Sari Pics ... Story to come!

Gotta see it all!

Dr. Rishikesh, our saving grace during our time here!

Wore for such a short time seemed shameful to take off, so just hanging out in  my sari!

With Dr's Patil, Jog and Wardhan.

In the temple after dinner.

Saris, Dinner, Temple, Guru

I know! It's a lot to process! But we have saris at the tailor being made as we speak (type/read) for our dinner at the temple with the hospital guru tomorrow. And I use the term guru in a respectable and politically correct way. Not the way we tend to use it casually in the US. More on this to come later. For now... here are the pictures of us sari shopping the other day. We have SEVERAL people that have volunteers to come dress us tomorrow so that we don't show up to dinner in colorful togas! So in the next day or so I hope to have pictures up for you to see :) Wish us luck!! A prayer or two wouldn't hurt either... we are SO out of our element here!

The Sari shop! Multiply what you see times 12 and this MIGHT be the number of Saris in this store!

Mobile Clinic and Julie's Birthday

Tuesday December 13^th 

^{Mobile Clinic} 

This was the day for Beth and I to go out with the mobile clinic, Julie and Jeremy had gone the day before. It was certainly an exhausting experience! We climb up in the van with the Medical Officer, 2 nurses, 1 nursing student, one assistant and the driver and began our journey to a village… somewhere… On these mobile clinic visits the CMO functions like a PA or physician, but they are provided only a few months of informal training. The CMO has the capability to assess and treat or refer the patients he/she sees during clinic. While in the hospital they work with the doctors and there is one in the ICU or wards at all times. 

After only 20 minutes in the van we made a stop. I was excited and thought we were there, “yay, no bumpy windy ride today!” But no such luck. This was just a brief stop for supplies. The village we were going to was a new location for the mobile team, so Beth and I were not the only ones who didn’t know what to expect. After stopping and asking random individuals on the side of the road for directions (who needs Mapquest?!) we finally reach our destination. A pretty little village that sat on the bank of a river lined with small fishing boats and surrounded by the mountains. 

We arrive at the village and are informed that we will be loading our things into a boat and taking a ride up and across the river to get to where the clinic was to be set up. We could get there by car but we would have to go incredibly too far out of our way. Not gonna lie, Beth and I got pretty excited over a little boat ride. So we took a little stroll into the village and along the river with the sisters (nurses) and the CMO while the car was to be unloaded. We get to the river and see one of the boats we are about to take. Not sure how I feel about this boat ride any more… the rim of the boat was about 6” from the water surface! Right about now I was regretting that second chapatti I had with dinner last night and the sweets they brought us for dessert. Oh well, good thing I know how to swim! We returned to the vehicle about 15 min later only to find out that plans were changed, we were to set up shop on the front porch of a home and there was no boat ride L. That was to be the highlight of our day! Then again, not sure I really wanted to swim in THAT river. Not the clearest I’ve seen!

Clinic is simple, not much to set up. A desk with one chair on 3 sides (one for Beth, myself and the CMO), an area for the lab assistant to collect blood, a place for the nurses to hand out the few medications we had available, and a station to do height and weight. Clinic started with a few children lining up for height and weight and then sitting on a mat waiting to see us. So Beth and I were doing this in a tag team fashion where one of us would work on the physical exam while the other spoke with the parent (CMO as translator) to get the history and make visit notes. 

This approached worked out for a VERY short period of time, until we became completely bombarded. People started coming and it wasn’t long before the front porch was FULL. Then it became so full that people were no longer taking their turn in line and began crowding tightly around the table. As soon the chair where the previous child had been seen was empty there was a parent throwing their child into it. So we reconsidered our approach and Beth and I each took on our own patients with the CMO acting as a translator to us both. This continued on for nearly 4 hours and in those 4 hours we saw nearly 85 patients between the 2 of us. Most were children, a few ante partum and post partum women, and a few elderly individuals at the end. 

Throughout this entire process there was absolutely no privacy what-so-ever. These were focused physical exams, so no undressing was involved and if the ante or post partum women required examination, they were brought into the home and examined there. But all the while we are interviewing patients and hearing about their weight loss, loose motions, loss of appetite, vomiting… you name it… 10 other people were crowded around, listening in and waiting for that chair to clear so they could throw their own child in it. It was just so unreal to us since we were so strictly taught to follow HIPPA. Certainly no HIPPA here!

Finally once all the commotion subsided and all the patients were seen, we were able to breathe! We thought this was a busy day for them, but this CMO said that 60 patients is about the average. This day was a bit busier since it was a new clinic, but otherwise the CMO will see all these patients on their own. Before we left the women of the village organizing the clinic brought us a lunch of potatoe patties with soft homemade buns and a Pepsi. The patties were delicious! After our little lunch, at 3:30pm, we packed up and headed back to the hospital, exhausted!
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Birthday PARTY!
Upon returning from the mobile clinic visit we take our showers and get ready to head out on the town for Julie’s birthday!! Ok… not really. But the previous day Beth and I made plans for the 4 of us to have dinner at a nice restaurant in Chiplun (30 min away). We thought we’d splurge a bit and go to the Riverside Hotel. The following is an adaptation of Beth’s rendition of our dining experience.

Julie’s birthday celebration, Let’s just say we had a grand ole time – minus the fact that our ride never showed up because of a miscommunication, nothing new there. Finally though, we were on our way to Chiplun, to eat at this restaurant I found on the internet. Well the hotel this restaurant was at was a little ways out of town (which I did not know) so we ended up driving through the entire city of Chiplun and out the other side into the darkness… Uh… hmm… hope we’re still headed for this restaurant… We are pretty much clueless and sitting ducks, just hoping that our little vehicle miscommunication was truly straightened out. 

Finally, we see a sign for the hotel. Phew! The website for the hotel seemed pretty nice, so I wasn’t sure what exactly to expect (the whole way there, again, I was just praying it wasn’t a shabby grass hut with chickens running around waiting to be eaten. The internet can be deceiving you know!) We pull up… and this place is AWESOME!! Walking in, we’re just hoping that they let us stay and eat (we’ve had experiences before where we’ve flat out been told we can’t eat in places… not sure why??). We get to the front desk and explain that we would just like to eat dinner… “Oh, yes, absolutely, right this way!”… This is a little too good to be true! We are shown to a table out on the veranda of the restaurant. Light music is playing in the background. The garden before us is immaculate. The seats even have cushions! We are in heaven. This is the nicest place we’ve been to since our arrival. We open the menu and low and behold, they even have adult beverages!! (The first we’ve seen of that as well since being here) Could this get any better!?... but just wait… it does! We open the menu… and all we’re really hoping for is non-vegetarian food… but out of some stroke of luck they even have non-Indian food!! (Yes, I know I’ve raved about the food here, and it is AMAZING, but after 3 and ½ weeks of nothing but rice and curries, our palates have been craving a little something different.) So we engorge ourselves in cheese sticks, mini pizzas, chicken pasta and prawns with potatoes. Honestly, some of the best food I’ve had in a LONG time – in America AND India! 

But of course, we must remember, it IS Julie’s birthday we’re out celebrating… So I do my friendly duty and tell the waiter. He responds with a toothy smirk, “Oh, don’t worry… I take care of it”. Oh great… can’t wait for this! A few minutes later different music starts to play over the loudspeakers and out he walks with an ENTIRE cheesecake in his hands with a candle on the top. The music then bursts into some Indian form of the “Happy birthday” that talks about how she “looks as young as she is”. So we laugh to our hearts content and enjoy our entire lemon cheesecake (which doesn’t taste like cheesecake at all, more like whipped lemony fluff on a crust, but still tasty). 

So we relish in our delightful meal and relax for awhile. After a bit the waiter comes over and brings us our bill. He quietly tells us he’s only charged us 200 Rupees (4 dollars) for the cheesecake. But what would be a night of ours if something weird didn’t happen right?? So after we thank him for our cheap dessert he turns to us and says… “But I do have one request from you… you’re all doctors right??... So I have these bumps on my arms and back…” We all look at each other and can’t help but to burst out laughing! Can’t get anything for free these days can we!?!? So we take a look at his bumps, which turn out to be many little lipomas (benign and nothing to worry about). We tell him this and he thanks us over and over again… Apparently his doctor told him that they were from him eating fatty foods. Which actually has NOTHING to do with it. It is merely a genetic variant that causes fat cells to build up under the skin. So enough of the medical talk, the waiter was pleased with his diagnosis, we paid the bill (which was still incredibly cheap for us) and made our way home… Laughing the whole way back of the crazy encounters we always tend to find ourselves in…

Getting there... only 6 days behind at this point! Don't worry there's more to tell, but it's 10:00 now and time for bed!

~Becky

Few Random Pictures

A Family watching the "American Spectacle" as we get a tour of their village from an elder.

Me splinting a femur fracture from a motor vehicle accident. Also had ruptured diaphragm and humerus fx.

STEEP and NARROW steps into a 5,000 year old well

Dr. Jog, the dentist, giving demonstration to the parents and children on how to swish and clean their teeth.

This was the day of Dental Clinic at a village school when a few of the moms wanted a picture with us as well!

                                             Our living quarters - 3rd floor, to the right. Close the white gate below at night or                    stray dogs wander in looking for a late night snack!

Our rooms

Making friends with the recovery room nurses

Lunch in Chiplun on our most recent day off

Appears to me to be on the verge of sinking.. but apparently this is normal

Family Portrait at an AMAZING restaurant for Julie's Birthday

Fruit and Vegetables at the Market in Savarde

A Pediatric Weekend

Saturday and Sunday, December 10-11:

Like all other weekends this was a weekend full of surgery for the most part. Different specialists come each weekend and this was certainly a weekend full of them. We’ve not seen the hospital this busy since we’ve arrived.
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There was an oncologist here from TATA memorial hospital in Mumbai, the largest cancer center in India. He comes to Walawalkar every 3^rd Saturday, and sees EVERY oncology patient, both inpatients and out. This is the only hospital in the area that has any sort of cancer treatment so you can imagine how busy he is. On Saturday alone he was predicted to see approximately 180 patients! During this time he will see new patients to assess and create a treatment plan for them and current patient to follow up on their progress.  We were scheduled to be with him for the day, but he sent us away shortly after we arrived because there was really nothing for us to do. He had done some of his work at St. Jude’s Hospital, therefore he was familiar with PA’s which is why he quickly realized there was little we would get out of sitting through office visits where everyone spoke Marhati and he just didn’t have the time to translate for us. In the end this was all ok with us because like I said, there are several specialists that come each weekend.
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The spine specialist was here just like every weekend. He did not have any surgeries to do so he followed up on his patients from the previous weekend, including the patient operated on for cauda enquina syndrome, and then assisted the orthopedist with some of his work. Another specialist in for the weekend was Dr. Daddi, a plastic surgeon from Mumbai here to run a cleft palate camp. He is over 70 y/o and still working like he’s in his 40’s. Typically he and his partner come to Walawalker once each month and will keep 2 OR rooms going for 2 days. His partner, however, was on holiday this particular weekend, so this meant a few less cases will be done.

Upon Dr. Daddi’s his arrival we followed him on rounds and saw all the patients with cleft lip and/or palate, and a few others with deformities requiring assessment by plastics. He was very enthusiastic about his work and very patient with us. He liked to pimp us and tell us about the deformities we’d never seen or heard of before.

The first case was a cleft palate that Jeremy scrubbed in on, the second a cleft lip where Beth scrubbed in and I was the official OR photographer.  After the cleft lip was completed Beth and I made our way over to the orthopedic surgical suite where the pediatric orthopedist, also in for the weekend, was performing a femoral osteotomy (removal of a piece of bone) on a little boy with rickets (Vitamin D deficiency in children leading to bone deformities and other complications). Some of the children with rickets here have deformities so severe that we were impressed to see they could even walk. They had adapted amazingly well! The correction for the bowing of the femur is to remove a piece of bone from the femur, place rods in the leg above the break and below it. Now these rods function as an external fixator (http://en.wikipedia.org/wiki/External_fixation). With external fixation the rods are screwed into the bone at a right angle from the lateral (outer side). There is one end that remains in the bone and one that remains outside of the leg. These portions outside of the leg, above and below the break, are fastened to one another to hold the leg in the correct position so it can grow back in proper alignment. This fixator will remain in his femur for 2 months until the break has healed. Once the first leg has fully healed, then the child will go back to surgery to correct the second leg in the same way. In this particular boy, the femurs were the only correctable deformity. Rickets may also affect other long bones of the body.
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After surgery to straighten the young boy’s leg we went back to the other ORs where the pastic surgeon was about to separate the fingers of a boy born with complex syndactyly, meaning that all his fingers (exception of his thumbs) were overlapping and fused together since birth. This unfortunately occurred to both hands and the surgeon gave the boy the option as to which hand he would like operated on first. Without hesitation he points to his left hand, the worst of the two.  It was Beth’s turn to scrub into this case and the surgeon was more than happy to have her back. I again played photographer and sat with the boy during the case. The boy was not actually put under general anesthesia for this, he was given a nerve block in the shoulder to numb his entire arm and then just sort of put him into a “twilight” to relax him and induce a little nap. Toward the end of the case he woke from his nap and was trying to peak over the small drape next to his face. It was still pretty messy looking and not time to see, so I had to raise the drape and sat next to him for the remainder of the case. Otherwise everyone was on the other side of the drape and he would have been essentially. I obviously do not speak Marathi, so when I’d see his pulse rise I’d just hold his hand or gently rub his arm. I assume that’s a universal mom thing to do. Dr. Daddi said that though his fingers are shortened (they did not grow to their full extent due to the fusion) that he would regain full function of his now separated fingers. Beth and I walked out of the OR at nearly 10pm that night. Luckily dinner was still waiting for us when we returned!
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Sunday we started our day by doing rounds up in the pediatric ward on all the kids who had surgery the day before. There were 9 in total between the plastic surgeon and orthopedist. Some were feeling a little miserable, but all were doing well and had not developed any complications overnight.

After rounding on the pediatric patients I spent most of the afternoon in radiology with Mr. Dr. Patil (there is a Mrs. Dr. Patil as well). While there I was able do a Thoracentesis, which is a minor procedure involving the guidance of ultrasound to drain fluid from a collection within the lung using a needle and syringe. He is incredibly patient and loves to teach, part of the reason I never mind hanging out in radiology.
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Ok… that’s one more day I am caught up on. Hope everyone is happy, healthy and warm!!

Becky

Day At the Beach

Wow… so earlier in the trip I could blame it all on our poor internet connection that I was not getting these blogs posted. Now, I have myself to blame as well. So since I am a bit behind on what has been going on around here, after this posting I will have to give you the quick version to get you up to speed!

Dec 8^th:  (told you I was behind!)

This was our second day off. At this point we were ready to leave campus again. As one of the doctors puts it “it’s a bit socially isolated around here.” So we decided to spend a relaxing day at the beach in Valneshwar. 

The excitement of our trip began the night before with trying to find a driver. We attempted to call the same driver we had taken on our previous day off, but he was already booked for the day. Uh oh, now what do we do? So we go to the front hospital gate where there are always rickshaws and cars waiting for passengers and we thought we could just arrange for one for the next day. This wasn’t exactly the case so we attempted to ask the front guard how to hire a driver. We soon found out that he didn’t speak English, but a moment later one of the nursing school professor happen to be walking by and the guard asked him to translate. The professor was very understanding and took it upon himself to go ask around for a driver. Meanwhile we continue to hang out with the guard and practically get carried away by the mosquitoes! Finally he returns and tells us he may have something for us. So we following the professor to meet a guy who says he has a vehicle and is available to take us the next day. After a bit of bargaining we settled on a price for the day and agreement that the man’s brother will be driving us, since the brother speaks some English. We had to put down 500 Rupees ($10) in advance, so we’re hoping he shows up in the morning. Ok… I realize how naïve this all sounds, but no worries… we’re all still alive and well J and the nursing professor was familiar with the man. Right… still sounds naïve, I know, but again, still alive and well!

So the next day we eat our usual breakfast of Poha and Upma, then run off to meet the brother of the man to take us to the beach. Low and behold… he is there, ready and waiting at 9am just as we had agreed! The trip to the beach was approximately 55 km and took nearly 2 hrs. It was a windy and bumpy ride just like every other. I took the seat that was facing the back of the van and was able to keep my cool for nearly the whole ride, until about the last 25 min when I had to ask Beth to switch seats with me. Riding backward on bump windy roads can induce a little carsickness in just about anyone! The main roads and highways are narrow but well maintained here. The back roads are however full of large pot holes and wandering animals! Good thing you can get Zofran without a prescription if needed!

After our 2 hour ride we finally arrive in Valneshwar and again are stared at. Totally used to it by now though, we just carry on with what we are there to do and that is lay out in the sand! It was a short walk down a narrow street to the beach, which was practically deserted. Yes! The beach is ours! Well… ours and the occasional stray dog or roaming cattle. 

After a few hours of relaxing we decided we were getting hungry and coming from the Midwest we likely had enough sun for the day. Ok, maybe that was just me. I don’t exactly get nice and brown like the other 3, I just tend to freckle more! So we left the beach and stopped in Chiplun on the way back for a snack at a local family owned restaurant. We could only order sandwiches and snacks because the kitchens tend to be closed between 3 and 7pm. Our stop in Chiplun was most likely the most entertaining part of our relaxing day! 

Our first waiter seems to struggle with taking our order, so an older gentleman comes to the table to rescue both us and the confused waiter with his bit of English. He starts to take our order and then he too becomes very confused. Finally, a little girl (approximately 10 y/o) with excellent English approaches our table, takes the pad of paper from the older man (who we dub as grandpa) and takes over as our waitress. She takes our order without a hitch! The little girls heads off to place our order and grandpa hangs around to visit. 

The following is Beth’s rendition of how the conversation with grandpa plays out:

Grandpa “So what country are you from?”

Us: “United States. Chicago.”

Grandpa” “Oh… ok!” and proceeds to inform us of various things he knows about the US. After which he wanders away and shortly thereafter returns.

Grandpa: “What country are you from?”

Us: “Uh… United States”

Grandpa shakes his like he knew that and wanders off again. A moment later he returns.

Grandpa: “You want some mango juice? It is our specialty here.”

Us: “Sure. We’ll each have one.” We had already ordered our food, but mango juice sounds refreshing.

Grandpa wanders off to inform the kitchen of our request for Mango juice.

Then he’s back…

Grandpa: “So what country are you from? You from Russia?”

Us: “Yes. We’re from Russia.” Probably not the correct response

We all start to giggle, we just could not help it at this point. He was a sweet man, but we realize at this point that poor Grandpa truly does not remember asking us where we were from.

Grandpa: “You want some mango juice?”

Us: “Yes. 4 please”

Grandpa: “Ok.” Then he points at Julie, “She laughs a lot.”

Julie: Now laughing out loud.

Us: “Well, she’s a happy girl.”

Grandpa: “We will call her laughing girl!”

Now we all bust out laughing!

Grandpa: “You want mango juice?”

Us: “Yes, 4 please…”

Grandpa: turns to walk away, stops and says to us “Russian people are so nice!” and wanders off…

He was so cute that we just couldn’t help but laugh at the whole situation. We came to the conclusion that though his memory is failing, he is still a good personable asset to the family restaurant in his happily confused state. The little girl, we assume to be his granddaughter, was so sweet and helpful that we tried to give her, her own tip but she would not accept. So instead we pulled out some American coins for her. Now those she was willing to take!

Bringing things back to a more serious note. Talking about grandpa reminds me to discuss the topic of caring for elderly in India and Indian culture. There are not any nursing homes or the concept of assisted living. You may find some nursing facilities in the cities, but those are few and far between. The elderly are cared for by their family seeing as there is nowhere else for them to really go. In most families of the rural area the women are housewives, so there is typically someone in the home at all times to look after an elderly family member. Ultimately, even though grandpa has some obvious dementia, he is still able to be with his family, work in the restaurant and interact with the customers. Though we were confused ourselves at times, we really enjoyed our conversation with grandpa. Honestly, it was the highlight of our day!

CMEs and Surgery

Disclaimer: No time to edit this post... so please bear with my mistakes!

Saturday, December 4, 2011

Last Saturday started off a little slow, but then while doing rounds with the Medical Director in the MICU (medical intensive care unit) when a patient became pulseless and the staff began to run a code on him. This was the first code that we experienced in the hospital and it was run quite different than what we’ve previously been a part of. First of all, there never seemed to be any one person in charge. Second, the medications that were being given were not by ACLS standards for the rhythm occurring. And third, there was no one in charge of notes and charting the events and medications given. The patient was a 65y/o male who had previously had 15 days of chest pain, presents to the hospital on day 16 and an EKG showing significant changes. The heart attack he had 16 days ago back caused a great amount of irreversible damage and there is no cardiologist here. Ultimately they were unable to resuscitate the patient and he passed away. Prior to the start of the code, there little hope for him to survive the damage caused. The staff and family knew that he was at the end of his life.

In India you will only see cardiologists in the cities. There is too much infrastructure and cost (to patients and hospital) required to have a cardiologist in the rural areas. Patients here who survive a heart attack are sent home on at least aspirin, Beta Blockers and a statin. But even still, very few will return for the required follow up or even refill their medications. People tend not to come to the hospital until their condition is severely advanced or treatment is no longer an option. 

It sounds bad to say this, but there were 3 good things that came out of this unfortunate situation. 1) Beth got to do chest compressions. 2) We got to practice intubation after he passed. It’s very different than on the plastic dummies. 3) Forced us to pull out our ACLS pocket references and review rhythms and code protocol when all was said and done.

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For the later part of the morning Beth and I spent some time with the orthopedic doctor in his outpatient clinic, while Julie and Jeremy did clinic with the internist. The orthopedist was very helpful, giving us pointers specific physical examination tests and findings to look for and a few new ortho tricks we hadn’t learned before. And his English isn’t half bad which makes everything much easier! We really got a lot out of the time spent with him and then were able to follow through by scrubbing in on a few cases in the following days.  

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Weekends in the OR are usually hopping around since the consultants are here from Mumbai and Pune. Julie got to scrub into a pancreatectomy for a patient with pancreatic pseudocyst and severe abdominal ascites. I was able to scrub in for a fractured radius that required reduction, plating and pinning. We do our best to take turns rotating through different surgeries so we all get a well rounded surgical experience, and so it’s not so crowded in the OR.

Sunday, December 5, 2011
Last Sunday we spent the day in CME course lectures with physicians from around the state. The topic: Nephrology and Urology. Great! I could definitely use a refresher in nephrology. Better yet… it’s in ENGLISH!! I won’t bore you with the details but the lecturers all seems to take one of the following avenues. 1) Try so hard to be entertaining that you were too distracted to get the material. 2) The presenter had a thick accent mixed with monotone. 3) The presenter would be running out of time and completely skip the slides on medications or anatomy and physiology. Instead we learned about surgical procedures that weren’t even in practice any more. So it was a bit of a drawn out day. There were 2 lecturers that were quite good, so it certainly wasn’t all bad!

After sitting lecture all day we felt the need to stretch our legs. So we all decided to go for a run. Jeremy and Julie go running several times a week, Beth and I… not so much. But off we went! I have decided that going for a run while in a tropical country is a bad idea. Too hot for me! And worse than that, people don’t run for exercise around here and I don’t enjoy having my picture taken when I look as I do while exercising. So I may be done with running for the next few weeks. Guess I will just have to cut back on the Chapati instead.

Medical Explanation…

HPI: 31y/o male was filling a large bucket of water, upon lifting the bucket he experiences sudden, sharp, bilateral low lumbar pain, falls to the ground unable to walk, unable to move lower extremities.

PE:  (significant findings)

Neuro: Decreased lower limb sensation, saddle anesthesia, lower limb paralysis, DTR: knees hypo-reflexive b/l, ankle reflex absent b/l.

Did you guess it? You shouldn’t have had to guess! Haha, just kidding… It’s Cauda Equina Syndrome.

Definition: a characteristic pattern of neuromuscular and urogential symptoms resulting from the simultaneous compression of multiple lumbosacral nerve roots below the level of the conus medullaris. Symptoms include low back pain, sciatica, saddle sensory disturbances, bladder and bowel dysfunction, and variable lower extremity motor and sensory loss. Although the lesion technically involves nerve roo and represents a “peripheral” nerve injury, damage may be irreversible and cauda equine syndrome is most often a surgical emergency. Typically several months of therapy are required to regain partial or full motor function.

Back to Surgery

So at 9pm I was scrubbing into a cauda equina repair and didn’t scrub out until nearly 1am, but it was entirely worth it! The surgeon was Dr. Nadkarni, an orthopedic spine specialist that drives the 5 hours to Walawalkar hospital EVERY weekend to volunteer his time doing surgery. When we asked him why he comes every weekend, his reply was “This place inspires me.” Simply put!

It was difficult to see exactly what was always going on through the case since we are working through an incision approximately 2 inches long. In the US many of the spinal surgeons will use magnifiers on the end of their surgical glasses, which many times is hooked up to a monitor so others in the OR can see. Definitely not the case here! This made some of the minor anatomy was difficult to identify (even when pointed out to me!)

I was able to follow this patient up to Post-op day 8, when he was discharged home. In those 8 days he progressed from complete loss of motor and sensory function of both voluntary and involuntary muscle movements of his lower extremities, but deep tendon reflexes present at patellar tendon bilaterally (hammer to the squishy spot just below the knee cap). TO full sensory in all parts of his lower extremities, regained function of both bowel and bladder and was walking with the help of a walker for stability! He will still require therapy to retrain the muscles in his legs (i.e. still hardly able to flex ankles when walking), to strengthen his back and core abdominal muscles. So he has about 6 moths of physical therapy in his future but the Dr. Nadkarni and the hospital’s orthopedist, both expect him to make a full recovery. This is mostly possible because the decompression of the nerves was performed within 8 hours of the injury occurring, the patient did not have complete loss of sensation and reflexes and his young age.

Still catching up on the posts I am missing… So, when the internet is cooperating again, I will get those posted. We have just over a week remaining at the hospital and then we are off for 2 weeks of travel and relaxation! We are busy now getting our homework done and organizing a presentation to be given to the hospital staff before leaving next week. We’ll keep you posted on our adventures. We miss you all.

Becky