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Straight Talk | Understanding Scoliosis and Thoracic Insufficiency Syndrome
Transcript: After surgery
John Dormans, MD: The postoperative course after spinal deformity surgery for early onset scoliosis, those children are usually getting a growing rod procedure and their rehab is very simple. They're up walking the day after surgery. They're often going home on the third or fourth postoperative day. They're often back to school within a week or two. And then back to gym and sports, if they were participating before, within three to six months.
Oscar Henry Mayer, MD: The ability to insert growing rods has provided a lot, in terms of stability and preventing disease progression, to the point where many of these children, if treated early and aggressively, don't end up seeing me or seeing my colleagues in pulmonology because they're stable. Their chest and spine is stabilized, and they're able to grow in a relatively normal manner.
John Dormans, MD: After surgery they notice that they're taller or straighter. And often the rib or chest wall asymmetry, the so-called rib hump, improves or gets much better, in some cases goes away.
Robert Campbell, MD: With the VEPTR approach -- after the initial VEPTR implantation they'll spend several days in the Intensive Care Unit and then about five to seven days convalescing on the floor.
Raymond Kleposki, MSN: We're expanding their chest walls. This is their drive to breathe. This is their intercostal muscles, their lungs, their diaphragm, everything is being changed.
Michael Nance, MD: It does give them a bit more volume. You usually have straightened the spine in many of these children, so you're improving the dynamics of respiration, the function of the diaphragm.
Michelle Holliman, Mother: And before this implant, you figure you've got a lung here, and this was her. That's how her lungs were, and now they're like this.
Tabitha Holliman: When I was a baby, I had a hard time breathing. When I was getting older, I had to use a inhaler. Now I'm breathing fine. I don't have to use an inhaler.
Michelle Holliman, Mother: When you're watching your child sleeping and you can see they're having a tough time breathing and all that-- and just to get to this point today, where she's out cold and enjoying herself.
Oscar Henry Mayer, MD: One of the advantages of using respiratory therapy is that we can help patients re-recruit and better utilize the lung that they have available.
John Dormans, MD: A lot of these kids have complex other problems.
Robert Campbell, MD: Multiple deformities, severe problems.
John Dormans, MD: And the nursing staff does a great job of knowing the intricacies of what these other diagnoses and conditions are. That's one of the advantages of being at a place like CHOP.
Raymond Kleposki, MSN: I think that the only way to truly care for these patients is to have an organization that has top rate NICU or PICU, top rate pulmonologists, top-rated doctors, top-rated orthopedic surgeons.
Robert Campbell, MD: So our team, from nursing to anesthesia to the rehab people, brace people, they're familiar -- they're comfortable with these rare conditions.
Michelle Holliman, Mother: Between the anesthesiologist and the pulmonary and the orthopedics, they're all together. They do this every day.
Sandra Franz, Mother: I hand over my daughter to them, and I know she's in good hands.
Tabitha Holliman: It may be scary in the hospital, but people are taking care of you, and they're trying to help you. So mostly you don't have to be scared of really anything.
Oscar Henry Mayer, MD: It's very important to maintain a close working relationship with the referring physician and have a bidirectional flow of information.
John Flynn, MD: We can send e-mail communications back and forth with images. I get pulmonary function tests sent by e-mail and then it gets very easy with a little bit of data to pick up the phone and talk with the referring physician and keep them together as a partner.
John Dormans, MD: Keeping the primary care team in the loop, up to date, communicating well with them is not only important for us, but it's very important for the patient and family. We put a lot of emphasis and effort into that.
Robert Campbell, MD: So this is all part of the treatment approach. Not just taking care of a child, but taking care of the whole family.
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