2010
Your mother always told you to sit up straight, but you do everything but that to be more comfortable because your back or your neck (or maybe both) hurts all the time – and this may be an indication you have a serious back or neck problem that needs immediate evaluation by a spine doctor.
While most episodes of back and neck pain last a few days and can be resolved completely, here are a few warning signs that may indicate a problem that requires immediate evaluation:
- Your pain persists beyond a few days
- Your pain awakens you at night
- You find yourself standing to alleviate pain
- You sit with poor posture to alleviate pain
- Your have difficulty controlling your bowels or bladder
- You have a fever, chills, sweats, or other signs of infection
- Any other unusual symptoms
At Texas Back Institute, a large number of our patients express regret they lived with pain before doing something about it. A few regret it more because waiting too long allowed the problem to progress.
Although National Spine Health Day is October 16, every day is important for taking care of your back and neck. While there are many things you should do to protect your back and neck, remember to maintain good posture, exercise and stretch regularly, and take care to always lift, pull or push carefully and properly.
Jim Wiese diagnosed with a bulging disc….
September 27, 2010
When pain caused by neck problems became more than he could bear and threatened his job, Jim Wiese visited his primary care physician in Iowa Park, Texas, and was diagnosed with a bulging disc. His doctor immediately referred him to Texas Back Institute.
Living with daily pain, Jim had to exercise caution in everything he did. At age 54, Jim’s day included pain and discomfort he described as tingling, cold and crushing pressure sensations in his left shoulder and arm. He couldn’t drive long distances or look down on the road while riding his motorcycle. Jim was miserable.
Initially skeptical of back surgery, Jim was hesitant to consider surgery. Under the care of Dr. Jack Zigler, Jim found the reassurance he needed to undergo an anterior cervical fusion between his C6 and C7 cervical vertebrae after non-surgical options were exhausted.
After surgery, Jim felt an immediate difference. “I knew as soon as I woke up that Dr. Zigler had repaired my damaged neck. I was not in any pain and didn’t have to use pain medications at any point after the surgery. I could feel a warm sensation in my left arm that I had not felt in over a year. I could not believe that I had waited so long to have something done about it. I had forgotten what it was like to physically feel good. I am back at work and can enjoy everything in life that I had been doing before my surgery.”
Offering advice based on his experience, Jim says anyone suffering pain shouldn’t put off seeing a specialist and concluded, “I have been given my life, as I once knew it, back to me.”
Let’s go backpacking (and remember to protect our backs)
September 23, 2010
As the weather cools off heading into the fall, maybe you’re thinking about a backpack trip you didn’t want to do during the hotter summer months. We thought it would be a good time to remind everyone of a few tips to help you protect your back and avoid back pain while enjoying this wonderful outdoor sport.
1. Get your back in shape before you backpack. Exercises to strengthen and stretch your back as well as daily exercise will help get you in shape before you go.
2. Stretch before you strap on your backpack and trek. There are a number of back stretches recommended by professionals. One we recommend you do slowly is to position your left foot about six inches behind you and position your right foot, toe-to-heel, behind the left foot. Then place your hands on a solid vertical object at shoulder level. Allow your body sag slowly forward, which increases the natural curve of your lower back. Now allow your back to twist slowly towards the left or right. Reverse your feet and do repeat this slow twist I the opposite direction. Make sure your motion is slow without any bouncing.
3. Take short trips. If back pain is sometimes a problem for you, avoid long backpacking trips that require carrying heavy gear. If you’re a beginner, work your way up to longer trips that require heavier backpack loads.
4. Plan trips with fewer obstacles, less inclines and other challenges. If you suffer from back pain or are a beginner, start with easier courses. More stringent courses can add stress to your back. If you stumble trying to cross big obstacles, the added pack weight can throw you off balance and result in injury.
5. Lighten your load every way you can. Invest in a good, lighter weight backpack and gear. Look for multipurpose gear that allows you to leave multiple items behind. Lastly, take only what you’ll really need.
6. Lift your backpack onto your back slowly and correctly. 1) Set one foot firmly on a solid object. 2) Slide your backpack by the shoulder straps up to your knee. 3) Put one arm into one shoulder strap. 4) Lean slightly forward and let your backpack pivot slowly around to your back. 5) Slip other arm into the other strap. 6) Adjust your backpack and all straps.
7. Use trekking poles. These been shown to reduce the weight on your back and hips and can also help stabilize your walking over rough terrain by reducing side-to-side swaying.
Backpacking is a great way to get exercise and enjoy the beauty of nature. Safe trekking!
Working out with the Wii
July 15, 2010
Over the past couple of years, people have turned to the Wii console for exercise programs. These programs offer more flexibility than traditional workout videos, in that they can be customized and offer a variety of routines. A limitation of some of these programs however, is that they cannot accommodate for individuals with medical conditions such as back or other joint pains. As with any workout program, it is important that individuals are able to modify their routine in order to avoid injury of underlying degenerative changes such as arthritic joints or the spine. Even classes such as yoga or Pilates are not universally good. Extension exercises such as “cobra position”, for example may aggravate some degenerative spine conditions. Flexibility may be limited, thus preventing an individual from performing the exercise properly.Following are some of the current Wii console programs, and my thoughts on their ability to accommodate individuals with spinal degenerative conditions:
Wii Fit Plus- this game is the standard software provided with the current edition of the Wii Fit board. It includes several fairly good, but basic, exercises that focus on different body parts as well as some aerobic exercises and is highly customizable. It does not get “hung up” if the individual is not “properly” performing an exercise. The biggest drawback with this software, however, is that there is a lag between individual exercises, which significantly disrupts the flow of a good workout program. (2 stars)
EA Active- this game is highly customizable and allows individuals to select which exercises they want to perform or they may select from preset workout programs. It can be very frustrating, however, in that the software expects the individual to perform exercises perfectly such as lunges and will get hung up until the individual completes the exercise to its expectation. This causes the game to often disrupt the flow of exercises. Thankfully individual exercises can be skipped, but again the overall experience can be frustrating. There are also several “fun” activities such as practicing volleyball, basketball or baseball maneuvers. (1 star)
Your Shape with Jenny McCarthy- this game, instead of using the motion detecting controllers, utilizes a camera that detects the participant’s motion and provides feedback as to how the individual is performing. The benefit of this software is that exercises may be performed in any fashion without disrupting the flow of the workout. A poorer score is provided if exercises are not performed as the software is expecting, however, it is unclear how this impacts the intensity or flow of future workouts. The software indicates that the program “learns” the participant’s capabilities, but it is unclear how accurate this claim is. The software also has options to include hand weights, a step bench and a Swiss ball, however, with my testing I have yet to see an exercise with the Swiss ball or hand weights despite always selecting that I have them. Most of the exercises are straight out of “step class” regardless of what body part you say you want to work on. Another drawback of this software is that individual exercise programs cannot be customized and the user is unable to skip particular exercises so if an exercise is being done that the participant is unable to perform, then he/she must wait until the end of the exercise before moving on. (3 stars)
Fitness Ultimatum 2010 with Jillian Michaels- so far, this is my favorite exercise program with the Wii console. It is highly customizable, you are able to skip exercises when needed, and there is no penalty for not performing an exercise as the software expects. It utilizes the regular hand controller as well as the Wii Fit board. There is a pause screen between exercises, but one is able to go to the next exercise as quickly as desired or is free to take a break. The only drawback is the limited number of individual exercises available, however, the overall exercise intensity is quite good. (4 stars)
Obviously there are many other titles available for the Wii console, including recent software based upon The Biggest Loser which has apparently received good ratings as well. My recommendation when looking at which software to purchase for the Wii is to ensure that the flow of exercises is not disrupted if the participant is not found to be performing exercises “properly” as with the EA Active software. Similarly, the user should be free to skip an exercise if desired and obviously being able to develop customized workout programs is beneficial as well.
Good luck, and stay safe.
Physical Medicine and Rehabilitation
Texas Back Institute
Spine Place 