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Pooka1
07-05-2010, 12:52 PM
http://drlloydhey.blogspot.com/2010/06/kaylas-6-week-follow-up-visit-after.html

Confusedmom
07-05-2010, 08:57 PM
What I think is most interesting about this is that the xray technician shielded her reproductive organs. Why do they do that sometimes and not others? Every time I ask for it they say it will get in the way of seeing the curves. But as you can see from this Xray, the shield is below the pelvis! I feel like I've been exposed to a lifetime of radiation with scoliosis Xrays since age 11 with no particular regard for my organs!

Evelyn

LindaRacine
07-05-2010, 10:04 PM
What I think is most interesting about this is that the xray technician shielded her reproductive organs. Why do they do that sometimes and not others? Every time I ask for it they say it will get in the way of seeing the curves. But as you can see from this Xray, the shield is below the pelvis! I feel like I've been exposed to a lifetime of radiation with scoliosis Xrays since age 11 with no particular regard for my organs!

Evelyn

Evelyn...

I think you may need to find a new specialist. The recommendation for scoliosis films is that they be taken with shields, and lateral films should be taken P/A (meaning the back is toward the machinery).

--Linda

leahdragonfly
07-05-2010, 11:01 PM
A lot of x-ray techs are unfortunately extremely sloppy and lax about shielding. I nearly always have to request/insist on proper shielding for my daughter, who started having scoliosis x-rays at age 6. You have to be very vigilant about insisting the shielding is applied properly and consistently.

I have noticed though that now, at the age of 43, my ovaries are not shielded--I am assuming because I am past my child-bearing years.

Evelyn, I'm not sure about your comment on the shielding of Dr Hey's patient. That looks like very good placement, actually. You can find a lot of info online by googling "gonad shielding." There are even articles with photos of proper shield placement.

Confusedmom
07-06-2010, 09:36 PM
Thanks, Linda. Actually, this unfortunately has been true at a variety of offices (latest was Dr. Bridwell in St. Louis). I ask for the shielding when I remember, but it seems like when I forget they just leave it off. Or at least I don't see anything blocked on the Xray. (Aren't they supposed to try to block breasts, too?)

Gayle, I think my writing was unclear. I also meant that the referenced xray looked like good shielding--what I would ideally want. As you note, perhaps they've decided that they don't need to shield me anymore since I'm 38--unlikely to have more children. But still....

Anyway, I'll be more demanding from here on out, thanks!

LindaRacine
07-06-2010, 09:41 PM
Thanks, Linda. Actually, this unfortunately has been true at a variety of offices (latest was Dr. Bridwell in St. Louis). I ask for the shielding when I remember, but it seems like when I forget they just leave it off. Or at least I don't see anything blocked on the Xray. (Aren't they supposed to try to block breasts, too?)

Gayle, I think my writing was unclear. I also meant that the referenced xray looked like good shielding--what I would ideally want. As you note, perhaps they've decided that they don't need to shield me anymore since I'm 38--unlikely to have more children. But still....

Anyway, I'll be more demanding from here on out, thanks!
I would definitely complain to Dr. Bridwell. I would assume he was part of the group that set the standard for taking scoliosis films.

twinsmom
07-07-2010, 09:52 PM
OMG !
I never thought of the girls needing to be shielded. Thanks for bringing this up!

We are going to another doc at the end of the month. This time a real consultation 2-3 hours. We are meeting with the current ID and will be deciding whether to stay with the orthopod,next week.

I had a retired phsycian friend read my narrative. He apologized for his profession and said he was embaressed. I think the doc is waiting for the residency program to start again with new residents. Because he was pushing for M. to enjoy the summer. Another Medical Social Worker agreed with this theory. He doesn't answer my phone calls- we only get answers when my husband calls. I don't know what I did wrong. Anyway. say prayers that we get this all worked out. M. is set on this Doc.

Vali
07-07-2010, 10:06 PM
Does keeping your undies on classify as shielding? If not, yowser, yowser, I always had frontal xrays and side without any shielding. Interesting.............
Wonder what the Aussie protocols are for these kind of xrays.

LindaRacine
07-07-2010, 10:23 PM
Does keeping your undies on classify as shielding?
Not unless they're made of lead. ;-)

Back-out
07-16-2010, 05:18 PM
Hi there!

A bit late, but I just ran into this by chance.
You asked for comments.

I have one about Dr Hey's own comments on his Blog.

He said he used a special heavy duty correction technique (to do with type or placement of rods) because of this adolescent's "nasty 90 degree curve", remarking how much better it would have been to operate before her curves got this bad - "preferably below 50 degrees".

Is this true mostly (only) of adolescent curves? With adults, especially older adults, it seems that the advantage of getting there sooner "under 50 degrees") is offset by other considerations. i

I wonder if (and if so, how), Dr. Hey might have changed his recommendations if he had been speaking of an adult with the same curves and correction? To be more general (and more what I want to know), I'm sure there are standardized SRS guidelines for when surgery is indicated (factoring in degree and location of curves, pain, progression rate, diisability). These must differ by age group.

Anyone actually know what these are?

Back-out
07-16-2010, 06:58 PM
Note: if such guidelines are available (I'm sure they exist), I'm sure first time adult surgery candidates of all ages would love to have access to them.

So maybe if someone (Linda! Haloo! :)) has an answer to this important question, both question and answer belong in that forum where more can benefit from seeing them.

titaniumed
07-16-2010, 09:56 PM
Amanda

A persuader was used with my construct. Its one on the many different tools that Synthes manufactures. On their site, there is no end to what they have thought of... Amazing. They have tooling for every possible scenerio. I have their "Pangea system"

Scroll down to page 15
http://products.synthes.com/prod_support/Product%20Support%20Materials/Technique%20Guides/SPINE/SPTGUSSJ4437A.pdf

Adults and kids with "nasty 90s" need persuasion sometimes...

This little girls curve was up high and makes things difficult due to the ribs. She really needed surgery.... Its such a shock to just find out your kid has a severe scoli, and so young.

I recommend deep breathing exercises for the parents.
Ed

elizabeth1st
07-18-2010, 12:16 AM
Ed

Great attachment! Thanks

Do you know how the surgeon gauges the depth/length of the pedicle screw; is xray imaging used during surgery?

I've read articles where the screw has been too long and caused irritation requiring removal later and others where the screw insertion caused dural tears

In cases where the spine has been rotated for some time, do you or others know, if some vertebrae are deformed and make placement of the pedicle screw difficult or impossible?

Thanks

titaniumed
07-18-2010, 05:23 AM
Hi Elizabeth

Good to see you posting again.

Placement of pedicle screws is challenging. On one of my levels, I was wedged, and in the hospital report, it said that a clear trajectory was not obtainable. One screw was omitted. A C arm was used.

http://www.medical.siemens.com/siemens/sv_SE/gg_spms_FBAs/files/brochures/3D_Navigation_eng_DRUCK.pdf

Ultrasound is used. Steinman pin or K wire used for depth check.
http://www.medschool.lsuhsc.edu/neurosurgery/nervecenter/tlscrew.html

http://www.ncbi.nlm.nih.gov/pubmed/9755762

http://www.ijoonline.com/article.asp?issn=0019-5413;year=2010;volume=44;issue=2;spage=163;epage=1 68;aulast=Rajan

Hope this helps
Ed

titaniumed
07-18-2010, 06:02 AM
one more
http://www.bioline.org.br/pdf?ni05158

Ed

Vali
07-18-2010, 07:45 AM
Synthes was the company of choice for my surgeon. I have the USS II - posterior and the Synfix-LR - anterior. Dr H apparently uses these products to teach future spinal fellows at our Medical Uni. I agree with Ed, they seem to have all bases covered.

elizabeth1st
07-19-2010, 12:07 PM
Hi Elizabeth

Good to see you posting again.

Placement of pedicle screws is challenging. On one of my levels, I was wedged, and in the hospital report, it said that a clear trajectory was not obtainable. One screw was omitted. A C arm was used.

http://www.medical.siemens.com/siemens/sv_SE/gg_spms_FBAs/files/brochures/3D_Navigation_eng_DRUCK.pdf

Ultrasound is used. Steinman pin or K wire used for depth check.
http://www.medschool.lsuhsc.edu/neurosurgery/nervecenter/tlscrew.html

http://www.ncbi.nlm.nih.gov/pubmed/9755762

http://www.ijoonline.com/article.asp?issn=0019-5413;year=2010;volume=44;issue=2;spage=163;epage=1 68;aulast=Rajan

Hope this helps
Ed

Thanks Ed
Always impressed by the knowledge the members have on this site. I have gathered a lot of articles from Spine and related journals (my work allows me to access many journals free thru' our library). I know the library does not subscribe to the Indian J Orthop - great to add the additional info
Susan

Back-out
07-19-2010, 07:36 PM
Ed, I'm sure you make a very good living now and love what you do. I know what I'm going to "wish" form you already do, in a way (and for free, God bless you).

But it would be lovely if you (or someone like you - as if there WERE another) were available as a trained lay person, to evaluate and guide patients through the labyrinth of decision making as we approach this surgery.

Patient advocacy services are supposed to offer such care (for pay), but I don't see how they could train to know as much as you do, in advising people about this very specialized field.

There are many professionals I've met who got into their advising services after becoming "inadvertent experts" . They educated themselves to handle their own or family members' needs in a given field. One example are a few really good college financial aid planning and guidance services. By the second or third child, they WERE experts! They wanted to share this hard won knowledge base.

There's a crying need for this kind of guidance but what patient advocate could learn as much as you did? They work with ALL areas of medical care.

Oh well, we're very lucky to have as much as you and Linda as you're willing to give us - not even counting the free inspiration you provide (which may be the most important of all).

What service could offer "inspiration guaranteed"? ;)

Pooka1
07-19-2010, 09:43 PM
But it would be lovely if you (or someone like you - as if there WERE another) were available as a trained lay person, to evaluate and guide patients through the labyrinth of decision making as we approach this surgery.

Yes exactly. And we could have a nick name or a code name for him... I suggest "Counselor Snookems." We would use that term when we want advice on scoliosis or advice on how to maintain a huge image file that is instantly searchable for just the right picture to make any given point or advice on how to fail at moving multiple women out of your house or etc....

As ideas go it can't fail!