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MUSC Health Blog

Date: 2018

Complex spinal deformities can cause debilitating pain, restricted movement, even low self-worth. MUSC Health Spine Center specialists partner with patients to get them relief – no matter the patient’s age or cause of the pain.

“There's a lot we can do to help people who have back pain related to a complex spinal deformity. With our skilled surgeons and comprehensive support team, we have capabilities today that we didn’t have before,” says Charles Reitman, M.D., an orthopaedic surgeon and co-director of the MUSC Health Spine Center.

Spine surgery can be complex. To avoid complications, Dr. Reitman pays particular attention to patients’ health prior to greenlighting surgery. Working together with patients, he helps improve their symptoms and self-image.

Common Causes of Back Pain From Spinal Deformities

Many adults with spinal deformities suffer from the effects of an untreated childhood ailment. However, spinal deformities may occur at any age and be caused by other factors, including:

  • Injury
  • Cancer
  • Infection
  • Inflammatory conditions, such as rheumatoid arthritis
  • Degenerative disease
  • Postoperative complications

“The main types of spinal deformities include sagittal plane deformities, such as kyphosis, and coronal plane deformities, such as scoliosis. For both these conditions, corrective spine surgery can be pretty complicated,” says Dr. Reitman.

Partnering With Patients to Make Spine Surgery Happen

Because spine surgery can pose so many complications, Dr. Reitman says many spine surgeons may be reluctant to perform surgery on older patients or those in less-than-ideal health.

The team at MUSC Health Spine Center works with patients to make spine surgery possible for them, regardless of their health impediments.

“A patient with a severe sagittal plane or coronal plane deformity, for example, may be in severe pain, unable to stand up straight and may have limited function. That patient shouldn't think twice about getting evaluated for spine surgery — no matter their health or age,” he says.

Dr. Reitman notes the importance of patients taking ownership over their health prior to spine surgery, which helps avoid complications and ensures more effective results. Dr. Reitman works with patients to overcome health hurdles before surgery.

Common roadblocks that can impede healing and recovery include:

  • Smoking
  • Overweight or obesity
  • Heart disease or lung disease
  • Diabetes
  • Low bone density
  • Poor bone quality


Dr. Reitman emphasizes: “If patients commit to tackling any health problems they have (with our support), then we can often get them through surgery safely and effectively. That’s our goal: to find patients relief, safely and help them lead a more fulfilling life.”

Spine Surgery Offers More Than Back Pain Relief

When patients optimize their health prior to surgery, Dr. Reitman says they optimize their chances of success.

“Spine surgery is not a walk in the park for anyone. At MUSC, we have a high-level, coordinated critical care team that can handle complicated cases. For patients who commit to ensuring they can reach their ideal health prior to surgery, it’s more than worth it,” says Dr. Reitman.

“With many complex spinal deformities, the body is in a position that it simply wasn't meant to be in. Corrective surgery does more than relieve pain – it improves patients’ self-image and self-worth. Even though it’s a high-risk surgery with potential complications, the vast majority of patients who have been through it tell me that they’d do it all over again, in a second. Patients say spine surgery gave them their life back. That’s what we’re here to do, for as many patients as we can,” he says.

For more information, contact Dr. Reitman at reitman@musc.edu.

MUSC Children’s Health welcomed Dr. Laura Hollinger in late 2017 as part of the pediatric surgical team and as assistant professor of surgery in the Division of Pediatric Surgery.

The Texas native earned her undergraduate degree from Texas Christian University in Fort Worth, Texas, which is also Dr. Hollinger’s hometown. From there, she earned her doctorate in medicine degree from the University of Texas Health Science Center in Houston at McGovern Medical School.

She also completed a two-year research fellowship at the Methodist Hospital Department of Surgery and Research Institute where she studied critical illness and the distant organ effects of kidney ischemia-reperfusion injury. She completed her fellowship in pediatric surgery at the University of Texas with training in both open and minimally invasive approaches to neonatal and pediatric general surgical diseases.

Her enthusiasm for building and repairing things started at a young age, and she says that she thinks her mother knew before she did that she would ultimately choose to become a surgeon. While in medical school, she was mentored by Dr. Barbara Bass, who is one of the female pioneers in general surgery and president-elect of the American College of Surgeons.

Dr. Hollinger has been recognized for academic excellence and is the recipient of many awards including the Raleigh Ross Scholar Award from the Texas Surgical Society, the American College of Surgeons Resident Award for Exemplary Teaching, The Methodist Hospital Department of Surgery Resident of the Year Award, and the Excellence in Research Award, Critical Care: American College of Surgeons Surgical Forum.

Her surgical interests include pediatric ECMO support during critical illness, congenital diaphragmatic hernia as well as prenatal diagnosis and intervention. She enjoys working with the MUSC Advanced Fetal Care Center multidisciplinary team and team’s ability to diagnose and offer counseling and therapy for babies with prenatal conditions.

Dr. Hollinger said it’s a thrilling opportunity to be at MUSC Children’s Health and the upcoming Shawn Jenkins Children’s Hospital scheduled to open in the fall of 2019. She said it’s nice to be able to focus on pediatric patients and their families and their complex needs while providing them with an environment that can be healing. She added the new children’s hospital reflects on the dedication MUSC has to the children of South Carolina.

By Kathleen Choate, ATC, CSCS, CEAS
Athletic Trainer
MUSC Health Sports Medicine

When I was growing up, children were not allowed to work out in the weight room of my local gym until they turned 12. There were fears that resistance training would damage undeveloped joints and that there were no actual benefits. Research has shown that was false. Participating in sports generally puts more stress on joints than lifting does.  We also now know that while kids naturally gain strength as they grow older, the strength gains from resistance training go beyond that of natural growth and development.2

Benefits

There are many benefits for children who weight train including improved athletic performance, muscle strength, bone strength, decreased risk of injury while playing sports, decreased body fat, improved insulin sensitivity, and enhanced cardiac function.1, 2

Is My Child Ready?

Don't go setting your kids loose in the weight room just yet! Check these boxes off your list to see if your child is ready to start resistance training.

  • My child listens and follows directions well.
  • My child wants to resistance train.
  • My child is not participating in too many other activities.

Getting Started

If your child met the above requirements, there are precautions to take to keep them safe in the weight room. The biggest key word here is supervision. The person who is designing and supervising these workout sessions should know and follow guidelines for strength training children. Kids should be taught proper technique and should be corrected with every lift until their form is perfect. A breakdown in technique will lead to an injury, which is especially true when the weights start getting heavier. Be sure to also teach them about general safety including avoiding pinched fingers and dropped weights.

Big Muscles!

Big muscles should not be a goal with children who are weight training, because it's just not realistic. Increases in muscle mass will start to be possible once they start going through puberty and have more hormones.2 Until then, you can still expect to see gains in strength, but this will be due to improvements in coordination and muscle fibers learning to contract more efficiently.

Injuries

Injury can still happen, even when you tried to do everything right. Be prepared to recognize and respond to a possible injury. Some signs of an injury include pain, swelling, loss of motion, and weakness. Ask yourself why this is happening. Was it the technique, too much weight, a growth spurt, poor program design, or something else? Don't be afraid to ask a medical professional for help.

With all of this in mind, letting your child resistance train can be a positive and beneficial experience. Once again, please make sure they are supervised by an appropriately trained professional.

For more information visit MUSC Health Sports Medicine.

References

1. Faigenbaum, A. D., & Myer, G. D. (2009). Resistance training among young athletes: Safety, efficacy and injury prevention effects. British Journal of Sports Medicine, 44(1), 56-63. doi:10.1136/bjsm.2009.068098
2. Haff, G. G., & Triplett, N. T. (2016). Essentials of Strength Training and Conditioning. Champaign, IL: Human Kinetics.

Providers utilize telehealth to assess patient
Providers utilize telehealth to assess a patient.

J. Antonio Quiros, M.D., director of the Division of Pediatric Gastroenterology at MUSC Children’s Hospital, has announced the addition of service providers in the Beaufort, S.C. office and plans to add tele-nutrition services in North Charleston beginning in March.

Quiros, who started seeing patients in Beaufort two months ago, said that Pediatric Nurse Practitioners (PNPS) Jennifer Beall and Karen O’Brien will now be available in the Beaufort location twice a month and GI telemedicine also has expanded to two days each month.

Beall and O’Brien are pediatric GI veterans.

Jennifer Beall is a PNP in the Pediatric Gastroenterology and Nutrition Program department at MUSC. She earned her master’s degree in Pediatric Primary Care at MUSC’s College of Nursing in 1998.  She is board-certified as a Pediatric Nurse Practitioner by the American Nurses Credentialing Center.  Jennifer has worked in the Pediatric GI division since September of 2012 and is a member of the Association of Pediatric Gastroenterology and Nutrition Nurses.

Jennifer treats children with a variety of general gastrointestinal disorders including celiac disease, chronic abdominal pain, constipation, encopresis, GERD, Eosinophilic Esophagitis, and failure to thrive. She has a special clinical interest in the area of bowel management.

Karen O'Brien is a PNP in the Gastroenterology and Nutrition department at MUSC. She earned her master's degree in nursing in pediatric acute and chronic care from the University of Pennsylvania in Philadelphia, PA in 1993. She is board-certified as a primary care pediatric nurse practitioner by the American Nurses Credentialing Center. Karen has many years of experience working as a primary care pediatric nurse practitioner then specialized in pediatric gastroenterology.  She is a member of the Association of Pediatric Gastroenterology and Nutrition Nurses.

Karen takes care of patients with general gastrointestinal disorders including; celiac disease, failure to thrive, functional gastrointestinal disorders, constipation, encopresis, gastroesophageal reflux, eosinophilic esophagitis, and childhood obesity. She has a particular interest in pediatric nutrition.

Tele-nutrition Services Added in North Charleston

MUSC Children’s Health is expanding access to registered dieticians in the GI Department in mid-March in the North Charleston office with plans to expand so that all outpatient locations will have dietician access.  Services are already available in the Mt. Pleasant and downtown offices.  The added service eliminates the need for patients to travel to multiple locations to receive consultations from their dietician.

Three registered dieticians support GI pediatric patients.  The dieticians will follow the scheduled appointments of the day five days a week and support patients in-person or through telehealth.  Dieticians offer consultations to a variety of patient needs including malnutrition intervention, g-tube follow-ups, food allergies, diet education, motility, liver disease and other gastro maladies.
 

Guest Post by:

Lindsey Clarke, MS, ATC, CMT
Athletic Trainer
MUSC Health Sports Medicine

“You work in athletics?  Awesome…that’s so cool!”

This is often the response I get when people learn that I am a Certified Athletic Trainer(ATC). It’s an understandable reaction, as most of the population will only ever see the glitz and glory of the bright lights, sidelines, and athletes from the TV screen or stands. It seems very exciting from those seats, but what they don’t see is the time spent in the training room doing treatments long before and cleaning up after the event has ended, packing sideline kits and bags for travel, arranging appointments, or prepping both lunch and dinner for the day as you’ll most likely be eating those meals on a bus, sideline or in your office while updating your athletes’ files. While being an ATC is immensely gratifying, it can also be a source of great stress. We are expected to be selfless, often putting other’s needs first, work long hours over nights and weekends, and perform at high levels to help our athletes recover and return to play. While all these demands are inherent to the job, these expectations can result in work-related stress. It is difficult to control work-related demands in any profession, but especially so with the constant flux of working in athletics; the game was rescheduled, practice ran later than anticipated, weather delays…the list goes on and on. In addition to scheduling, there is the ever-present threat of injury or emergency. While most of the time it may seem we are standing around observing, we are constantly scanning and taking note of hits to the head, mis-steps, and collisions. More often than not, the ATC is taping, evaluating and responding to manageable injuries, but sudden cardiac arrest, gross trauma or spinal injury are very real possibilities that are always at the back of our minds. The uncertainty of managing an ever-changing schedule, in addition to the emotional drain of providing care, can leave the ATC little time, opportunity or inclination for a life outside of their job.

To provide the appropriate care, an ATC’s training includes primarily academic and practical skills; unfortunately, the ATC does not commonly receive sufficient preparation for the emotional reality of their responsibilities and its impact on their personal functioning and self-fulfillment. If not managed properly over time, these constant stressors can create feelings of apathy, depression, chronic exhaustion, depersonalization towards your athletes, and reduced accomplishment towards one’s work or ineffectiveness in one’s role/performance.

This culmination of stressors and the resulting inability to effectively deal with them can lead to burnout; a very real psychological health concern among professionals working within dynamic, fast-paced environments. According to Merriam-Webster, burnout can be defined in a number of ways, but it all boils down to the exhaustion of physical and/or emotional strength and motivation; it is very common amongst service-related professions such as teachers, public servants, and health care providers. Occupational burnout is typically measured using the Maslach Burnout Inventory (MBI); one of the most commonly used tools to assess burnout in human service professions. In 2008, the Athletic Training Burnout Inventory(ATBI) was created to examine specific characteristics within the profession such as: emotional exhaustion & depersonalization, administrative responsibility, time commitment, and organizational support.

There are three hallmarks of burnout:

  • Overwhelming emotional and physical exhaustion from being overextended; the ATC feels drained, “used up”, barely able to face another day, practice, game or athlete presenting with a problem.
  • Reduced personal accomplishments at work; feelings of frustration, anger, cynicism, and inadequacy can lead to a sense of failure or ineffectiveness in helping their athletes or enhancing their work circumstances
  • Depersonalized attitude toward others; the ATC may adopt a callous or emotionally detached response to their athletes and co-workers.

Certainly, stress is felt differently for each individual, but this sense of burnout, caused by the prolonged response to chronic interpersonal stressors on the job, can impair social and personal functioning. This may cause the ATC to feel less than professional with these negative feelings, and may begin to question their ability and commitment to their profession, leading some to actually leave athletic training to pursue other careers. The specter of mental health disorders is constantly lurking in the background whenever the dynamic of burnout is present. Being a health care provider does not provide immunity from developing a mental health disorder. Rather, their very responsibilities may be putting them at a higher risk if they are unable to effectively deal with the inherent stressors that lead to burnout in the first place; this may put the ATC at risk for developing a mental health disorder, or exacerbating a present mental health disorder that is under control.

An ATC is exposed to stressful events on a daily basis. Knowing how to recognize how stress might affect you, and learning effective stress prevention and management strategies is extremely important. Below are a few preventative measures on how an ATC can help prevent and avoid burnout, and/or the possibly of developing a psychological disorder.

  • Workout, meditate or practice yoga on a regular basis.
  • Practice good nutrition. Be sure to eat; don’t skip meals. Be well hydrated.
  • Get enough sleep.
  • Don’t abuse alcohol or drugs.
  • Even if you are busy, try to establish a daily routine; disruptions of routine may cause stress.
  • Take time for yourself; even if for a short period of time, make time for a hobby or period of relaxation daily. Spend quality time with friends and/or family as they are your greatest support.
  • Try not to dwell on fleeting negative emotions or experiences. Doing so gives them momentum to negatively take over your day. It is OK to have a bad moment or day, but concentrate of moving forward to the next day or opportunity to make something positive happen.
  • Be candid with your departmental manager or supervisor. They know you work long and hard. When possible, they may be able to help arrange your schedule, by scheduling mornings and days off, working remotely for administrative work or reduced work hours for you during a less competitive season or on team off-days.

Talk to others you trust about your feelings in a safe and productive way. Know your resources. If an ATC feels the signs and symptoms of burnout or a mental health disorder, seek professional assistance through your place of employment. A good resource for learning about mental health and wellness, and steps to address stress to prevent mental health disorders can be found at Mental Health America. Knowing your limitations and acknowledging when you are struggling will not only make you a better healthcare provider, but it will set both you and your athletes up for long-term success.
 

 

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