Best Docs Network Forest Park Medical Centers May 26 2013

On this edition of the Best Docs Network featuring Forest Park Medical Center, Dr. Daniel Aldrich, Dr. Charlotte Hodges, Dr. Garner Newton, Dr. Michael Musacchio. And hi again everyone, Jim Knox along with Kandace Krueger and welcome back to another edition of the Best Docs Network featuring Forest Park Medical Center, of course the top medical center in the entire Dallas, Fort Worth area. And we've got a great show for you today. Let's start off with our first Forest Park doctor, it's orthopedic surgeon, Dr. Garner Newton. I had torn my ACL about in 2008 I believe playing soccer and it was something that I just kind of tried to rehab without having the surgery. I just was concerned about finding the right doctor to have it done. Honestly I didn't have the time at the time to go through the rehab process. And what happened was, I was in the back yard hanging a swing up for my daughter and jumped off the ladder because it started to move, and when I jumped I hurt it again. Well, most any sporting event that requires cutting puts you at risk of an ACL tear, soccer, downhill skiing, football, basketball. It's a ligament that we can pretty much put back where it's supposed to be to try to allow you to return to that previous state of, or that previous level of activity. I went to see Dr. Newton and first visit he said absolutely that my ACL was torn and there was no reason at my age that I should leave it that way, that it wasn't a very difficult surgery. It's an outpatient procedure this day and age and the patient can walk even out of the hospital if they feel like it. Now sometimes I will use crutches if they need them, but most of the time people don't need crutches even the day of surgery. I will use a CPM machine which is a motion machine to help them get their motion back and an ice machine to help them with their pain. But the first six weeks usually is just letting them get their motion back. I do use a brace postoperatively and then after that, after they've had some healing, then I start working more on strength and then endurance training and then hopefully activity related exercises to get them back to sport. The surgery went excellent, better than I could have imagined. I wish it was something that I had done a lot earlier because I played a lot of sports for many years wearing a knee brace and I didn't really need to do that. I'm continuing to do a little bit of the physical therapy. Since we're towards the end of this now I can't wait to be able to get back out and play sports and just throw the ball with my kids in the backyard and not be concerned about my knee hurting, slipping again. Stephanie has a question for Dr. Pero. She'd like to know can someone with severe allergies be helped with surgery? A lot of patients have severe allergy problems and many of them also have chronic sinus infection problems and/or nasal obstruction. Sometimes those patients can be helped with surgery. Typically like to make sure that we have their allergies under as good a control as possible before deciding to proceed with surgery. In other words, the allergies themselves might be contributing to swelling in the nose which could be contributing to blockage of their breathing, could be blocking the openings of the sinuses that leads to sinus infections. Our hope would be that we could treat the allergies by themselves which would decrease the swelling enough to improve their airway and decrease the severity and frequency of the infections. In some patients based on their anatomy that's not possible and those patients are ones that would benefit from surgical intervention. Best Docs Network featuring Forest Park Medical Center, welcome to the twenty first century of cutting edge medicine, Forest Park Medical Center. I just decided that in my thirties I was not going to be fat and I needed a little help, literally. It took me three years to get up to that moment. I had been putting it off, putting it off because I work in a hospital, I don't want to be a patient there. A bypass is restrictive and malabsorptive. It's restrictive in that we make a stomach small. We make a small pouch from their stomach. The remaining portion of their stomach stays in their abdomen. Don't' change the blood supply, don't change the nerve supply so it doesn't shrivel up and it doesn't die, it doesn't go away. And we then reroute their small bowel and that's the malabsorptive part. Which is a little bit better than for me long term weight goal. Slow process in the beginning but overall it'll all come down. I think the bypass probably is going to offer the most weight loss and the most sustained weight loss and in particular it's the only bariatric procedure right now that we have long term studies that show it'll help resolve hypertension, diabetes, symptoms of reflux disease as well as a myriad of other health problems that people get whenever they are overweight and obese. At the end of the day she will have you to where you are aware of what you're getting ready to do, you understand the procedure and you feel safe. With my surgery she said today is the big day, are you ready? I am, let's do it. When I saw her one week after surgery she was already down 16 to 18 pounds. We'll see her again for her one month follow up and I think that she'll probably be down another 15 to 20 pounds. She's having a really good outcome. When I seen her for my follow up visit I couldn't do nothing but say Dr. Hodges give me a hug and I gave her a high five. So she asked me how I was feeling, I told her how I was feeling, no problems. She told me to take it easy and she was proud of me. We're here at Forest Park Medical Center of Dallas where we are a Bariatric Center of Excellence through the American Society of Metabolic and Bariatric Surgery. What a Bariatric Center of Excellence is, it's a designation that a facility has to actually apply for. It covers ten very vigorous standards that are set forth from the American Society for Metabolic and Bariatric Surgery and they actually come and interview, they audit charts, they look at outcomes and they look at ten very vigorous standards to make sure you meet the standards from the equipment you have to care for you patients, the personnel that you have involved taking care of the patients and it's there for patients to be able to select a facility that is above and beyond for their care of bariatric patients. Part of being a Bariatric Center of Excellence means that we are able to handle any complications that occur with our patient, so we have several physicians that we can consult for whatever needs we may have. Whether that be pulmonology, nephrology, neurology, any of those things that we may need we have those here at our fingertips and we have that for the ICU and the ER as well. I oversee all of the medical nutrition therapy both before and after surgery with the bariatric patients so up to six months prior to bariatric surgery patients can come and see us and work on lifestyle changes and then we also visit with the patients here in the hospital immediately after surgery and we offer post-op classes just to kind of keep everybody on track up to a year following the procedure. I help teach the pre-op in the seminar classes for our bariatric patients or our prospective bariatric patients. We do inpatient teaching after they've had surgery as well as do the lap band adjustments. Once they've had surgery we do upper GI's. We do see them from prospective patients and postop wise we see them throughout the whole course of their procedure as well as two years out, three years out so we continue to follow up with them and see how they're doing, continue their education. The pre-op procedures that we do in radiology are the upper GI's and they like to do that to be able to see the intestinal tract before they have surgery so the doctor knows what they're working with and then postop we bring the patients down and we do upper GI's so the doctor can make sure that all the suture lines look good and there's no leaks and everybody's good to go home. We do around three percent of the cases nationally for bariatric surgery. That means that out of all the thousands of bariatric surgeries nationwide this specific hospital does three percent of them. We have a great multi-disciplinary team and we do have a great team of our dieticians, our nurses, our surgical staff, our respiratory therapists, physical therapists, radiology techs, everyone and it takes every one of those members of the team to provide great patient care. And without any one member of the team we couldn't be as effective as we are. Did you know that Forest Park Medical Centers are designed and constructed to meet or exceed the standards of the U.S. Green Building Councils Leadership and Energy Environmental Design (LEED) program. The purpose of LEED is to reduce energy and resource consumption, minimize environmental impact and provide healthier and more connected buildings. Throughout the building and grounds you will see signs which highlight Forest Park's sustainable efforts. Gastroesophageal reflux disease is actually commonly thought of as heartburn. The main malfunction is a malfunction of the valve at the lower esophagus because food should be able to go into the stomach, but bile, acid and food should not reflux back into the esophagus. And often patients have symptoms from this. One of the typical symptoms is burning pain in the chest that represents the acid refluxing back into the esophagus. Some people have difficulty swallowing where they feel like food is getting stuck in their chest. Some people can have abdominal pain and a lot of times patients have trouble at night. They can't sleep flat in the bed because the acid goes up into their throat. Gastroesophageal reflux disease can be treated in a variety of ways. Usually mild GERD can be treated with lifestyle change, avoiding certain foods, propping yourself up on pillows at night in bed, losing weight. Then when patients really are not relieved of their symptoms with that, they can move on to medications. But about 40 percent of those patients who take medications are not well controlled with medications and therefore we have a new treatment called the LINX reflux management system that I'm performing here at Forest Park Medical Center that will treat this disease. And it actually will treat the disease at the source of the disease which is the weakened lower esophageal sphincter. The LINX procedure is a new FDA approved procedure and I am partnering with Forest Park Medical Center to be the only center to perform this procedure in Dallas. It's a very simple and elegant treatment. And basically LINX procedure involves a band of titanium beads that have a magnetic core. And this is basically a necklace of magnets that are placed around the lower esophagus to help augment the weakened lower bowel. And what happens with this necklace is that it actually will open when you eat and it breaks those magnetic bonds but then it closes and doesn't allow acid or fluid to reflux back into the esophagus. I'm really excited about the LINX procedure because I think it's a revolution in the treatment of GERD. I think patients who have been suffering from reflux symptoms and decreasing their quality of life and it's affecting their normal activities, this is going to be a great solution for those patients. All of the doctors here at Forest Park Medical Center are dedicated to changing people's lives, like our next best doctor, it's neurosurgeon Dr. Michael Musacchio. A very common patient we see is a patient who has lumbar stenosis. Lumbar stenosis is the most common condition that we treat surgically in any patient over the age of 55. But it can really happen earlier in life, even as young as the 30's. What stenosis is, is a series of changes in the spine that results in the nerves becoming pinched by disc bulging, thickened ligaments, arthritis in the joints and as the spine becomes more narrow a patient develops aching and pain through their back, sometimes through their buttocks and all the way down their legs. It can be very debilitating. It can affect the way they walk. It can limit their activity level. It can be quite painful. With those patients we like to follow a conservative approach if possible using therapy, sometimes chiropractic care, injections, pain medications and behavior modification. But as the disease advances it might require surgical intervention. Traditional surgical methods can include open laminectomy approaches which involve large incisions and muscle splitting approaches. They can be debilitating painful surgeries. Newer advances in technologies in our field involve what we call motion preserving technologies. These include such things as artificial disc replacement and in some cases interlaminar stabilizing devices, one of which is called a Coflex. The purpose of these products is we want to stabilize the spine and decompress nerves but not necessarily have to fuse the spine or put screws and rigid constructs in the spine. We want to help the patient preserve their normal anatomy. The purpose of this is to help the patients current condition of back and leg pain but hopefully prevent problems in the future. With posterior approaches we can use something called a Coflex or an interlaminar implant. It's a flexible titanium device that after we decompress the spine, we can place this in the back of the spine. It helps stabilize the spine and also preserves the patient's normal motion. It relieves the back and the leg pain and ideally it will create a more stable spine so that they don't have problems resurface in the future. Motion preserving devices are intended to decompress the spine and help back and leg pain. But by restabilizing the spine with a artificial disc type device we are able to avoid fusions. The benefit of this is maintain the patients normal spine motion and ideally down the road they have less problems, less need for surgery, less pain and hopefully protects the remaining levels of the spine from degenerating in the future. The quality of life before a replacement is miserable. The shoulders hurt, you can't sleep, the pain is sharp, dull, burning and it's always there. Joint replacement is a very common procedure now in our country but most common are knee and hips. A lot of people aren't even aware that shoulder replacement exists but it is a really great option for people with severely arthritic shoulders. We've come a long way in the last 10 to 20 years with the materials we use. The techniques have been really refined so that people can get a very good result with a shoulder replacement where they can have pretty much full use of the arm again without pain. We did the right shoulder replacement in 2010 and since I loved the way my right shoulder was doing and the left shoulder was still giving me a lot of fits, I thought okay, maybe, maybe it's bad enough I can get a replacement on the left one. So in January the fifteenth I had the left shoulder replacement. Belinda was a typical case where she was someone who had gradual deterioration in her shoulder and she had both shoulders involved with severe arthritis. And she had tried the usual treatments, Advil's and Aleve's and cortisone injection and physical therapy until the point where she just really was having severe pain all the time and that was the point where we had to talk about replacement. And we did full replacement on both shoulders and she's done extremely well and has had a great result and is pain free and has true unrestricted use of both shoulders at this point. The new shoulder replacement Belinda is a very happy person. Dr. Aldrich is a very good doctor. He's knowledgeable in all he does. The quality of my life is improved by what he's done. You know Jim, not only do some of the best physicians operate right here at Forest Park Medical Center but they're using some of the most advanced, latest technology. Exactly right Kandace, like the MAKO robot used by orthopedic surgeon right here out of beautiful Forest Park Medical Center. Before we even start the surgery on the patient we actually review the plan. The 3D analysis that was obtained from the CAT scan allows us to see the knee in real time and this allows us to see the orientation, the alignment and actually the size of the implant that we'll use. So I can actually look with 3D technology to see exactly what the implant looks like, the alignment, the rotation. As we get into the surgery I can actually make adjustments in surgery to balance the ligaments inside of the knee as well. So once we place these pins into the bone we attach what we call arrays to the pins and this allows us to consistently always know the position of the bones at all times. Once we register both the patients anatomy and register the robot then the next step is to actually begin the surgery itself. So I can slowly chisel away the bone that's necessary. When I look at the screen, the green data tells me the extra bone that I must remove. What's critical is this robot will not allow me to go outside of the plan that we've instituted in the very beginning of surgery. The surgeon is actually still doing the surgery. The robot is just allowing the surgeon to do it in a more precise manner because the robot will not let me deviate from the plan at hand. Then the next step is to trial or place the implant to see if it fits correctly and as you can see it's perfectly aligned, the rotation is perfect and as a surgeon it's very exciting to see that we can do this reproducibly consistently and do it successfully. This technology allows us to do surgery with the smallest incisions possible. Our patients are recovering much quicker than the traditional approaches. I had a probably a three year extended period of deteriorating knees. They just got to where I had been able to work out and run, and then the pain got to be such that no, you couldn't run anymore and I could jog, and then it got to where I couldn't jog. At one point I finally tweaked one of the knees, tore some more cartilage and then I was looking like the mummy for about 7 months. It was horrible. There are three compartments in the knee. There's the inner knee, there's the outer knee and there's the compartment behind the kneecap. When patients have arthritis in one or two areas of the knee, they're candidates for robotic partial knee replacement. Osteoarthritis of the knee is very common. Often patients have activity related pain but later it can progress to having pain at rest or pain that even wakes them up from their sleep. I went to see Dr. Toulson, a very personable guy. He x-rayed both knees and looked at it and said well I got bad news and worse news. The bad news is it's really true that you did tear some more cartilage in the knee. The worse news is even if I repair that, both knees have substantial osteoarthritis and doing the arthroscopy now is really not going to give you the relief that you're seeking. Steve was a unique case. He was a 64 year old gentleman with osteoarthritis of both knees. His arthritis was confined to both the inner aspect of both knees so he was a great candidate for getting bilateral knee replacement using the robotic technology. Steve is incredible. He is back to his active lifestyle. He has no pain, he has no limp and his incisions are very small, you can hardly see them. I'd say it's been a grand experience. I will never again take for granted walking without a limp. You just don't realize all the things that you give up when you're walking around in pain and dragging a leg. It's not any fun and all that's gone. Now I can get in and out of cars, I can go up and down stairs, I can do pretty much anything I want to do now. For more information about Forest Park Medical Centers and of course the outstanding doctors that operate right here out of Forest Park Medical Center, head to the website, bestdocsnetwork.com and click on the Forest Park Medical Center tab. Right now it's time to head to our next best doctor operating right here out of Forest Park Medical Center, it's gynecologist, Dr. John Dulemba. Many patients when they first hear the concept of robot, they go I want my doctors hands to be touching me. Well we haven't been touching the patient for a long time. We've been doing laparoscopy and even doing other types of incisions our instruments are touching the tissue not our specific hands doing that. With the robot, I'm sitting at a console probably 10 feet away from the patient but the instruments and the camera that I'm looking for, it's as if I'm immersed inside the abdomen. You don't even think that you're away from the patient. I feel like I'm inside. So it's almost like an airline pilot doing flight simulator flying or jet pilots doing fighter simulation. You are in that abdomen and it's 3 dimensional. Everything is magnified 10 times so whatever disease process you're looking for it's right there in front of you and you can treat it and deal with it in such a great manner. So when we get in we can cut out and see a significant more amount of endometriosis with the 3 dimensional aspect of the robot. The precision, we can scale our movements down, we can sit and relax versus standing up and being very uncomfortable. The instruments that we have have wrist actions where the standard laparoscopy is just a straight instrument. So there's so many different tools for addressing what might be causing a woman's pelvic pain. So we get in there, when a woman wants us as their expert to be as accurate and precise to find out what's causing their pain and the robot is a wonderful tool to address those issues. So when patients have their hysterectomies or they're having surgery for endometriosis or having fibroids removed or prolapse repair, when you do it robotically those patients will have somewhat less pain and will be able to function back at their normal functions than they would having other procedures done to them different ways. Best Docs Network featuring Forest Park Medical Center, welcome to the twenty first century of cutting edge medicine, Forest Park Medical Center. Steve has a question for Dr. Glenn Ihde. Why do I keep having to take medicine for reflux? Reflux is when acid in food and enzyme gets out of the stomach, past the valve at the end of the esophagus and then irritates the lining of the esophagus or really burns it. When you take an acid medication, it reduces the acid component but doesn't take care of the digestive enzyme or the fluid that's in the esophagus. The only way to treat the reflux itself is to fix the anatomy. If we reconstruct the valve at the end of the esophagus then we can stop fluids and food in the stomach from getting back into the esophagus. One thing I really love about Forest Park and I tell everyone that I talk with in my nursing career about Forest Park. I like to talk about the camaraderie that's here. I really enjoy just a positive energetic setting with the staff. Everyone works quite well together. Inter department, pharmacy, ER, X-ray, the doctors, the nurses. It's just a really cohesive unit and I really enjoy that and I feel like every day I come here I enjoy my day and that says a lot because nursing can be really stressful so to be able to come here and feel support from my teammates and to have a good day at the end of every day is something I really appreciate. I do feel like our administration provides us the resources that we need to provide quality patient care. We have the equipment that we need, we have updated you know top of the line equipment, we have the supplies necessary to care for our patient population and then they're always accessible. If they're not you know readily available in their office, they have their phones that are always on and you feel like you can call them with anything that you might need and that brings another great sense of comfort. I do know that I'm a very fortunate person to have found a career that has provided me such satisfaction and happiness in my life and I feel every day that I've learned something or have provided something really excellent to my patient population. I'm really glad that I'm able to do it every day. That will do it, that will wrap up another edition of the Best Docs Network featuring beautiful Forest Park Medical Centers, of course the top medical center in the entire Dallas, Fort Worth area. And for more information on Forest Park Medical Center or any of the doctors that operate right here, just visit our website, it's bestdocsnetwork.com and be sure to click on that Forest Park Medical Center tab. And Kandace, for the folks out there who have a question or comment for us, we'd love to hear from you, send us an email at info@bestdocsnetwork.com. So long everyone, we'll see you next week.