Sunday, August 21, 2011

Game Time

We’re always a little hyped up. It’s a little early, 7am, but we’ve been up for 2 hours.  Everyone prepares in a different way. For some it’s a physical movement or mental traits- brisk calculated activity, silent concentration, talkative, etc. There is usually some music in the background the genre varying. The importance of the event doesn’t need to be discussed, we all get it. The team is not random but carefully selected- they are the best of the best. They all chose to be a part of this elite team, some at considerable personal expense. There is a hierarchy, there has to be for this type of operation. Even though there is a hierarchy it does not belay the importance the essentialness of each person that’s a part of our team.

The team leader asks the members “Are we ready to begin?” – a resounding “Yes” with a sense of purpose is elicited.  A member of the team leaves the room to begin the encounter.
For security purposes, the target will be identified as “Bill”.
A team member approaches Bill, gathers the appropriate information, asks if he has any concerns and begins pushing the gurney into the OR.
We’ve already slipped Bill some specially prepared “medication”. He’s “happy”.
The mood as he enters the room is of quiet confidence. Everyone on this assignment has been here many times before, and the sense of winning is in the air.
Positioning, preparation and draping occur as a matter of routine.
There is a “time out” where the entire team stops, we review our goals our tools our mission and before beginning we all confirm that we are on the same page.
“Time to rock and roll” says the leader. There is some “white noise” in the background, better known as music. There is very little talking, everyone knows their roles so well there doesn’t have to be words- there are motions, there is anticipation, an occasional request. We move quickly, without the sense of rushing, but with deliberateness that radiates confidence.

The operation is going smoothly and there is a relaxed joviality in the air. Suddenly in a calm but firm manner- “bleeder” is verbalized. Sudden change in the atmosphere, flight or fight response instantly. No jokes all business. Suction, clamps, ties- control quickly achieved. Second and third checks – OK everything good. No high fives or celebration, just the professionalism that comes with experience. The mood shifts and we relax again.  The components of the joint replacement are placed and the results are up to the standards of the team.

Now there is a moment where everyone feels it- that sense of “Yeah Baby”, perfect. We don’t necessarily say it but we feel it- everyone in the room does. We relish that feeling for a bit (we live for it), and then get ready for our next mission.

Friday, August 5, 2011

Operation Walk Syracuse Extends Its Gratitude to Franciscan Companies

Operation Walk Syracuse would like to extend our heartfelt appreciation to Franciscan Companies for their tremendous support to Operation Walk Syracuse.  Thanks to their donation our Nepalese patients will have the use of reacher/grabbers, sock aides, commodes, raisted toilet seats, wheelchairs, oximeters, and glucose monitors during our November visit.  It is through the generosity of groups like Franciscan that we are able to provide this life-altering procedure for people around the world with limited access to care.
Franciscan Companies is an affiliate of St. Joseph’s Hospital Health Center. Through a variety of companies and partnerships, Franciscan Companies extends the reach of the St. Joseph’s network throughout the Central New York community. From home health care services to durable medical equipment, from infusion services to medication dispensing machines, Franciscan ensures that patients discharged from St. Joseph’s Hospital—as well as other hospitals in the area—receive the continued care, services and products they need for improved health and comfort.

Tuesday, August 2, 2011

Follow Up to Channel 10 Story

A recent YNN story which aired on Saturday, July 16th focused on two elements related to joint replacement surgery:
·         Implant materials (surgeon interview)
·         Outcomes after joint replacement surgery (physical therapist interview)
Unfortunately, the two twains of the interviews never intersected and there was no opportunity for the surgeon, board-certified and fellowship trained in adult reconstructive surgery, to weigh in with his expertise on the topic of functionality after total joint replacement surgery.
The  physical therapist interview cited a study (studies) which report findings that significant impairments and functional limitations continue at one year post total knee replacement.1  This study, published more than ten years ago, also clearly had a major design flaw.  Patients in the study group were significantly heavier and had a higher percentage of body fat than the control group members.  This makes the reported findings suspect because clearly the two groups had major differences.
Two more recent publications in the physical therapy literature cite dramatically different findings than the 1998 study.  A recent meta-analysis of the literature published just this year reports that in the areas of perceived physical functioning, functional capacity, and actual daily activity, patients experienced significant improvement postsurgery compared to presurgery.2
Another study (published in 2008) evaluated physical activity after total hip replacement and found that despite having experienced a major surgical procedure, patients having undergone total hip replacement had achieved a level of physical activity consistent with the normative population, and even exceeded the intensity of physical activity for the same group at both light and moderate intensity levels.3
Restoration of mobility and function are obvious reasons to pursue joint replacement surgery, however, the number one reason patients choose to undergo a hip or knee replacement is to obtain relief from debilitating arthritis pain.  Joint replacement surgery is a last resort intervention after more conservative interventions such as physical therapy, medications, and injections have failed.  After the risks, benefits, and alternative options have been thoroughly discussed with the patient, he or she is the sole decision-maker to move forward with joint replacement surgery.  The surgical procedure itself relieves the arthritis pain, but the surgery itself only serves as the conduit for improved motion and function postoperatively.  Patient participation in the postoperative rehabilitation plan is the most important determinant in achieving physical activity goals.

1Walsh, M., Woodhouse, L., Thomas, S., & Finch, E.  Physical Impairments and Functional limitations: a Comparison of Individuals 1 Year after Total Knee Arthroplasty with Control Subjects.  Physical Therapy.  1998; 78(3):  248-254.
2Vissers, M.M., Bussman, J., Jan, V., et al.  Recovery of Physical Functioning after Total Hip Arthroplasty:  Systemic Review and Meta-Analysis of the Literature.  Physical Therapy.  2011; 91(5):  615-629.
3Wagenmakers, R., Stevens, M., Zijlstra, W., Jacobs, M., et al. Habitual Physical Activity Behavior of Patients after Primary Total Hip Arthroplasty.  Physical Therapy.  2008; 88(9):  1039-1048.

Our thanks to Megan Hickey, Manager of PM&R, for her assistance in this review of the physical therapy literature.