Monday, July 28, 2008

Arrowhead Orthopaedics Sponsors Rotation in the Dominican Republic

On behalf of Loma Linda University and CURE International I would like to thank Arrowhead Orthopaedics for their generous financial support of the international pediatric and limb deformity rotation in the Dominican Republic. To our knowledge this is the only ACGME approved orthopaedic elective rotation in the developing world making it a unique feature of the Loma Linda orthopaedic residency program and CURE International. Because of the financial support of Arrowhead Orthopaedics and the administrative support of Loma Linda University and the orthopaedic department an important part of the mission of LLU has been reintegrated into the residency program and placed us at the forefront of modern humanitarian and outreach efforts in orthopaedic education.

Over the past several years there has been a growing interest amongst medical students and young physicians in medical missions and social responsibility. This has spread throughout secular universities throughout the modern world. In contrast to years past, most of these efforts are purely humanitarian as opposed to previous years where the large majority of this work was carried out by religious groups. Loma Linda University was established with the unique charter to train physicians for this type of work long before the secular world became interested. At LLU there is a resurgence of interest in this work as well as strong administrative support which has made possible the success of this orthopaedic rotation amongst other similar endeavors.

The rotation at CURE International in the Dominican Republic and Haiti is a unique opportunity to provide first world orthopaedic care for the challenging problems of the developing world. Due to consanguinity, environmental contaminants, and public health and safety issues we treat a wide variety of rare congenital deformities, developmental problems, post-traumatic disorders as well as other diseases such as polio and TB which are rarely seen in the US. As if many of these problems were not challenging enough, they often do not present themselves in a timely fashion and often have been mistreated at other centers making the challenge even more difficult.

Over the past 3 years a number of top quality visiting professors have greatly added to the resident education and quality of services we offer. This has given the opportunity for the residents to work and develop relationships with surgeons from other programs in the United States. (We are still awaiting a promised visit from Maestro Jim Matiko – possibly this will be realized in 2009.) In addition the armamentarium of equipment has substantially increased over the last several years. Spinal deformity corrections are commonly performed with the latest pedicle screw systems. As well, we have developed an in depth experience with external fixation and limb deformity correction and limb lengthening reconstruction. Residents are getting extensive experience with Orthofix external fixation, Ilizarov, and with the Taylor Spatial Frame which is a computer assisted six axis deformity correction device recently placed on the orthopaedic market.

Sam Chen MD quotes “Thanks to the sponsorship by Arrowhead Orthopaedics, I was given training not obtainable in my home program. I was able to see the effect of untreated pathology and the suffering it can cause. More importantly, I was also able to see the gratitude of people when they are provided with help from outside organizations.”

At CURE International Dominican Republic we have hosted residents from New York, St. Louis, Mayo Clinic, Riverside County Regional Medical Center and Loma Linda. We also have become a regular part of the curriculum for residents from two of the Dominican orthopaedic surgery residency programs. Although the rotation for US residents is ACGME approved, administrative support and financial support has been lacking at other institutions (aside from LLU) inhibiting the ability to formalize the elective for the residents from other programs many of whom have used vacation time for their visits. For this reason we owe a great degree of gratitude to Arrowhead Orthopaedics for financially supporting this endeavor and appreciating the importance of this educational experience and our heritage as educators and students at Loma Linda University.

Sunday, July 13, 2008

Biomet Donation Saves a Leg in the Dominican Republic

Multiple surgeons in Santo Domingo had recommended amputation, but when 43 year old Marineris came to CURE International’s hospital she was given a new hope. She had been diagnosed with an advanced giant cell tumor which had completely destroyed the bone just above her knee. In spite of working in an environment of limited resources I very seldom compromise my surgical indications. But in this case I knew it would be difficult to provide state of the art limb salvage reconstruction surgery for this patient whose resources were already exhausted with a few simple preoperative imaging studies.

The first step was to confirm the ambiguous pathology report with Dr. Craig Zuppan at Loma Linda University a ‘virtual missionary’ who gives his time and expertise for people he never meets. Thanks to FedEx and email, one day later, Dr. Zuppan had received the specimen in southern California and confirmed the diagnosis. Lung metastasis were ruled out and with a marginal resection her prognosis would be good. I presented the situation to some of my contacts at Biomet who had helped one of our patients a couple of years ago. Not much hope was initially given due to new government restrictions on any donations that could be construed as physician enticement. After a month long approval process government monitors determined that my practice does not represent any lucrative incentives for corporate donations and Biomet approved the donation. When I announced the news to Marinerys and her husband, tears came to their eyes and hope of living a relatively normal life was restored.

Multiple emails were exchanged with Mark Bollinger and Troy Hershberger of Biomet, Warsaw, IN. Final preoperative planning was wrapped up with a meeting at Starbucks Santa Monica, CA between myself and Tyler Jolley the Los Angeles Biomet limb salvage specialist. I returned from my trip to California loaded with instruments and implants.

After maximal preparation and a prayer… the operation was initiated. The absence of a vascular surgeon, vessel clips and a Biomet rep added to the difficulty of the case. But after 3 hours of surgery the tumor was resected and the prosthetic reconstruction begun. The innovative Biomet Compress prosthesis addresses the problem of loosening at the implant bone interface by loading the bone with up to 800 lbs of continuous spring loaded force to invoke an incredibly strong biologic bond between the metal and bone. We released the spring loaded force and placed the $20,000 implant without difficulty. Her recuperation phase was begun.

It does not matter that Marineris knows nothing about Warsaw, Biomet, Loma Linda, Lemoyne, bone ingrowth, or all the work and resources that multiple people around the world have invested to make this operation a success. She appreciates her leg and her life. Worth more than a insurance reimbursement are the two mangos and a hug that I pass on to all who have given unselfishly to make this possible.