Keith roberts collage

Two years ago, Keith Roberts was relocating his office. He began to feel immediate pain in his lower back after lifting a table. The pain became progressively worse from that point. His doctor told him it was just a sprain, but he soon learned more about his diagnosis.  After a regimen including rest and anti-inflammatory medications, he didn’t get better. “I’m a fairly active person and I knew there was something more to this,” he said. His first doctor ordered an MRI and the scan revealed a herniated disc. “My wife and I did a lot of research and we decided to try Texas Back Institute,” Keith said. “It was the best thing we’ve ever done.”

Keith made an appointment with Dr. Jessica Shellock and hasn’t looked back since. Texas Back Institute helped him navigate through the sometimes laborious paperwork involved with a worker’s compensation claim. “Without Dr. Shellock’s medical expertise and Tonya’s help with everything, I have no idea where I would be today.”  The Tonya he is referring to is Dr. Shellock’s medical assistant, Tonya Edwards. Medical Assistants are imperative to the delivery of healthcare for the providers at Texas Back Institute. They help obtain information about the patient including vital signs, medication, and their medical history.  They also assist the patient with future testing and appointments. “If it wasn’t for them, I wouldn’t have been able to get the surgery that I really needed to get better.”

After failing to respond to conservative treatment and without sustained relief following a microdiscectomy, Keith ultimately underwent a L5-S1 fusion in November 2012 with Dr. Shellock.  It was after progressive worsening of his symptoms at this point that I recommended the fusion,” said Dr. Shellock.  “He has done fantastic. “

He took three months off of work to recover properly and is now attending outpatient physical therapy sessions at TBI. He went from being very active to no activity and is now making a comeback. In April, he was able to complete his first 6-mile bike ride and this summer, his plans include a 12-mile hike in the Ozarks with his wife.  He and his wife are avid photographers and have donated art work for Dr. Shellock’s patient rooms.

“It’s amazing to go from being able to walk less than a half a mile and having so much pain to this,” said Keith. “I missed out on 2 years of my life and I would be missing more if it weren’t for Dr. Shellock.”

Graduation

With the sound of “Pomp and Circumstance” ringing in their ears, the graduates of 2013 will be marching up to the stage and on to their future. There is a sense of accomplishment, pride and even relief at graduations because the participants feel they have completed something important. Texas Back Institute congratulates every graduate!

With graduations, it seems as if something has concluded, when in fact the term “commencement” suggests a beginning. This idea of “conclusion vs. commencement” has of course been employed by more than one valedictorian in their one, final address to their esteemed classmates.

Traditions of Graduation

This is the time of year when seniors in high school and college who have completed their courses successfully are awarded diplomas. This tradition goes back to the 11th Century when medieval colleges in Paris and Bologna reportedly began this practice.

Over the centuries, the traditions have evolved and changed, but many have remained remarkably similar to the original ceremonies. The students, who were known as apprentices in these early graduations, learned skills from the masters of the crafts and to note this accomplishment, they were give a “testimonial of skill,” now known as a degree.

The song that most of us associate with graduation ceremonies – “Pomp and Circumstance” – is a relatively new wrinkle on this ancient celebration. It was written by Sir Edward Elgar and first performed in Liverpool, England in 1901. Its melody, a combination of solemnity and dogged determination, is the perfect accompaniment to purposeful marching of the soon-to-be graduates.

Another interesting graduation ceremony tradition involves the attire of the honored matriculates. The cap and gown, which is worn by students and (in some cases) faculty, was once called a “hood” and this is believed to be dated back to ancient Celtic Groups. Capes and hoods were worn by the Druid priests to symbolize their higher intelligence.

What’s Next?   

After the music finally stops, the mortar boards are tossed and the diplomas are filed away, what happens then? The graduate – of high school or college – must commence the next stage of his or her life. For many, this means getting more education and beginning the process of deciphering how to spend the rest of one’s life.

Texas Back Institute is internationally known for its state of the art treatment of neck and back injuries, back pain, scoliosis, artificial disc replacement, occupational and sports medicine and its exemplary physical therapy practice. However, for the past 27 years, Texas Back Institute, led by one of the organization’s founding partners, Dr. Richard Guyer, has offered a select group of medical school residents a remarkable opportunity – a one-year fellowship to focus on spine surgery.

To anyone talking with Dr. Guyer about the Texas Back Institute fellowship program, it is immediately obvious that he is just as enthusiastic as the young doctors who are chosen for the program. Much like the master craftsmen who trained the apprentices in earliest institutions of learning, there is a commitment to teaching these future surgeons that goes beyond cursory. The doctors who emerge from this program are changed forever.

With his interest in teaching, we thought Dr. Guyer might be a good source of advice for graduates of any level – high school, college or graduate school. Here is that conversation.

guyer

What areas of medicine will be in high-demand in the coming years?

There are so many opportunities in medicine, especially if a young man or woman is interested in computers, science or engineering. We’ve all read that more and more kids are interested in business, finance or high technology, but the opportunities in medicine are exploding. For example, the latest high tech robotic surgery equipment is still directed by a human who is a trained physician and many of the best practitioners of this specialty were video gamers when they were kids. Genetic engineering is going to be a very hot area of medicine in the coming years and this specialty requires a very analytical mind which many youngsters who are good at math and science possess.

If someone is graduating from college and accepted to medical school, what types of specialization might they consider for spine surgery or other specialties offered by Texas Back Institute?

When I first started in medicine, young physicians would spend a couple of years in medical school before they decided which specialty interested them. Things have changed a lot since then and now that decision is often made when they are in college. The types of procedures we do at Texas Back Institute involve a wide range of medicine. We handle spine surgery for both children and adults. Our doctors deal with trauma surgery which would be required for automobile accidents and other accidents. We treat injuries that are the result of aging – wear and tear damage. We also have quite a few sports injuries that our physicians treat. So you can see there is a wide range of opportunities just in the spine area.

How did the Texas Back Institute Fellowship program come about?

I’ve found that when you teach students, you learn as much as they do and I loved teaching. In the mid 80s, I approached my colleagues here and shared my passion about teaching. I mentioned that I’d really like to build a fellowship program here for residents who wanted to specialize in spine surgery. Since our beginning in 1986, we have trained more than 100 fellows and I have been the chairman of this program for 27 years. This keeps me young and sharp! We work hard at sharing the latest research and techniques about spine surgery for these young doctors and for everyone on the Texas Back Institute staff it is very gratifying when that light bulb comes on over the head of these talented young people.

How does the TBI fellowship program work?

These doctors have been through medical school and have completed their residency program. They find us through the network of former TBI fellows and through the American Academy of Orthopedic Medicine. Once they are accepted to the fellowship program, they work with all of the surgeons on our staff. They get hands-on training in deformative and degenerative medical issues, trauma, tumors and disc replacement surgery.

What are the criteria that Texas Back Institute uses to recruit new physicians to the practice? Does completing your fellowship help in gaining a position?

The last 4 or 5 physicians that we have hired have gone through the Texas Back Institute Fellowship program, so that suggests that there is an advantage of going through this training. When we recruit new doctors for our team, we look for a young woman or man with a high degree of intelligence, an excellent bedside manner, his or her ability to synthesize a large amount of information and apply it to treatment and most importantly we look for integrity.

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From Left to Right: Dr. Rey Bosita, Dr. Rajesh Arakal, Dr. Jack Zigler, Dr. Jason Sparks (Fellow), Dr. Richard Guyer, Dr. Ralph Rashbaum, Dr. Troy Morrison (Fellow), Dr. Kirill Ilalov (Fellow), Dr. Michael Duffy, Dr. Kenny Edwards (Fellow), Dr. Andrew Block, and Dr. Dan Bradley.

Successfully completing a course of study and celebrating this accomplishment with friends and family is one of life’s great pleasures. As speakers who are chosen to impart wisdom to a group of graduates are fond of noting, this ceremony is not the conclusion, it is the beginning. Congratulations to every graduate and their families. Now, let’s get busy!

Update from Ethiopia

March 27, 2013

Surgery on that cutey was Sunday. She is doing great. It took a few days to coax another smile, but all is well. I have a lot of great cases to show when I get back.

Ted Belanger

Facet Joint Pain

Recently Spine-Health.com featured the blog post below by Dr. Stephen Hochschuler, co-founder and orthopedic spine surgeon at Texas Back Institute.

Stephen_Hochschuler_MD

Facet Joint Pain after Spine Surgery

The facet joints are two small joints in the back of the spine, on the left and right sides, at each level. These joints work with the discs to provide support and motion to the spine.

There are several ways in which these joints can produce pain:

  • Nerves in the joints can be compressed and/or irritated by inflammatory agents
  • Facet joints can degenerate, become arthritic, and produce pain by forming osteophytes (bone spurs) which compress nerves passing into the legs.

As with many joints, degenerative changes can occur in the facets, which can become painful. Degeneration is likely to occur in the spine as a part of the aging process, regardless if surgery has been performed or not. However, some types of spine surgery may alter load or movement patterns of the spine, which in turn can affect the facet joints.

Causes of Post-operative Facet Joint Pain

Facet joints may be related to pain after spine surgery in several ways:

  • These joints may continue to degenerate after a surgical procedure to treat a herniated disc or compressed nerve roots at the same spinal level
  • Surgery may change the loading or movement patterns of these joints, leading to degeneration and pain.

Following a spine fusion at one spinal level, motion of the level(s) next to it may be altered to compensate for changes the fusion caused. This change in motion pattern may cause facets at the adjacent segment(s) to degenerate and become painful.

Facet joint pain is difficult to identify without injections into these joints. In back pain patients, pain may arise from more than one source within the spine. While surgery may address one problem, existing facet joint pain may not have been recognized prior to the spine surgery, and therefore not addressed.

Treatment Options for Facet Joint Pain

Treatment of facet joint pain may include one or a combination of the following:

  • Physical therapy
  • Medication
  • Chiropractic care/manual manipulation

If these treatments do not provide relief, then more invasive procedures are an option, including:

Treatment Considerations

The most important aspect of pre-operative planning for facet joint pain is the diagnosis. As with real estate investments, where the focus is on “Location, Location, Location,” for spine surgery the name of the game is “Diagnosis, Diagnosis, Diagnosis.”

It is therefore stressed that before any spinal surgical intervention is considered, a thorough diagnostic work up is needed to determine any and ALL causes of the back pain one is addressing.

This is part of the reason that a preoperative discussion and a patient education program is necessary. This process will afford the patient a full understanding as to what is known and unknown in each individual case and what expectations can be set in accordance with all treatment variables.

The EMG Study

As featured on Spine-Health.com. Dr. Patel is a physiatrist and treats patients suffering from neck and back pain.

Contributed by Nayan Patel, MD

For the spine patient with Failed Back Surgery Syndrome, the electrodiagnostic study helps the physician assess for nerve damage coming from the cervical or lumbar spine, as well as evaluate for other nerve-related problems in an extremity (such as peripheral neuropathy).

Because symptoms from a patient withFailed Back Surgery Syndrome can be complicated, additional electrodiagnostic tests can help the physician with accurate diagnosis of the origin(s) of the patient’s pain.

An electrodiagnostic study, commonly called an EMG, is used to evaluate muscle and nerve function of a person who has extremity or facial pain, numbness and/or weakness. The study can be used to assess for cervical or lumbar radiculopathy (nerve damage from spine disease), any co-existing peripheral neuropathy (nerve damage from diseases like diabetes), myopathy (muscle disease) or focal neuropathy.

The test also helps localize the location of spinal nerve damage as well as distinguish if the damage is new or old, and progressive or stable.

There are two parts to an electrodiagnostic evaluation: nerve conduction study (NCS) and electromyography (EMG).

Nerve Conduction Study (NCS)
The NCS is done with a stimulator that generates a mild shock that travels down the nerve; the signal generated is picked up by an electrode placed at a specific distance. The data obtained give the testing physician information regarding the speed and strength of the nerve signal. The NCS picks up signals from two types of nerves: the sensory nerve, which provides sensation signals from the skin, and the motor nerve, which provides power signals to the muscles.

Electromyography (EMG)
The EMG study is done with a sterile, small gauge amplifier needle inserted into the muscles of an affected extremity. Each muscle is powered by specific sets of spinal nerves: for example, the bicep is powered by the C5 and C6 spinal nerves. If an abnormality is seen in the activity of a muscle or group of muscles, the physician can determine which spinal nerve is likely involved. The study can also help assess the age, extent, and possible progression of damage.

The complete EMG test takes 30 minutes to one hour. Although uncomfortable for some patients, the test is well tolerated and there is no persistent discomfort. The ordering physician may use the study in conjunction with other diagnostic studies, such as an MRI or CT scan, especially if the problem is thought to originate in the spine.

Since a patient who has failed spine surgery syndrome can have complicated symptoms, the evaluating surgeon can have difficulty telling if a person’s ongoing pain is coming from a spinal nerve. The EMG study will help evaluate active versus inactive spinal nerve damage as well as localize the spinal level of nerve damage. It will also help assess for any coexisting peripheral nerve damage.

Failed Back Surgery Syndrome

The post below was featured on Spine-Health.com and was contributed by Dr. Stephen Hochschuler, co-founder and orthopedic spine surgeon at Texas Back Institute.

Failed Back Surgery Syndrome (FBSS) refers to chronic back or neck pain, with or without extremity pain, which occurs if spine surgery does not achieve the desired result. Contributing factors include recurrent disc herniation, compressed nerves, altered joint mobility, scar tissue, muscle deconditioning and degeneration of facet or sacroiliac joints.

The problem of failed spine surgery has long been a perplexing and intriguing problem my colleagues and I have tried to accurately analyze and pro-actively prevent. My goal as a spine surgeon is to help treat patients with pain stemming from their spine. Many times I am able to treat patients with nonsurgical treatment options, such as physical therapy or medication, and they do very well. In some instances though, this treatment plan does not provide patients with the pain relief needed so we have to pursue more aggressive treatment options including surgery.

I always consider surgery to be a last option approach to spine care and therefore am very careful to make sure my patients are in the best position to have a successful surgery, in turn minimizing the chances of FBSS. Through experience I know there are several factors that have shown to contribute to failed back surgery syndrome, and therefore I follow the protocol below to make sure my patients are set up for their best outcomes:

  1. Before the surgery:
    • Always treat patients conservatively (non-operatively) first
    • Make sure the patient is correctly diagnosed – meaning that the cause of the patient’s pain has been accurately identified
    • Provide a thorough pre-operative evaluation
    • Make sure the surgery is the right one for the patient
    • Appropriately educate and set expectations for the patient, including pre-operative psychological evaluations.
  2. During the surgery:
    • Take all proper precautions to minimize intra-operative issues.
  3. After the surgery:
    • Keep a close eye on post-operative recovery
    • Work closely with the patients’ interdisciplinary care team.

If you are considering spine surgery, it is important to sit down with your surgeon and determine how he actively attempts to minimize the risk for failed back surgery syndrome. If you have been diagnosed with FBSS, it is not necessarily the end of the road. There exist many alternative treatment approaches to deal with this syndrome, but once again one size does not fit all. It is important to find a surgeon who has experience in treating patients with FBSS and can offer you multiple treatment options.

Dr. Scott Blumenthal was the first Orthopedic Spine Surgeon in the US to perform an Artificial Disc Replacement (ADR) surgery. This life changing surgery has now helped over 1,400 Texas Back Institute patients. Recently SpineUniverse.com featured the blog post below about the choosing the right spine surgeon for you.

Choosing the Spine Surgeon Who Is Right for You

Patients often wonder how to choose a spine surgeon to perform their total disc replacement.

The easy answer to this question is simple:  carefully.

The longer answer to this question is:  do your research, both on your surgeon and on the procedure.

Tips for Choosing a Spine Surgeon for Disc Replacement
While thousands of surgeons have been trained in disc replacement techniques, very few have adopted it into their clinical practice with any regularity.

Certainly, the bare minimum requirements for choosing a surgeon would be to ensure he/she is a board certified or board eligible orthopedic or neurosurgical spine surgeon.  “Board certified” means that the doctor has gone through a rigorous testing and peer evaluation process by a specialized medical board.

You can ask your doctor if he/she is board certified, or you can research it online.

Some tips to get a better feel for the expertise of the surgeon are:

  • Ask how long he/she has been performing disc replacement surgery and with what frequency they do this procedure.
  • Make sure your surgeon performs many types of surgery and can tailor your treatment to be most appropriate for your condition. Not every patient is best served with a spinal fusion, nor is every patient best served with disc replacement.
  • Make sure you have open communication with your physician.
  • Make sure you trust and have confidence in your surgeon’s abilities.
  • Look at the surgeon’s academic credentials or published papers.  Find out what they have written on disc replacement and if they are leaders in this specialized area of spine care.

A warning to patients:  Don’t depend on fancy advertising or marketing when choosing a surgeon.  Use all your resources when making a decision this critical. The Internet, medical directories and societies, as well as your regular physician can all be great resources in helping you decide which surgeon to go to.

There are also additional resources such as patient chat rooms and blogs where you can read about other patients’ experiences with surgeons.

Choosing a spine surgeon is a very important decision, and the more facts you can get, the better. Luckily, there are many resources to help you find a spine surgeon who is right for you.

Mistakes Men Make Concerning their Back Health

Men taking charge is nothing new in most situations.  At work, at the gym, on the sports field or even when a little spider invades the kitchen.  When it comes to their back health and safety men can be known for being a little lackadaisical.

Dr. Ted Belanger, an orthopedic spine surgeon at Texas Back Institute in Rockwall shares 5 mistakes men can make when it comes to their spine health.

 

1)       They don’t exercise their back.  Guys go to the gym and exercise their “glamour muscles” to get strong and look trim, but they only rarely do any exercises to strengthen their back.  Your back is made of the same tissues as your arms and legs, and responds to exercise in much the same way.  The old adage that it’s dangerous to exercise or use your back for strenuous activity is a myth.  You can strengthen it just the same as you strengthen your biceps—with repetitive range of motion against resistance until you reach muscle fatigue.

2)       They don’t do enough research.  Very often evaluation of back problems is sought without any careful research to determine who might be the best person to see.  There are big differences in the training, background, certification and experience of the various practitioners available to assess a patient with a complaint about their back or spine.  The list includes chiropractors, primary care physicians, physiatrists, pain management doctors, orthopaedic surgeons, neurosurgeons and orthopaedic spine surgeons.  Among these, no specialist has more training and experience assessing and treating musculoskeletal conditions than an orthopaedic surgeon.  Most of the others on the list either have very little musculoskeletal training (neurosurgeon) or have no experience at all in the surgical treatment of spine conditions (all the rest).  An orthopaedic spine surgeon is in the best position to diagnose and treat a patient with a back/spine problem, whether or not they need surgery.

3)       They don’t ask enough questions.  Patients often present for a second opinion to our clinic.  A common element of their frustration and sometimes confusion is a lack of understanding of their problem.  This can be avoided by insisting your questions be answered the first time around.  Bringing a list of standard questions is a great way to make sure you are communicating well with your doctor.  Good questions are:  What is my diagnosis?  What will happen if I don’t do anything about it?  What are my options to treat it and what can I expect from the treatment?  How does the treatment work, exactly?

4)       They don’t recognize the difference between amateur and expert advice.  People often put as much weight on their neighbor or friend’s back advice as they do their doctor. While good-intentioned, the patient should at least recognize that their doctor, particularly if they are an orthopaedic spine surgeon or neurosurgeon, has much more insight and understanding about the diagnosis and treatment options.  A common comment made by patients and their friends and family is “back surgery doesn’t work”.  But that’s a drastic generalization that simply isn’t true.  There are many different kinds of back surgery (discectomy, fusion, disc replacement, decompression, etc.) and many different reasons to undergo back surgery (degenerative conditions, fractures, trauma, scoliosis, deformity, tumor, infection).  Whether or not surgery is successful depends largely on the diagnosis you are treating, the details of the workup, the execution of the surgery, the choice of surgical technique, and the alignment of the expectations of the patient with what the surgery can accomplish.  Orthopaedic Spine Surgeons know this better than anyone else.

5)       They too often think their back problem is hopeless and they just need to “live with it”.  Patients are often afraid to seek advice about surgery because they are afraid.  They should think of the office visit the way the doctor does: a consultation to answer questions and provide information.  The decision about what treatment to participate in always rests with the patient.  If you are still not sure after visiting with a doctor, feel free to do more research, ask more questions, and seek more advice from experts.  Sometimes second or even third opinions are necessary to come to a decision about how to proceed.

If you or someone you know has fallen victim to one of these mistakes, it’s not too late.  Give us a call today and we will talk to you about your situation and help you figure out what the best treatments are for you!

Day 10 – Ebola?

Today we only had one case booked at Mulago hospital. We all woke up in the morning a little bit unsettled because we had all heard conflicting stories as to what the state of Mulago was in regard to the Ebola situation. Although most of the stories involved New Mulago, which is a part of the greater Mulago hospital, but located a short distance away, we were still not completely clear what was true and what was hearsay  As it stood, only half of the team was meant to go to Mulago to work on the case. There definitely seemed to be some tension within the team because it seemed like people were unhappy about this situation, but no one was speaking up. Thankfully, before we headed out, there was a team meeting called where we were told what was shared with Dr. Lieberman from the acting director of Mulago Hospital, and from his perspective it was safe for us to go in and perform the operation.

Off we went in the van, the group of us scheduled to do the case at Mulago. This case was an idiopathic scoliosis instrumentation, reduction and fusion on a 21-year-old female. Despite being slightly nervous about the Ebola situation, we all pulled together as a team and supported each other, mostly with lighthearted humor about the situation, and got through the case very successfully.

Day 11 – Last Day of Surgery at Mulago

Today there were two cases planned, one at each of the hospitals. At Case Hospital, we had planned to perform a difficult procedure on a 3-year-old female with a mass in the cervical region of her spinal cord. Knowing the delicate nature of this procedure, Dr. Holman had organized late last week to have some of his more specialized neurosurgery equipment shipped from the United States to help perform this procedure. Unfortunately, although it appeared that the shipment had arrived in Uganda, it was being held up by customs, and thus we were unable to obtain it. Consequently, this case had to be cancelled. This was such a frustrating outcome, after having planned to perform this procedure, and hopefully make a real difference for this little’s girl life, but instead the Ugandan government prevented this from happening.

While the Case half of the team were dealing with their setbacks, the other half of the team was working on a case at Mulago on a 50-year-old female with a suspected infection in her spine. This group at Mulago also faced their own set of obstacles in trying to undertake this case. When we arrived in the morning we found that the instruments we needed for the procedure had not yet been sterilized, and furthermore, the truck that was supposed to come and pick it all up to take it to where it can be sterilized, was out of gas. As we waited around for the necessary equipment, we rounded on patients, caught up on writing operative reports, grabbed a quick power nap, and Dr. Ughwanogho cracked the whip to ensure our patients were getting their post-operative x-rays after being told that they couldn’t get them because they had to pay for them themselves. Dr. Ughwanogho’s persistence paid off and sure enough, before we knew it we had all of the post-operative x-rays.

Finally, at around 1 pm, we had our instruments sterilized and returned, the patient was ready, and we began the case under the very competent leadership of Dr. Ughwanogho, with assistance from two Ugandan orthopedic residents. There was some uncertainty going into this case because this particular patient had been investigated for an infected process in her spine, but we did not know exactly what we would find. What we did find was a very inflamed spine, with cavitating lesions. Due to the precarious state of this patient’s bones, likely due to underlying  osteoporosis, this case took longer than we had anticipated; plus, we had had a considerable late start. Bottom line, it was a late night at Mulago, and when we finally had finished it was around 8 pm.

The rest of the team had gone to an evening reception, hosted by the Mulago administration, but as we had had a long and frustrating day, exhausted and starving, we headed home and went out to grab a late dinner. We eventually met up with the rest of the team at the apartments and discussed the trials and tribulations of the day, but encouraged by the positive outcome for the patient. Moreover, I think this was an important day for Dr. Ughwanogho, as he was able to reaffirm to himself just how talented and competent he is as a young orthopedic surgeon, even in the most adverse conditions.

Day 12 – Last Day in Uganda

Today, our last day in Uganda, was spent operating on a 5-year-old male with congenital scoliosis at Case Hospital. While half of the team was at Case operating, the other half of the team went to Mulago to wrap up any loose ends, check in on post-operative patients, and clean up our equipment. Once we had finished up at Mulago, we bid a bittersweet farewell to this place that had quickly become a home away from home for several of us. Although we had only been there for two weeks it became very apparent to us that we had established very strong and special relationships with the health care staff we had been working alongside; not to mention the relationships we had formed with the patients we had operated on and were now on their way to recovery. To me there was definitely a sentiment of this trip not being long enough. It seemed like just when we were starting to get into the swing of things, and starting to really mesh with the Mulago staff, it was time to go. Afterall, there is always more we could do.

Once we had finished up at Mulago, those of us who were not part of the operating team at Case went home to work on outstanding reports, sorting of the thousands of pictures that will be necessary to supplement the trip report, and catching up on other odds and ends. However, our ability to do work was interrupted by a building-wide power outage. Thankfully a generator was brought in, but only lasted as long as a full tank of gas, and then we were once again powerless. This made for more of relaxing afternoon that we had anticipated, but we were not too upset about that!

The operating team finished up the case successfully and without any complications. Upon their arrival home, we all packed up, sorted out the equipment that would be getting shipped back to the United States, and cleaned up the apartments, as we had an early morning departure on Friday morning. After all of our dirty work was completed, we gathered for our final team dinner at a restaurant called The Lawn. It was a lovely evening, with great food, drink, company and lasting stories and memories shared among us all. As usual we shared our personal lessons, but this time it was the lesson of the trip. Although we all shared very profound and meaningful lessons, it became obvious to me that this trip could never be summed up in a single lesson. Each of us has learned invaluable lessons from our patients, colleagues, from the Ugandan way of life as a whole; and more importantly learned more about ourselves than we probably even know. It is my hope that these lessons and memories remain strong and fresh in my mind for years to come.

Uganda Mission

November 6, 2012

Day 9 – Second Week Begins

Contributed by Erin Sadler

                Today marked the beginning of the second week of surgery. We had procedures taking place at both Mulago and Case Hospitals. At Case Hospital, Dr. Lieberman was performing a revision of hardware. At Mulago, Dr. Ughwanogho, one of Dr. Lieberman’s fellows, completed his first case on his own. He did a fantastic job operating on a 20 year old male with a cervical burst fracture. It was not only his surgical competency that I was so impressed by, but earlier in the day while he was rounding, Dr. Ughwanogho blew me away. It was during his interaction with a young man who had been in a motorcycle accident and had an odontoid fracture in his neck. After discussing with him the potential surgery that may be necessary for him, Dr. Ughwanogho proceeded to get to know more about the patient, and in doing so learned that he was in school training to be a pilot. Furthermore, learning the operation he had been suggesting, could potentially compromise this young man’s future career. Immediately, Dr. Ughwanogho realized these implications and quickly adapted his plan to accommodate an outcome that is more in favor of this young man’s future profession. Dr. Ughwanogho’s display of compassion and patient-focused care makes him a very strong role model that any surgeon-hopeful can, and should, look up to.

                After a long day, we arrived back home and turned on the television to watch some Olympics, but were quickly distracted by the CNN headlines of the Ebola outbreak in Uganda. After a few seconds of watching we were even more surprised to see a screen shot of the Mulago hospital, the hospital we had just operated at all last week, and all day today. Although we had been aware that Ebola was present in the Kibaale district, we were not informed of its presence at Mulago until now. This made most of us quite uneasy, and in no time family members were sending emails and texts sharing their concerns for our safety. We were later told that Mulago had not yet confirmed cases of Ebola, but there were several health care professionals being quarantined. We were more reassured when we heard that the airports were still open, there had been no travel restrictions placed on Uganda, and the belief from health officials that if there was any suspicious virus, it had been contained at Mulago.

                In an attempt to take our minds off of our worry about the current situation, we went for an absolutely incredible dinner at the Kampala Serena Hotel. This buffet dinner had the most delicious fresh avocado  smoked tilapia, beef kebabs, and a smorgasbord of desserts. After filling ourselves to the brim, we headed home. Before going to bed, much to the delight of our Polish anesthesiologists, we watched the Poland Men’s Beach Volleyball team (or as Jason astutely puts it, “sand” volleyball since they are not playing on a beach during this Olympics) defeat the USA team.  We then retired to bed, some us quite nervous as to what tomorrow would hold with respect to going to Mulago to operate, and furthermore, the implications of our travelling home with this health threat brewing.

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