Closer Look: Scoliosis Surgery

, c;lToday, I was able to assist in a Scoliosis Surgery. I was only able to assist in this surgery once and in what I remember, it's one of the long surgeries done in OR. Anyways, here's a closer look in this surgery.

SCOLIOSIS SURGERY

Definition: Surgery for adolescents with scoliosis is only recommended when their curves are greater than 40 to 45 degrees and continuing to progress, and for most patients with curves that are greater than 50 degrees. Scoliosis surgery is designed to reduce the patients curvature and fuse the spine to prevent any further progression of the deformity.

Besides preventing further curvature, scoliosis surgery can also reduce the amount of deformity. Usually, about a 50% correction can be obtained with surgery using modern instrumentation systems in which hooks and screws are applied to the spine to anchor long rods. The rods are then used to reduce and hold the spine while bone that is added fuses together.

 

Procedure:

Surgery involves an incision in the posterior aspect of the spine. The child lies on their stomach as the procedure is performed. The length of the incision will be based on the location and extent of the curvature. The muscles of the spine are moved in order for the surgeon to access the spinal column. 

Surgery for scoliosis is a form of spinal fusion. Rods and screws are connected to the individual vertebrae and a wire is often used to help realign and straighten the curve. The use of Harrington rods are a common fixation device for this type of fusion.

In many cases, a bone graft is used to connect one vertebra to another to form one segment and provide additional strength to keep the bones in place. Although donor bone material may be used, the surgeon may harvest bone to be used for this bone graft from the child’s pelvis (called an autograft). Generally bone that comes from a synthetic form or donor is not as successful as the autograft. Scoliosis surgery is involved and generally takes 4 to 6 hours to perform, depending on the specific case.

Instruments and Supplies:

• Sharps
• Kelly
• ochsner straight
• freer
• wetlainer (curve)
• adson-beckman retractor
• rongeur/ gooseneck
• mallet
• harrington/cobbs
• cottonoids
• 2/3s
• rubber sheet
• bone wax
• cautery tip
• NST
• Suction tube
• curette
• sterile cover for C-arm
• PDS OCT1
• Vicryl OCT1
• Vicryl 2-0
• Prolene 4-0
• osteotome
• bone gouge

Sources: Scoliosis Surgery, Spine Health

When Jealousy Strikes!

It's Mam Barney's birthday today pero wala siya at nasa Coron.

We have a few case today and so I thought. kala ko nga hindi ako mag-oovertime today but I guess my hunches towards my work is always right. Anyways, I was supposedly on another case when Mam Mai put me together with Mam Kim. I just never thought that being with her will bring some disaster afterwards.

Anyways, among all my friends in OR, only with Sir Ge and Mam Kin that I could confide anything from my small concerns to my bigger problems but unfortunately evr since Mam Kim became the gf of Sir JA, confiding my problems with her became impossible. I wasn't allowed to be near her, text or even call her.

Today is also the first time that we had a case together. After our first case, Mam Kim approached me and told me that Sir JA saw us and got angry because of our attitude to each other. Although, I can't even remember what I did, so to avoid the misunderstanding I joked na lalayo na ako sa kanya ulet.

At dahil ang tagal nung third case namin dumating, natapos na si Sir JA sa case nya. Akala ko naman kung ano yung sasabihin nya ng pinatawag nya ako yun pala e para i-confront ako sa nakita niya. I cannot forget his look, talagang galit sya with matching tremors pa yun. Ang weird pa kasi kahit sinabi niyang asawa na niya si Mam Kim at pinaghirapan niyang makuha si Mam Kim, tama bang sabihin niyang bibitawan niya si Mam Kim, sabihin lang namin na may namamagitan sa aming dalawa? Hindi ko talaga alam kung ano ba ikinaiinit ng ulo niya, e magkakaanak na nga silang dalawa e.

I felt really bothered after that incident. Naawa rin ako kay Mam Kim kasi sana kung gusto ako i-confront ni Sir JA, sana tago na lang and not with Mam Kim. It's just really weird when the green monster strikes! Ewan ko kung magkakaayos pa kami nitong si Sir JA, pero for now, dpat hindi muna kami magsama sa mga kaso. o baka magunaw ang mundo.

It's A Manic Monday

I requested a 5-1 shift not to avoid the Manic Monday, gusto ko lang talagang umuwi ng maaga hindi ko nga alam na Manic Monday pala yun. When I arrived in OR, I saw the whiteboard and I was shocked to see na iba yung format ng pagkakasulat ng mga kaso doon, instead of according to scheduled time ang list, nakaarrange by room ung mga case, nagmukha tuloy na konti lang ang case pero when I saw the clip board hala shocking dahil punong-puno sha and for sure OT to the max nanaman ang mga tao.

Anyways, I was placed in the 6am case dahil 5-1 ako, pero nagulat ako dahil ung monster anesthesiologist pala yung may hawak nung case na yun. Ok naman, carry ko na siya at dahil mabilis din yung case sandali lang niya ako nakasama pero kahit ganun, feeling ko nag15k run ako sa dami niyang pinapakuha. Anyways, after that akala ko ok na hindi pa pala, dahil after kong ma-transout yung patient sa PACU, hala nagwala ang patient, to think na intern pa siya ng hospital namin. Ang pangit ng emergence niya sa anesthesia. Sa sobrang lakas niya para kaming nagwrestling at dahil sobrang gulo niya natanggal na rin ung IV niya.

To calm him down, binigyan siya ng nalbuphine thru IM then his IV was reinserted and a propofol was given to him. Akala ko ok na ang lahat tapos umalis na ulet yung anesthesiologist, kaso after 5 minutes hala parang walang epek yung mga gamot at ayun nagwala ulet siya. Binigyan siya ng nalbuphine thru IV naman at another dose of propfol but to no effect pa rin. At dahil nagtaka na yung scrub nurse ko bakit hindi pa ako bumabalik after 30 minutes, sinundan niya ako sa PACU and siya ang pumalit sa akin para magawa ko yung mga charges ng patient. After a while napag-alamanan ko na naka-precedex at propofl drip na yung patient.

Anyways, kahit 5-1 ako na overtime pa rin ako dahil yung dalwang staff sa hapon absent so isa na lang yung 2-10 staff. Anyways ok naman yung mga naging kaso ko: 3 lap chole at isang removal of implant. Akala nga namin sobrang tagal nung removal of implant buti na lang at hindi. Kaso yung isang lap chole namin nag-open dahil sobrang lala na nung patient.

Anyways, after that day, napaisip kami paano pa kaya kami after mag end of contract yung apat na casuals namin. Siguradong patayan nanaman ito sa OT.

Saturday Night Duty and Early Sunday Trip

It's Saturday once again and our theme for tonight's duty is Street Food. And for the sake of no emergency case, Jops and I decided that each of us should bring something because we realized that if only one of us bring something, magkakaroon at magkakaroon kami ng case. Or if we don't bring any at all meron pa rin. So this time around both of us should bring something. I'm in charge of bringing the fishball, squid ball and kwek-kwek while Jops is the one responsible for the chicken and pork isaw.

Anyways, as usual late nanaman ako pero pagdating ko doon wala pa rin itong si Jops. After 40minutes dumating din siya together with Sir A and Sir P.J Hindi naman sila invited pero dahil andunna sila ininvite na rin namin sila. Yung mga inimbitahan namin, sila naman yung wala, although Benj came with mangga with bagoong.

Anyways, I realized na effective talaga ang pagdadala ng food every night dahil this time around hindi na kami nagkaroon ng case, although napull out naman itong si Jops sa DR-Pay dahil nagkaroon sila ng emergency CS.

Anyways, ambilis naubos ng food namin dahil andami ngang uninvited guests so in the end (ng umuwi na at natulog na ang mga uninvited guests) nagkwentuhan na lang kami nila Benj at Jops sa workroom at around 4:30 in the morning na ng magdecide kaming matulog dahil hindi na namin kaya.

Around 6 in the morning dumating na itong si Rain, na supposedly ka-COS ni Chia pero maya-maya biglang nagtext si Sir R na sya daw ka-COS ni Chia at parating na sya. Ayun nagulantang ang mga katauhan kung sino ba talaga, in the end ang naevict ay si Rain at dahil sobrang nabad trip si Rain dahil sayang lang ang effort niya, Jops and I decided to accompany her somewhere para hindi na sya umuwi. We decided to have a cup of tea in Tomas Morato. 

As usual kapag mga juniors lang ang magkakasama, andami naming napagkwekwentuhan, love story ng mga tao sa OR, mga experience namin from different monster surgeons atbp.

After almost two hours of sipping our teas, we decided to change location: Bannaple. Dahil sobrang aga pa at akala namin 10am nagbubukas ang establishment ayun dumating kami dun na sarado pa. After 30minutes nag-open din sila and we ordered Banoffee pie, Double CHocolate Tiramisu Cheesecake at Baked Creamy Cheesy Penne.

After that naglakad kami papuntang National Bookstore sa may Quezon Avenue. Syempre hindi pa rin naubos ang kwentuhan namin. Ito yung mga araw na gusto ko, yung tipong nag-eenjoy ka lang, walang stress at kasama mo lang ang mga taong hindi stressful. Talking anything, everything under the sun without any pressure. It's nice knowing some people like them.

A Little Errand From Sir Ge

Dahil na ot nga ako kanina, mga 11am na ako nakauwi at mga 12 na ako nakatulog. Around 3pm nagising ako and to my surprise tinatawagan pala ako ni Sir Ge. Ever since nagkaanak sya madalang na syang tumawag sa akin, most of the time ako ang tumatawag sa kanya so nagulat talaga ako. And as usual feeling ko may kasalanan nanaman akong nagawa dahil bakit sya tatawag.

Anyways, I called him back but to no avail. But regardless gumising na ako at nag-prepare dahil Saturday nga at may usapan kami ni Jops na ang theme namin for tonight is street food so I still need to buy those foods na naka-assigned sa akin. After a while tumawag ulet itong si Sir Ge and pinapapunta nya ako sa kanila, sa bagong bahay nila at bilisan ko daw.

After 30 minutes nakarating din naman ako sa kanila and supposedly uutusan lang pala niya akong tulungan siyang magbuhat ng bigas niya paakyat ng bahay nila. Akala ko nung sinabi nya yun sa phone e joke lang, yun pala totoo, pero dahil late nga ako dumating, yung taxi driver na lang yung inutusan nya na mag-akyat ng bigas. 

Anyways, isa pa palang goal nya e para makapasok na ako sa bagong bahay niya. Kinukulit ko kasi sya na sana naman makapasok na ako sa bahay nila pero parating hindi pwede dahil parating may tao sa bahay nila, kung hindi yung misis nya, yung nanay naman niya.

Anyways, tama nga siya, maliit lang yung bahay nila and medyo masikip although feeling ko dahil lang yun sa hindi pa organize yung mga gamit nila. Parang mas bagay ngang bachelor's pad yun kaysa sa for family e. Anyways konting linis at ayos lang ng gamit at itapon lang nila yung mga gamit na hindi naman kelangan luluwag rin yung bahay nila.

After that, sinamahan ko syang magbayad ng credit card niya sa SM then sinamahan naman niya akong bumili ng contact lens solution after. Tapos diretso na kami sa Novaliches para maglaro doon. Buti na nga lang at doon din yung bagsak namin dahil mas maraming nagbebenta ng mga street foods doon at least hitting two birds with one stone ang nangyari sa akin, nakapaglaro na kami ni Sir Ge, nakabili pa ako ng mga kelangan ko for the night duty food tripping namin.