Saturday, March 26, 2011

Operation Walk 2011 - Day 2, March 25

Day 2 of Operation Walk picked up right where Day 1 left off -- with a planned 16 joint replacements in 9 patients, it was sure to be a busy day. The team arrived to the hospital to make morning rounds, taking over from our Dominican colleagues who had been in the hospital overnight. All of the patients operated on the previous day, and all those yet to have their surgeries were seen and all were doing very well. Preparations for the day's OR began in earnest, and the first surgeries proceeded without a hitch.

In seeing all of the previous day's postoperative patients, one thing that stuck me was how relatively comfortable our patients were, despite the use of very little narcotic pain medication. Our anesthesia specialists had done an outstanding job of controlling postoperative pain with a combination of regional anesthesia (spinal, epidural, and local nerve blocks) as well as non-narcotic IV and oral drugs. The contrast between postoperative pain control strategies in the Dominican, as opposed to the United States, was stark -- a unique challenge for our anesthesiologists has been the cultural differences with respect to the use of narcotics here. Past Op Walk missions have found (through feedback from Dr. Alcantara and others) that our patients here dislike the narcotic side effects, so much so that they would rather not have them. This has led to the pursuit of alternate pain control strategies, and our patients are seeing the benefit of that hard work already. (below are images of two of our anesthesiologists, Dr. Katie Nicholas and Dr. Emily Maher. Dr. Nicholas is placing a femoral nerve catheter and Dr. Maher an epidural).


Post operative pain control is a concern with any type of surgery, but it is particularly important in joint replacement surgery. Much of the ultimate surgical outcome of having a joint replaced is dictated by how active a patient is following their surgery, and how able he or she is to participate in physical therapy (PT). We expect our patients to be up and working with PT less than 24 hours after this significant operation. They are much more able to do this with improved pain control. This was demonstrated on day 2 (as seen in the photos below) as our patients who underwent surgery on Day 1 began the process of postop rehab. With the assistance of our enthusiastic physical therapists, all were able to be out of bed and moving -- many taking their first steps. It was an exciting thing to see.
(Op Walk physical therapists Rachael Percoco and Brooke Fontana are pictured assisting their patients, below)


The operating room proceeded smoothly through the day's cases. In a number of the surgeries two of our attending surgeons assisted one another. Its a relatively unique situation to have two experienced attending surgeons operating together, and in the case of our surgeons the amount of combined joint replacement experiece is immense. It was again an incredible opportunity for the residents and students who were able join (Dr. Burke, Thornhill, and Scott are pictured at left, and Drs. Mattingly and Dalury on the right, below).


Another exciting educational opportunity took place during the day when our Rheumatology specialist, Dr. Jeff Katz, conducted teaching rounds for our Dominican Medical student colleagues. A patient with a new diagnosis of rheumatoid arthritis was presented to the students, and she happily consented to being interviewed and examined before the group so that everyone could learn. There were 30+ medical students in attendance, and all benefitted greatly from the experience (Dr. Katz is pictures at the left of the image).


We look forward to another exciting day on Day 3 of our mission. Please check back for more updates tomorrow!

2 comments:

Jamie said...

Love to see PTs making headlines. I feel very lucky to have been part of the mission last year and wish you all the best of luck with the rest of the trip!
Mucho abrazos,
Jamie (PT 2010 mission)

p.s. Did someone find Kanu the shopping cart?

Donna said...

There is a stark contrast between what the Operation Walk folks are doing to enhance the lives of people in a foreign country they don't know, and what is happening at "our" hands in a number of Middle Eastern countries. It is heartening to see so many of you doing so much good for so many people in need. We should all be so selfless.