Rings and Things……..

 

 

I was called to the ER during the morning hours, say around 11 am to see a young girl from the local High School who had an injury to her little finger of her right dominant hand. She was helping roll up the volleyball nets after PE class and got her little finger caught inside one of the small holes in the volleyball net poles and had removed all the skin and contents of the finger from where the finger met the hand to the end of the digit. This is called a “de-gloving” injury.  The problem is that there remains attached to the hand, only the bones and ligaments and tendons and the nerves, vessels and all of the skin has been basically removed.

This type of injury is also seen when mechanics or people working around machinery wear their wedding or other rings and get the ring caught in the machinery which pulls off the ring along with the rest of the finger. Even one of our astronauts who went to the moon lost a finger this way jumping off a wagon and his wedding ring caught on the side of the wagon and pulled off all the “meat” from his finger. Insurance companies for a lot of manufacturing facilities forbid the wearing of rings for just this reason. So it’s a pretty well-known problem and results in an amputation at the level the ring was when it left.

The problem wasn’t the injury to this little high school girl, it was the “rest of the story”.  She was a GREAT high school varsity basketball player, one of the stars. This was her dominant hand.  She is a beautiful young lady and she needed a revision of her amputation to a previously beautiful hand (think rings and pictures and things). Finally, her Dad didn’t have any sons, so he had poured all his sports knowledge into his star player /daughter and thought this would be the end of her career if it couldn’t be repaired.

There is no good operation for this injury except to revise the amputation at the level of the “ring” injury and give the patient a functional hand, minus portions of one digit.

You can imagine the emotional maelstrom that was occurring in the room in the ER. After much discussion, to include cosmetic finger prostheses and a promise that she could still play basketball, I took her to the OR and surgically revised the amputation. There was nothing left past the little finger metacarpal so she lost the finger as it joined the hand.

I had a wonderful compassionate hand therapist at the time and she had many, many interactions with this young lady. We made her appointments with a finger prosthesis manufacturer etc. but after she began using the hand and found out that it didn’t really affect her Basketball game, her entire demeanor and personality snapped back to normal, as did her dad’s and she even declined to have a finger prosthesis made for her. (the prostheses are quite good BTW and look very real, but they are very expensive and are only good for looks, not sports).

She went on to play basketball thru the rest of High School and college, got married and ended up with twins.

She still lives in town here and I see her dad and mom all the time and she runs a pretty profitable little business here.

She does everything she wants with no problems.   A great ending to a potentially devastating injury.

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State Wrestling

 

My son wrestled during high school. It’s the only martial art that is really left in our physical education curriculum. Man to man, the field of battle is engaged and your job is to subdue your opponent. Wow. Tough to watch. There were some really good wrestlers on his high school team. He did well also going to state 2 years in a row. One young man was a very quick and strong wrestler. Because my son wrestled and I was usually there to watch him, I was the “de facto” physician for the wrestlers.

This really quick and strong fellow, we will call him Albert, injured his knee during one match. He dislocated his medial meniscus and then “popped it back into place”. The meniscus is a circular piece of cartilage that occupies the space between the rounded condyle of the femur and the relatively flat tibial plateau and is torn during a twisting injury to the knee. You can read more here:  http://www.howardluksmd.com/types-meniscus-tears/

He could do quite well when his meniscus subluxed back into its normal position but upon occasion it would slip out and “lock up” his knee and he couldn’t wrestle. He put up with it, learning how to put his meniscus back into place until one day it dislocated and stayed out. It was one week before the State Tournament his senior year and he was expected to place quite high. I obtained an MRI that confirmed the diagnosis and had a sit down talk with him. He wanted it fixed and wanted to wrestle in the state tourney one week away. I told him that was HIGHLY unlikely but we would see. I scoped his knee on Monday before the tournament on Saturday. The operative findings were the best they could be and with a couple of quick snips, took out the damaged, torn portion of his meniscus.  After arthroscopy, patients usually have a swollen sore knee. He started immediately on Physical Therapy with Ice and compression and ROM exercises and more exercises.  His treatment was intense but his desire was quite tenacious.  Saturday, he was ready to wrestle. He made weight and had several matches before him. He won them, one by one.  And he won the State Title in his weight class.

He has gone on to start his own business and be a successful business man. He isn’t bothered by the knee which healed nicely.

Drive, Intensity, and Desire cannot be minimized in his accomplishing his short term and long term goals. Also, young people heal faster than older folks!!! LOL!!

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Its the Little things……

We here in the South have a number of sayings that are not conventional or easily translated from the words that are used. I grew up in a large city and didn’t come across very many of these “sayings” that Jeff Foxworthy has made a living from until I came to this county.

When I was in Atlanta, during my residency, working in a metropolitan downtown office, there were stories that were told of some of these “sayings” and when I came to the more rural setting where I started my practice, I was confronted with some more.

I never knew that being “ILL” was something that had to do with attitude rather than diseases. Apparently when someone is “ILL” in this area, they are out of sorts or disgruntled about something. Usually it goes like this……….”Sarah sure is ILL about the church supper the other night”…..and they go on to enumerate the cause of the ILLNESS.

My nurse came from the West coast (California) and was quite well spoken and had a great command of the English language. When she went to a supermarket here in town, she checked out with her groceries at the counter as usual. As she was walking out the store with her groceries, someone said, “You come back now”, and she promptly turned around and went back to see what the concern was, thinking that she had left her change or something of that nature.

Another nurse from Indiana was working in “our area” and was doing the interviews of the patients before the doctor was to see the patient. She was going in and asking the usual questions such as, “well, what are you here for today?” and the sort. She entered one room and asked the question, “well what can we do for you today?” and the patient said….”I’ve got a risin’ and its come to a biling and its got corruption in it”.  She smiled and said, “OK, the doctor will be right in” and turned and left the room.  She closed the door behind her and the MD said, “what are they here for today?”

She said,” I have NO IDEA”.

Finally, I was discussing the treatment of a “fracture” in a forearm in a small child, and was trying to explain to the parent, who had been to see another physician before coming to my office that I wasn’t sure that I saw the need for more than “skillful, watchful, neglect” for this injury because I didn’t see a fracture line on the x-ray and I thought that the line that the radiologist called a “fracture” was probably a nutrient foramen, and it was going to heal fine without treatment and that I wasn’t sure that I could “appreciate” a fracture line.

The parent looked stunned for a moment and said, “I didn’t mean to make you mad, I was just telling you what they told me and I didn’t mean to offend you!!!” He didn’t understand that I didn’t “See” the fracture, i.e. didn’t “Appreciate” the x-ray findings that he had been told were present.

It’s the little things………

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A good friend sent me this…

A Christian Pastor’s Analysis of the U.S. Election Drama
Is Trump good for America?  I mentioned Sunday that I would speak on this next week.  Unfortunately, I found that I was shoehorning this topic into my planned message.  To properly present what I want to speak on Sunday, I may have to leave the Donald out of it!  But let me take a minute for those that wonder and give some of my thoughts…………
When I first heard that Trump (DT) was entering the race last year, I told my wife that perhaps it was a good thing for the party and America.  I knew that he was not a “saint,” but I thought that he would be like a bull in a china shop.  He is a disrupter and I believe America could use a fresh thinker especially in the political arena.  I didn’t think he would get the nomination, but that he would shake up politics as usual.  I was correct on the shaking up!   

Lance Wallnau likens him to a biblical Cyrus.  Someone who is dynamically used of God even though not perceived by many as a God follower.  God has used many people in history that I would probably not like or agree with.  I’m not sure I would have liked all the disciples, or David, or Moses.  Somehow, God did not seem compelled to consult with me on His choices!

I have always admired Winston Churchill.  He is seen as one of the greatest national leaders in the 20th century.  Last year, I had the privilege of going through the War Museum in London.  Winston is a key feature.  His life is controversial.  He was not always celebrated as a great leader.  He was a bombastic, cigar smoking, at times crude, even misogynistic leader.  It is alleged that he told off color stories to his children before bedtime!  A woman once told him he was disgustingly drunk.  His response was “My dear, you are disgustingly ugly, but tomorrow I shall be sober and you will still be ugly!”  

There are many websites that discuss the outlandish comments and activities of this great world leader.  But, he had exactly what was needed to stop Hitler at the Channel, to rouse a nation to never give up and to partner with America to find final victory in Europe.  
You probably wouldn’t want him as your pastor, maybe not even your father, but he was the right leader for that moment in England’s history.  Such a brazen man that would go up to the roof of his quarters in central London and smoke cigars as Hitler’s air force bombed all around him.  I’m not sure I would have voted for him….but he was the right man!

I think it would be awesome to have a righteous leader, one that understood the intricacies of the economy, health care, defense, immigration, with great sensitivity to religious institutions, a heart for the poor, a vision for the future.  If that leader was a praying person, formidable in the word of God and loved the local church, I would rejoice!   I do not think that is the choice we will have in November.

Instead….we will look for someone who is imperfect, yet will fit the times we are living in.  Particularly, that ‘whoever’ we vote for, will be someone who might possibly have the opportunity to appoint up to three Supreme Court justices.  That could radically shape our culture in America for the next 30 years.  The America of our grandchildren could be very different….and that may not be good.  We cannot stand on the sidelines.  A non-vote is a passive vote for a direction we may very well regret.  

So….is Donald Trump good for America?  I honestly believe that he has been already.  He has shaken the political system.  Do his comments offend me?   At times!   Do I agree with all he says?  Not at all!   But could he be a “Cyrus” being raised up by God to preserve America?   
Nobody liked Gen. Patton, but he sure WAS an instrument of the United States for the right things.
This I know.  I will vote for the best chance for America.  I will pray for our leaders as I have already.  In the end – God will continue to be my source and my hope.   I do believe that God has had a hand in America’s history.  I hope and pray that He will also have a saving hand in America’s future.
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The blizzard ….

I woke in the morning with a snow blizzard outside. Its freakin’ April in Georgia!!! AND 16 degrees!!

I woke that spring with the snow covering the ground. I thought that would be some impairment to my driving to work but not a significant problem.  When the storm started coming as the worst storm in the last hundred years and dumped 2 feet of snow in this North Georgia town that had never seen more than 2 inches of snow, I knew we were in for an experience.  The strange thing to me was that the storm was so severe that thunder and lightning appeared in the storm clouds of snow.  There were piles of snow, like I have never seen.  I was raised in Birmingham and Atlanta and the most snow we had ever had previously was six or 8 inches.

I was on call at the Hospital and then responsible for taking care of the patients in the emergency room. I was not too concerned that it would be a huge volume of patients in the ER (nobody could get out!) however I did have patients in the hospital.  I had gone to work in the snow in years past, but never of this severity.  Power was out and we were heating the house with a gas fireplace.  For some reason the phones did work.  I tried to figure out someway to make myself available to the hospital.  We have a large pasture at my house that I use a tractor to mow with a 6 foot Bush hog.  I figure the tractor would be able to navigate the snow.  I didn’t have any four-wheel-drive vehicles at this time.

I went out to the shed and cranked up the tractor. It was bitterly cold and actively snowing.  I’m sure people in Minnesota deal with this all the time, but for me it was a new experience.  I put on every cold weather outfit that I had.  I was in long coveralls with thermal underwear and a large coat.  In addition to put a good hooded jacket on as well as gloves and a wool cap.

With my leather gloves pulled on tightly, I navigated out of the shed into the snow on the tractor. I travelled easily up the driveway.  I looked at my diesel gas gauge and found that it was about a quarter of a tank left, which for that tractor would carry me well into the day.  I then began to navigate slowly down the driveway and turned onto Burnt Hickory Road.  As one would imagine there was no traffic.  I meandered down the country road, which was desolate except for the snow, me and the tractor at about 15 miles an hour.  It was easy-going in the tractor in the drifts weren’t that significant.  I tried to stay on the surface streets and stayed off the divided highway.  I eventually meandered into the hospital parking lot, which was covered with about 2 feet of snow.  I drove up under the emergency room overhang  went in the hospital tp change into some scrubs in the surgical suite made rounds and talk to a number of the hospital personnel.

Some of these people had been there throughout the night and knew that they were not going home. The kitchen was open for those folks who need it have something to eat and we did have a snack machine area.  However, this was going to be rapidly depleted.

After a making rounds and visiting the few folks I had in the hospital and making myself available to the nurses to help with whomever they might need, I talked to the physical plant People there at the hospital. It was apparent that they needed someone to clean off the hospital parking lot so they can get cars in and out of the parking lot.   It was also apparent that in the county there was not an extra vehicle to do this. About a quarter mile down the road was the Ford tractor business.  I hopped on my tractor after assuming my armor against the cold, and drove down to the tractor place.  Interestingly enough, they were open.  I might mention that this is good weather for heavy equipment dealers.  At any rate, I bought a scrape blade, which for those of you are not familiar with tractor equipment is a blade that you attach and drag behind the tractor and you can angle it so that it will push dirt or snow off to one side.

I then returned to the hospital and filled up my tractor from their emergency diesel tank at the hospital. Most hospitals maintain a emergency supply of diesel fuel in order to fuel the emergency generator if such a situation should arise that they do not have enough power or that they lose power, and they can run their diesel generator for power.

That was the deal I had struck with the physical plant employees. I would clean off the parking lot and hospital drive if they would allow me to use some diesel fuel.  I then began to methodically scrape off the driveway around the hospital on my tractor.  I’m sure it was quite a sight for about four hours.  But at the end of that four hours parking lot was cleared as were the roads down to the divided highway and the roads back to hospital.  By that time it was well into the day and I needed some lunch and thought it would be appropriate for me to return home.  The freezer downstairs at my house had begun to defrost and we were going to eat steaks every meal for a while!

I hoisted up my scrape blade and meandered back to the house through the small surface streets, taking the opportunity to scrape off some of the service streets that I thought needed a little extra attention on the way home.

It’s interesting that when you have such bad weather as this very few people get out. If they don’t get out, they don’t get hurt, if they don’t get hurt, they don’t come to the emergency room.  The rest of the day and evening was very quiet.  I was elated because I knew that my partner was on the following day and that’s when people begin to get out snowmobiles or when they figure out what the fun it is to ride around in the snow.

My nurse remembers the date of the blizzard because it was the date of her son’s birthday.

After about four days, things returned to normal, but always remember the day that I cleaned off the parking lot at the hospital on a blue Ford tractor with a scrape blade at 16°.

BLIZZARDFILE_521397

 

 

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Integrity…my 2 cents

 

I initially thought that my description of integrity would be easy to put together as an essay that would lay down my personal principles about how one could obtain and pursue a life of integrity. It seems however that the concept of integrity has many facets.

Integrity reflects how consistent one is with their adherence to a belief system or moral code. It is the quality of being predictable according to a set of values or a dogmatic approach to situations and lifes problems. To judge someone as having integrity usually means that they have adhered to most of the standards that we think of as important.

I come from a long line of dogmatic individuals. I was taught a code of moral values and honesty that has remained increasingly incorruptible as I have gotten older. This dogma contributes to one’s integrity. Obviously, this dogma needs to be sound and based on what are considered good and appropriate social values.

Honesty and truthfulness is another significant part of my perception of integrity. That you speak what you know as the truth with the qualification that it is your personal belief and experience, must be mandated as part of the formula for integrity. For example, writing this essay about my personal beliefs and practices as opposed to putting to paper what I think you might want to read is a great example of personal and academic integrity. I have always been taught that you should keep your “word” and be thought of as someone who always “keeps his word” and”does what he says”.

I think an unbiased approach to the truth is an important part of integrity. I tried to instill this principle of integrity in my students and advisees by telling stories. I have many stories from my experience as an orthopedic surgeon over many, many years. The stories that I remember convey consequences and outcomes about integrity and life choices. My response to the personalities in these stories speak loudly about the principles of integrity as well as about my perspective about integrity

I think that it was important (when I was on faculty at a local college and had advisees) to tell my advisees that they don’t make good medical school candidates and that they need another plan for their life if that is indeed the truth. I think that it is a disservice to them if they are given false hope for a career that is really not within their abilities to grasp. It is not easy to do this but I feel that my integrity as an advisor requires me to do this.

Social context cannot be forgotten in describing integrity. Those societies that encourage people to be honest with themselves and use their abilities to be critical of their own persona, are usually more conducive to promoting integrity. This society would promote values of honesty and individual responsibility, as opposed to those of success and career at any cost.

I think that personal adherence to this values system is also a manifestation of integrity. One must “walk the walk” and live their life following the principles that you preach, otherwise you have no credibility or integrity. One must be continually self-aware and maintain a constant watch over the incessant bombardment of the world against personal standards and beliefs. To acknowledge these conflicts and to declare them to others helps them learn how to live with integrity. You must care enough about yourself and others to maintain your personal integrity as one of your highest priorities.

I try to portray integrity to my students by being fair and just in my handling of their grades and academic measures. I try to portray Integrity by being available when I say I will and by being on time or early to appointments. I try to be fair in assignments and responsibilities in course work and try to put myself in their shoes. Part of integrity is having respect for the views of others. These small things leave an impression on my students and advisees. I try to tell the truth and if I don’t know, I tell them I don’t know. I try to convey the lessons about life that I have learned by using my life as an example, sometimes as a bad one as well.

When all is said and done in life, the only thing that people will know about you is your character. Once that is damaged, it is very difficult to repair. They will know whether you were fair, honest, straightforward and trustworthy in dealing with them. How you behave when no one is watching is the best assessment of how you really are as a person.

Integrity-is-doing-the-right-thing-when-no-one-is-watching

Proverbs 19:1: Better is a poor man who walks in his integrity than a rich man who is perverse in his speech and is a (self-confident) fool

 

 

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You can’t be serious!!!!

In our practice, I saw a number of individuals with carpal tunnel disease. The problem with these Worker’s Compensation patients is that it’s sometimes difficult to discern real pathology.

Workman’s compensation is a unique section of my practice and that there is also all sorts of secondary gain that is available to patients who find that they have a disability. They will be able to have time off from work plus first dollar coverage of their care with no deductible.  As a result, the insurance companies that cover Worker’s Compensation have made any an extra special effort to ensure that valid claims are made.

I had a young lady come into my practice with classic symptoms of carpal tunnel disease under the w/c carrier from a local company. She had tingling in her thumb and index finger and long finger at night and with use, and she had numbness in the median nerve distribution as well. She had a positive tinel’s sign.  This is a test that is done by tapping over the median nerve at the wrist which causes numbness and tingling in the involved fingers.  The confirmatory test for this disease and the “gold standard” for testing is an electrical study done in the office called an EMG or a nerve conduction velocity (NCV).  This young lady in my office had such obvious symptoms that I thought it not necessary to do this examination because it was clinically obvious and that it was expensive for the insurance company and uncomfortable for the patient.NCV

I call the insurance adjuster and explained to her that this situation was such that the test was probably unnecessary.  She said that the only way that she would approve surgical treatment for this disease and this problem was if there was a positive EMG and nerve conduction velocity test done.  I explained to her that I would do the test myself in the office.  It was going to be positive.  I want her to make sure that she understood that I was going to do the test in the office and that in the exam was going to be positive.  She said to call her back when that test was done and it was positive.  This caused the insurance company to have to pay me another several hundred dollars and did not change the findings of my examination or the diagnosis.

I did the exam. It was positive, and on the return the phone call to the adjuster I explained to her the positive findings. Then, she was more than delighted to pay me for not only the office visit but the EMG /NCV studies as well as scheduling her for some future surgery.

 

Ridiculous!!! But she eventually got her surgery and did well and returned to work.

 

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