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WVU Medicine develops in-office surgery options

Dr. Shafic Sraj leads ‘Wide awake local anesthesia no-tourniquet’ surgery effort, which provides lower costs and more convenience to patients

Featured on wvnews.com

As featured on WVU News: “WALANT – Wide Awake Surgery at WVU Medicine”

From WVnews.com

If you need hand surgery such as carpal tunnel surgery or cyst removal, you don’t necessarily have to go to the hospital to have it done. There’s a newer way to do hand surgery — in the doctor’s office with local anesthesia. Mary Ravasio Minard explains WALANT — wide awake surgery.

Follow the link to watch it on Youtube

https://youtu.be/PVHgYWxS25g

AAOS’s Innovation Theater a Huge Success

I am very pleased to share that our first-time Innovation Theater has been a huge success. I am proud to be a member of the AAOS Exhibits Committee and the chairperson for the Innovation Theater Sub-committee.

West Virginia State Medical Association Advocacy Day 2019

Advocating for Public Health and the Practice of Medicine at the WV State Capitol.

WV Senate President Mitch Carmichael and WVSMA members

Avocado Hand

Avocado, the green-skinned, egg-shaped fruit, is getting more popular than ever. With it, there are increasing reports in media and medical news about avocado related  hand injuries .

 

Accidental knife injuries happen to fingers of the hand holding the avocado while peeling it. Such injuries has increased to the point that is they have been named ‘ Avocado hand’.

The hard shell covering a soft fruit allows the knife to slip through the flesh of the avocado and aim straight to ones fingers.  The best way to safely cut the avocado is not to hold it in your hand, but on a plate and aim the sharp edge of the knife away from your fingers. This can lead to serious injuries such as cut tendons, nerves, and blood vessels.

Ir Med J. The Avocado Hand. 2017 Dec 18;110(10):658.

Washing Your Hands

Adapted from BBC

Washing your hands- straightforward, or is it?

There’s plenty of evidence that washing one’s hands can reduce the spread of disease, only 5% of people wash their hands ‘properly’ ‘all the time’.

10% of 3000 people were witnessed leaving public toilets without washing their hands, and of those who did,33% didn’t use soap. While it is well established that we need to wash our hands properly, there are plenty of myths about what is proper.

Does the water need to be hot to get your hands clean?

In a survey of 500 adults, 69% believed that the temperature of the water has an impact on the effectiveness of hand-washing. Researchers found that water temperature made no statistically significant difference when other factors are controlled. Temperature still affects washing, though, because excessively cold or hot water lets people spend less time washing their hands than comfortable water temperature.

Is anti-bacterial hand wash better than soap?

A 2007 and a 2015 review both concluded that anti-bacterial hand washes  did not reduce the number of bacteria remaining on people’s hands after washing any more than soap did, nor was it any better than soap. Triclosan, a main ingredient on most antibacterial hand soaps, May increase anti-bacterial resistance and that and has been banned in the US and in the European Union.

Do you need to dry your hands afterwards?

Letting new hands air-dry is fine as long as he did not contaminated hands before they try out. Durkan’s transfer to your hands more easily if they’re wet.

Hand dryer or hand towel?

There’s a lot of debate surrounding this one. Most of us don’t want for as long as 45 minutes needed for the hands to dry using hand dry. New were hand dryers take 10 seconds hand and our equivalent to paper towels.

Making toilets nicer also makes a difference. One study observe 3,000 people in the US, found that if the toilets were clean and well-kept, people were more likely to stop and wash their hands properly. When the sinks were dirty, they just wanted to get out of there.

Whichever way you choose to wash and dry your hands, do it for longer than you think.

Pins and Needles

Adapted from BBC

Does it feel like pins and needles? (Credit: Science Photo Library)

Does it feel like pins and needles? (Credit: Science Photo Library)

Everyone has experienced that tingling sensation in the hands. It is commonly called “pins and needles” because it feels like tiny pointy needles. Some describe it as numb, or “falls asleep,” and is uncomfortable to place pressure on it.

The sensation itself is called “paresthesia,” or alternate sensation.

Sensation is transmitted from your body to your brain via nerves, your biological Internet cables. If you place too much pressure on one of them, the signal gets distorted. We call it Neuropathy, ie sick nerves. Once the pressure is relieved, it goes back online soon. If the pressure is not removed within reasonable time, it causes permanent change to the inner structure of the nerve and permanent change to the signal. More severe and long standing pressure can cause permanent loss of signal even. There are several nerves in the arm, and each may be subject to pressure at several spots. For more info, check the Numbness and Tingling page.

Harry Potter’s Brackium Emendo- healing broken bones in Witchcraft

Adapted from HarryPotterWikia

Harry Potter fans know very well that witchcraft can be dangerous.

Harry broke his ‘arm’ ( in reality, it was both-bone forearm fracture) during a Quidditch game and was ‘doctored’ by Professor Lockhart. The spell he used, Brackium Emendo, did not work as intended: instead of healing the bones, it made them disappear. Harry was then taken to the Hospital wing and treated with Skele-Gro, an awful tasting potion that grows missing bones.

 

I offer these few points to consider from an Orthopedic point of view:

This is a Sports injury! Should Quidditch players not wear protective ‘armor’?

Can this spell truly heal broken bones instantly?  No cast! No Surgery! No down time! I should go spend sometime at Hogwarts.

Oops. The spell did not work after all. On top, it had the unintended consequence of missing bones: a Complication.

The ‘Doctor’ did not explain the treatment ( the spell itself), its risks ( missing bones), other alternatives ( let it heal with a cast), and did not get consent for treatment. In fact, Potter did not want him to cast the spell! In our world, it is an easy law suit!

The ‘credentials’ of the ‘doctor’ were suspicious to start with. Was he Witchcraft-Certified? even better for the law suit.

Skele-Gro was used to reverse the complication. Where can I get one? Would it work on stubborn fractures ( nonunions) and missing bone fragments? Yet another reason to visit Hogwarts.

 

 

Dream Land

​I just attended the feature presentation by author Sam Quinones at the WVSMA Healthcare Summit.

He describes how aggressive promotion of highly a addictive painkiller and the development of cheap underground heroin production, marketing, and delivery industry led to the current opioid epidemic.

The book won several awards including Amazon’s Best Nonfiction Book for 2015.

Athletic Hand Injury

Adapted in part from the Hospital for Special Surgery PlayBook

Sports related injuries can be the result of a single trauma or due to repetitive overuse. Certain sports such as boxing, basketball, and volleyball have greater risk of injury to the  bones, ligaments and muscles of the hand and wrist.

One common injury is a boxer’s fracture, which is a fracture of one of the metacarpal bones: it happens when your punch lands wrong.

Basketball and volleyball players frequently get ‘jammed’ fingers. This happens with a forceful encounter with the ball. There may be visible misalignment of the finger. A jammed finger can be anything from an innocent sprain to a bad fracture-dislocation requiring urgent surgery. 

Looks can be deceiving and these injuries should never be underestimated.It is easy but costly to dismiss a serious injury. If pain and swelling do not go away in reasonable time, you should seek medical attention including proper x-rays.

Appropriately sized, and well applied hand wraps and/or gloves protect the hands from such injuries, and proper training is essential to prevent such injuries. Some of these injuries come with an easy fix while others require surgery and dedicated hand therapy.

While still recovering, you may still work on staying in shape and game ready by running, working on lower body and strengthening your core.Your treating physician, together with your therapist, will set the schedule and time frame towards full use and will let you know when it is safe to start exercising your injured hand.If you do too much too soon and push through pain, you may be delaying your recovery or reversing the outcome of your treatment.

I know what distracts me. Do you?

April is Distracted Driving Awareness Month. The American Academy of Orthopaedic Surgeons released its “No Small Distractions” videos  that highlight the importance of safety behind the wheel.

Distractions behind the wheel may not be as small as they seem.

No More Powdered Gloves

Adapted from Medscape

For several years, there has been a push to ban using powder in medical gloves. The US Food and Drug Administration (FDA) recently unveiled a proposal to ban powdered surgeons’ gloves and the absorbable powder lubricating them, as well as powdered gloves for patient examinations. Both synthetic gloves and those manufactured from natural rubber latex are covered.

Professional groups such as the American College of Surgeons, the American Academy of Allergy, Asthma and Immunology, and the American Nurses Association had already taken stands against powdered gloves. Government agencies such as the Centers for Disease Control and Prevention joined the chorus, as did the healthcare systems of Germany and the United Kingdom, as well as several healthcare organizations, such as Cleveland Clinic and Johns Hopkins, have either restricted or forbidden the use of these gloves.

Surgical gloves were first used in 1889, and soon, all sorts of lubricants were used to make them easier to don. Several studies has indicated respiratory complications.

 

 

Hospital Day at the Legislature 2016

The 2016 Hospital day at the Legislature was an opportunity to raise awareness to engage with the delegates, senators, and governor with regard to healthcare related matters. Several bills are under review with direct impact on hospitals and physicians. I had the chance to discuss and present input as a hospital advocate and a physician member of the WV State Medical Association.

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WV Governor, Earl Ray Tomblin

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Congress members Facemire, Romano, and Smith

Doctors and Santa Claus may be Equally Reliable

Source: Doctors are as Reliable as Santa Claus (or Vice Versa)

A team of researchers decided wanted to find out what people thought of doctors how that compared to … Santa.

The researchers showed a film in which a narrator dressed as either Santa Claus or a doctor and told an identical story.

The results:

1- Santa Claus was perceived to be friendlier.

2- Both were equally reliable….

 

Music and Surgery

Adapted from NRP

Music has always been suggested as a powerful tool to comfort patients recovery from surgery. The idea goes back to the days of Florence Nightingale. Music was used to ease surgical pain as early as 1914. Several studies have attempted to prove it, but those studies were small, and really didn’t find all that much.

Researchers in London started combing the medical literature for such studies and found hundreds of small studies suggesting some benefit. But once we put all the data together, they were able to find better evidence, that, yes indeed, surgery patients who listened to music, either before, during or after surgery, were reported less pain, less anxiety and more patient satisfaction.

On average, music helped the patients drop two points on the 10-point pain scale. That’s equal to pain relief reported with some pain medicines! And, unlike drugs,  music doesn’t seem to have side effects.

Titanium Rings

Adapted from NPR

Emergency room staff frequently have to remove rings and wedding bands of the fingers of patients when fingers swell up for any of several reasons. Finger swelling traps rings, which in return restrict blood flow, and cause even more swelling and pain. It not taken off in time, more severe blood flow restriction may lead to the loss of the finger- not fun.

Ordinarily, this wouldn’t be much of a problem. But… this was before Titanium rings became fashionable. Titanium rings are growing in popularity because they’re very strong, light, hypoallergenic and less expensive gold or platinum rings. But that strength makes them more difficult to remove, even with ring cutters. Sometimes bolt cutters have to be used as seen in this picture.

 

 

 

Your Chef is: a Pair of Robot Hands!

Adapted from NPR

Tim Anderson, a freelance chef who won the BBC’s MasterChef competition in 2011, donned a special pair of gloves and started cooking. Those were motion sensor gloves, and his moves were being recorded and coded- and the data was fed into the all new Robot Chef!

Anderson taught the robot how to prepare stir fry, sushi, steak, pasta as well as crab bisque. The plan is to teach the robot about 2000 dishes before releasing it to the public.

But don’t give away all your cookbooks just yet. The robot chef costs about $15,000.

Will A Transplanted Hand Feel Like One’s Own?

Adapted from National Public Radio

Hand transplants have been controversial for decades because, to prevent rejection, patients have to take powerful drugs that suppress the immune system and prevent it from attacking the transplant hand.

Until now, everyone who’s had a hand transplant got it because of an accident, or an illness. Would you request a transplant hand because of a birth defect?

The situation may be different, and Ethics specialist are looking into it.

Patients with birth defect had had lived their whole childhood with their defect and had adjusted well to it for the most part. Besides,  a hand transplant could end be a huge disappointment. The patient has to accept somebody else’s body part as their own, especially that the transplanted hand is visible, compared for heart and lung transplants. The first person to have hand transplant surgery couldn’t get used to having someone else’s hand; he ended up asking his doctors to remove it.

Besides no one knows whether the patient’s brain is even wired to use a new hand- there was never one on that side since before birth!

An apple a day does not keep the doctor away

Adapted from Becker’s Hospital Review.

The proverb “An apple a day keeps the doctor away,” dates back to the 1860s. (The Washington Post).

A recent study published in the April Fool’s issue of JAMA  found no significant difference regarding doctor’s visit between daily apple eaters compared to others.

Apple eaters were slightly more successful in avoiding prescription medications, suggesting the proverb should say, “An apple a day keeps the pharmacist away.”

Presenting at the Hand Surgery Specialty Day

Just presented: Pearls for Treating the Incarcerated- Can we Give Quality Care?

Better Late than Never…

I forgot to post this at the time…Thank you from Cutting Edge Meeting 2014

Driving Safely Following Injury or Surgery

Adapted from NYTimes.com.

Driving is one of the many functions that we perform with little effort yet has a huge impact on our safety. It you think about it, though, you will notice  the many joints and muscles you must engage before you even start the car: fingers, wrist, elbow, shoulder, neck, head, ankle, knee, and hip.

Following injury or surgery, a natural question surfaces: When is it safe to resume driving?

The short answer is: There are no widely accepted timeline.

For patients who must wear casts, slings, neck collars or fracture boots, and for patients recovering from a sprain, fracture, or surgery,  the ability to steer, glance at mirrors and brake safely can be seriously impaired.

Immobilization of either arm in a splint or sling significantly impairs driving ability. Patients should not drive if the wrist, elbow, or shoulder are immobilized, be it  a cast, splint, sling, or an immobilizer.

Patients should not drive if they are in enough pain to impair their ability to steer or respond to sudden events while driving. Patients should also not be driving if they require narcotics for pain control as narcotics affect the patient’s ability to make proper and timely decisions, as well as execute them quickly.

A lot of studies focus on the ability to drive following lower extremity injury or surgery. They focus on how long it takes to make an emergency stop. Braking function returns to normal four weeks after right knee arthroscopy, nine weeks after surgery for an ankle fracture, and six weeks after the patient can walk unencumbered after a fracture of a major lower-body bone.

When the patient feels ready to resume driving, it’s best that to practice in a parking lot or low traffic area and determine how much comfortable he/she is to drive around other people. It is also a good advice to do resume driving in good weather and during daytime until the patient is comfortable handling emergent situations.

Unfortunately, many patients dismiss the advice and return to driving earlier than what is considered safe.

E-cigs’ liquid nicotine causing poisonings – CNN.com

Adapted from CNN

As electronic cigarettes increase in popularity, calls to the nation’s poison control centers about exposure to the liquid nicotine used in many of the devices have surged. In February 2014, there were 215 poison center calls compared to one per month in September 2010. 51% of those calls involved children 5 and under. The total number of cases is likely even higher.

So far, E-cigarettes are not yet regulated by the FDA, and are not required to be childproof. They come in many different flavors like banana, candy and bubble gum, which make them appealing to children.

For this and other reasons, the FDA is starting to look into this. Last April, the agency proposed rules that call for strict regulation of electronic cigarettes, cigars, pipe tobacco, nicotine gels, water pipe tobacco and hookahs. Currently, only cigarettes, smokeless tobacco and roll-your-own tobacco come under the FDA’s regulatory authority.

Banning the Handshake From the Health Care Setting?

The handshake represents a deeply established social custom. In recent years, however, there has been increasing recognition of the importance of hands as vectors for infection, leading to formal recommendations and policies regarding hand hygiene in hospitals and other health care facilities.1 Such programs have been limited by variable compliance and efficacy. In an attempt to avoid contracting or spreading infection, many individuals have made their own efforts to avoid shaking hands in various settings but, in doing so, may face social, political, and even financial risks.

Particularly in the current era of health care reform, innovative, practical, and fiscally prudent approaches toward the prevention of disease will assume increasingly important roles. Regulations to restrict the handshake from the health care setting, in conjunction with more robust hand hygiene programs, may help limit the spread of disease and thus could potentially decrease the clinical and economic burden associated with hospital-acquired infections and antimicrobial resistance. Effective development and implementation of such a handshake ban will likely require further study to confirm and describe the link between handshakes and the transmission of pathogens and disease; the promotion of an alternative, health-conscious gesture to substitute for the handshake; and widespread media and educational programs.

via JAMA Network | JAMA | Banning the Handshake From the Health Care Setting.

Decide to Drive

Did you know:

  • 421000 motor vehicle crash injuries were related to distracted driving in 2011?
  • Eating is related to three-fold increase in risk of crashing a vehicle?
  • Risk of crashing increases 700% when a teen driver reaches a phone?
  • Texting increased risk of crashing a motor vehicle by 2300%?
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