The clinic was definitely smaller. I still saw several new patients including two new untreated clubfeet age 5 and 10. The 10 y/o had bilateral very rigid clubfeet. The left has already had a talectomy (removal of the talus bone of the foot) but the right side has never been treated. I tried a stretching cast. We'll see what Dr Herzenberg says about it. The younger child's foot is much more flexible. I also saw a teenager with Blounts. John and I can put a TSF on her if there is time. We still have four more clinics before the Herzenberg team gets here. I continue to be amazed at the pathology that continues to present here. Since we weren't pressed with a huge throng of waiting patients, I spent a fair amount of time teaching ZJ. I really enjoy that a lot. Unfortunately, Franz, our clinic X-ray tech didn't come in today. ZJ took a few X-rays. I finished by midafternoon. I spent the rest of the afternoon with Emmanuel, Roosevelt and Joseph. We took the pickup down town and went to several different places to price out bumpers and tiptop materials. We found a guy who will make the doors and windows close properly. It was fun tooling around with the guys. I bought and ate a roasted corn on the cob on the street. It wasn't like Wisconsin sweet corn but I ate it and it wasn't bad.
The anesthesiologist didn't come until one pm so I had the morning to email and recruit anesthesia and orthopedics. Dr Howard Place is a spine surgeon in St Louis. He has gone to the Dominican several times and done several spine cases in a week. He is planning to come here this fall. I sent him the pertinent information on four patients that are potential candidates. One is a teenage girl with idiopathic scoliosis of 70 degrees. The second is a young man with a bullet in his spinal canal at L4. The third is a lady with Grade III spondylolisthesis that is very symptomatic and the fourth is a quake victim with a severe compression fracture of D12 that is very symptomatic still. I also had time this morning to teach ZJ more orthopedics. He is really soaking it all in.
We had four cases this afternoon including a hip hemiarthroplasty. They all went well. JJ scrubbed and ZJ assisted and we had a good time.
For a Friday,the clinic was big. It made up some for the small one on Wednesday. I saw two morbidly obese ladies with back and knee pain. They have both had treatment from other doctors including knee injections that have given them good temporary relief. No doctor had explained to them the relationship between their obesity and the musculoskeletal problems. I explained to them both the importance of weight loss and how it might help relieve their knee and back pains. I told them they would have to go back to their regular doctors for their knee injections until they each lost at least 150 pounds. I am sure they came for free injections. I won't use the limited resources we have here to treat patients that make no effort to help themselves. I tell them that when they sit down to eat they need to take their plate of food and take at least 2/3 of it and put it on a separate plate and go out and find a hungry Haitian. When I say that, they all give a big smile and agree. More patients came in today for the Herzenberg team including a lady with a large rotator cuff tear. Several interesting peds cases came in as well. The best case was one I am going to do myself this coming week. She is a lady who was injured in the earthquake when her house collapsed on her and broke her leg. She lost a 7 y/o daughter. Her tibia is malunited with 30 degrees of varus. I scheduled her for a Taylor Spatial Frame and tibial/fibular osteotomy next week when we have anesthesia.
We finished the clinic in time to throw the football a bit and try our first scrimmage. A couple of younger kids and Emmanuel and Roosevelt and I had a lot of fun playing. We then took the pickup and spent about an hour looking for some more material to turn it into a taptap. We found just what I was looking for, some abandoned parts for the back of a taptap. It isn't rusted much, just basically needs some paint. it isn't quite the right size for the short bed but nothing that a hacksaw and a welder can't cure.
I am so glad that this week with no orthopedist to help me is done. I will have an anesthesiologist and a 5th year ortho resident next week. Now it is the Sabbath. What a delight! I do have a wound vac change on one patient tomorrow but otherwise no medical work unless something urgent comes in.
Today was a very quiet Sabbath, just like I like them. We went to both Sabbath School and church up the street at the university. The sermon was given by a fairly young Haitian preacher. He speaks very good English. His topic was "Time." He chose ten Bible verses that had the word time in them. of course his topic was related to the well publicized prediction that Christ would return to earth today. I am sure there were a lot of disappointed people who fervently believed that the difficulties associated with living here on earth in this day and age were all going to end May 21. I too believe that Christ will fulfill the promise that He made to His disciples that He would come again. It is very clear in the scriptures that no one knows exactly when that will happen. We are told that once the gospel commission has been fulfilled to take the gospel to the ends of the earth, then He will come. The Bible also indicates that there are signs that will occur that indicate the "time of the end" is near. Those signs include wars, pestilences, marked increase in knowledge and natural disasters of increasing frequency and severity. It certainly does seem as if those signs of Christ's imminent return are happening in the last several years. Earthquakes causing unprecedented damage and death as well as severe storms, volcanic eruptions, AIDS and its unbelievable death toll across Africa and India and the internet with the worldwide availability of undreamed of amounts of knowledge could certainly be the fulfillment of many of those Biblically predicted signs. I certainly am looking forward to the day when there will be no more sickness, sadness, pain and death. No more intramedullary rods for broken tibias and femurs. No more wound vacs for open lesions and infections, no more Taylor Spatial Frames for severe bowlegs, no more ACL reconstructions, no more clubfoot casts, no more hip fractures or chronic back pain. No more kids with short deformed legs, scoliosis, myelomeningocele or cerebral palsy. I can lay down my scalpel, turn off the C-arm, put away the SIGN nails, and throw away cast padding, plaster and fiberglass. What will I do with no fractures to fix or deformities to correct? The possibilities are nearly limitless. Reading, music, travel, gardening, reading, woodworking, sporting activities and more reading. We are also promised to be reunited with our loved ones who have died. What an experience that will be! That day just cannot come soon enough for me.
We followed that with rounds including the wound vac change. Everybody is doing well. The afternoon was tranquil. I was able to do some reading and emailing family and friends. A 90 y/o lady with an intertrochanteric hip fracture was transferred in this afternoon. We have an anesthesiologist coming tomorrow so we should be able to do her surgery as soon as she has blood ready and is cleared by the internist.
Sunday, June 5, 2011
Rounds took a while today. We have quite a few patients. Several had big dressings to change. Two of the wound vacs needed changing also. Our diabetic patient's amputation stump incision looks good but unfortunately his blood sugar is very high. We had to get the doctor working in the ER to evaluate him and make recommendations.
Nathan and ZJ were out in the storage area working on cutting some wood to make shelves so I helped them for a couple of hours.
Later in the afternoon, we took the man with the pelvic injury to the OR. I gave him some sedation and put in a distal femoral traction pin with local anesthesia. I used the C-arm to see if his displaced hemipelvis would reduce. It did come down to the right level but the S-I joint was still widened. It definitely needs a screw or two to get it together. I will need good anesthesia for that so will probably need to wait a week. After I finished and was starting to move the patient to the gurney, his oxygen saturation dropped significantly. We put him on oxygen which didn't seem to help. We finally decided to put him on heparin. He improved a lot in less than an hour. I wish I had consultants available to help with these complicating problems. Fortunately, he stabilized and seems pretty normal. ZJ, Lynne and Mark helped monitor him through the night.
The clinic today wasn't nearly as big as the clinics last week. I saw several more patients for John Henrzenberg today including a 20 y/o with severe spastic club foot and knee flexion spasticity. I think he can be improved a lot with surgery. Dr Stutz of the Lovejoy team did a major procedure on his spastic upper extremity. I put him in a preliminary stretching cast. Our 12 y/o girl with the comminuted femur fracture suddenly had a lot of pain in the therapy department. Her external fixator had come loose so we admitted her. We will only have anesthesia for a few hours tomorrow. I hope we can get all of the casts changed and pins removed on the clubfoot patients and still have time to get her ex-fix back on. I still have the man with the hip fracture that needs a hemiarthroplasty. Maybe I can do him on Thursday if we have anesthesia long enough.
The anesthesiologist came today between 8:30 and 9 am and told us she had to leave by 11. We hustled and used all three rooms and were able to get 5 cases done including replacing the ex-fix and reducing the fractured femur on the 12 y/o. The anesthesiologist really did a good job. She had some of the OR nurses monitoring the patients as we changed casts, removed pins and did manipulations. We then had 3 cases using local anesthesia. It turned out to be a very productive day. We only had to cancel the patient for clubfoot correction. We finished all of the cases in time for JJ and I to throw the football for a while. We had fun. He is a very good natural athlete. Tomorrow is Flag Day here in Haiti and the clinic might be smaller. If so, I'll try to get all of the translators to get their Packers tee shirts and we'll try to have a little scrimmage.