Week 6:
Children’s Hospital Colorado

July 13, 2014

This week, Bridget and I shadowed neurosurgery and hardware removal. We were scheduled to only shadow Dr. Wilkinson in neurosurgery, however two surgeries were being done on the same patient, and hardware removal first, we decided to stay since both of us have never seen this procedure before.

The patient had a history of triplegic cerebral palsy; extension osteotomy was done to both her bilateral distal femurs, and rotation osteotomies to her bilateral distal tibia. She had these implants in for about a year, it was the surgeon’s preference to remove it. Dr. Chang states that there was an article published by John Hopkins about hardware removal, and found that re-fracturing and infection was minimal after removal. There were more complications associated if implants were kept in. During my data collecting, there were less than 4 patients that did not remove hardware, reasons were family preference or excellent union of the fracture. But, removing hardware is very common.

The procedure for this surgery included marking the proper operative sites, then anesthesia and appropriate preparation and draping of the extremities in a sterile fashion. Incisions were made at the previous incision site. Blade plates were identified and cleared of overlying soft tissues. Six screws were removed from each distal femur, and four screws from each tibia using a screw driver, then the plate was removed. It was interesting because there was the surgeon and three fellows/ residents removing hardware all at the same time. Since there were four of them, they each picked the area they wanted to do.

We also watched Dr. Chang put a cast on a patient that sustained an injury to her fibula. It was interesting because he personally designs the cast depending on what the child wants. Today, he cut out stars in the cast, put some glitter, and even made one look like a shooting star. The cast was also glow in the dark. He showed us pictures of the other casts that he designed, some were Frozen, Nike, Angry Birds, and Hello Kitty inspired. He had a bag full of glitter and stickers, it was like Michaels in a bag, one of the nurse’s stated.

In addition, the neurosurgery that we shadowed was a baclofen pump replacement. Normally, muscles receive electrical signals via nerves to contract and relax. However, spasticity is caused by an imbalance in electrical signals coming from the spinal cord through the nerves to the muscle. Baclofen works by restoring the normal balance to reduce hyperactivity and involuntary spams. This drug can be taken orally, or a metal disc can be placed under the skin of the abdomen near the waistline, which delivers baclofen directly into the spine. The medication from the pump reservoir goes through the catheter.  This procedure was done because of battery depletion. Every six years, the battery needs to be replaced. This is really effective. Doctors can adjust the dose, rate, and timing of medication. This is helpful for the individuals who have a hard time taking pills, or who will forget to take their medication.

I was glad that Bridget was shadowing with me today, she has done this multiple times so she was able to help me. She showed me where the scrubs were, gave me some tips since this was my first surgery, and explained some of the regulations. Shadowing surgery was not what I expected. I guess I had that stereotypical hospital/ ER mindset from television, showing serious doctors and tense/ stressful environment. However, it was pretty laid back. Doctors/ nurses were so calm and casually talked about their life, telling stories while performing the surgeries. They even had music playing in the background. I guess that means they are good at what they do. If it was me though, I don’t think I would be able to concentrate.