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The Pulse Twin Cities Pediatric Specialty Care Orthopaedic Volume 2 Issue 10 October 25th is a day filled with costumes, parades, and thrills – all In This Issue provided through the generosity of “Spirit Halloween” stores and our Spirit Halloween Stores Child Life Department! The Man Who Had No Crafts and activities will be featured in the clinic area with Child Life staff Will and members of the Spirit Halloween stores. New this year will be music provided by the Okee Dokee band! The annual staff costume contest will Hero of the Month be held in the clinic area and everyone will get to vote! Back by popular “Tanner” demand, pumpkin painting will be a featured activity through the Child What is Selective Life Department. Dorsal Rhizotomy? “Spirit Halloween” stores, the largest seasonal Halloween retailer in Outpatient Services the United States, through their corporate program “Spirit of Children” Rank in Top “5” raises money at the store level through customer donations. One 2,400 Pounds of hundred percent of the funds raised are donated to the Child Life Aluminum Pull Tops Departments within the participating hospitals. For the third year in a row, six of the local Spirit Halloween stores in the Twin Cities area are Dr. Mielke to Guatemala donating their proceeds to the Twin Cities Hospital. Go Commando 5K A special 10% off Spirit of Children shopping pass has been sent to Adventure all employees. If you didn’t get one, stop by the Administration office. Take-Home Traction Ireland is where it all started. Halloween in Ireland is still celebrated On the Road Again much like it is in the United States. In rural areas, bonfires are lit as they Tips from DIA were centuries ago, and all over the country, children get dressed up in costumes and spend the evening "trick-or-treating" in their Breakfast with Santa neighborhoods. After trick-or-treating, most people attend parties with Augustana College neighbors and friends. At the parties, many games are played, including Football Team "snap-apple," a game in which an apple on a string is tied to a Zuhrah Antique Car Club doorframe or tree and players attempt to bite the hanging apple. In addition to bobbing for apples, parents often arrange treasure hunts, with candy or pastries as the "treasure." What will Halloween is one of the world's oldest holidays, and today it is celebrated you be this by more people in more countries than ever before. There's a simple Halloween? explanation: it is good, clean, harmless fun for young and old alike! for Children®? If you find yourself without a will, or with a will that is out-of-date, contact a reputable estate I asked him straight out, “Jim, do you have a planning attorney and make an appointment will?” He replied without blinking, “No, and I today. If you want assistance in finding a don’t need one either.” qualified attorney or some helpful literature I swallowed. Here was a married man in his late about making a will, contact Don Engel in the 50s who was either grossly misinformed about Donor Relations office. the need for a will, or who simply didn’t care. Our formal legal name is Shriners Hospitals for Instead of backing off, I decided to press on. Children®, and you can add “Twin Cities” if you wish Perhaps I could persuade him to change his to designate your gift on our behalf. For more infor- mind. If so, I could do both him and his family a mation contact Don Engel at (612) 596-6201 or by favor. email at firstname.lastname@example.org. “You know,” I began, “you’re wrong about not needing a will.” He blinked. “That’s right,” I said. “If you die without a valid will or other appropriate documents, state laws will determine the disposition of your estate. And the state’s will for you may be a far cry from what you yourself might want.” “Since they must ‘go by the book,’ they will not be able to consider your real intentions. Nor will they provide anything for the charities you have supported so faithfully over the years. Probate costs will likely be greater and a stranger may be named to represent you. Your lack of direction concerning your desires will likely cause confusion and frustration among your relatives. Tanner is a bright 16-year old with a big smile In short, you could unintentionally leave behind a and an even bigger heart. He was born mess.” prematurely at 25 weeks, and has cerebral I told him about estate taxes and how they could palsy. It primarily affects his legs and as a diminish what passes through to his children result, he must walk with forearm crutches. after his wife’s death. “By making certain This doesn’t slow him down a bit! Tanner has provisions in your will,” I explained, “these taxes had two major surgeries since coming to the could be reduced or avoided altogether.” Twin Cities hospital - one on his back and the I sensed he was having second thoughts about other on his foot. Despite his surgeries Tanner his no-will mindset. I pressed on: “By the way, always has a huge smile and is always have you considered what would happen if you interested in what the other person is doing and wife should both die in a common disaster?” rather than himself. He looked down. He had never allowed for that Tanner is a voracious reader and he loves to possibility. He just assumed he would die first play games on the computer. He sings in the and his wife would then do some estate planning school choir and the church choir. with the help of the kids and an attorney. Tanner volunteers his time at a home for the I could see the wheels turning as he imagined aged. He loves spending time with the elderly the various scenarios of a common death. and helps out in any way he can. He is very Where would the estate go? How would the well-versed for a young man of 16 and can talk children and grandchildren benefit? What about about almost anything. He completely focuses the court-appointed administrator and the on the other person – one can only imagine the expenses of selling property and gathering way he makes those seniors feel. A gift indeed! records? What about all the misunderstandings Watching Tanner grow from a feisty 5-year old and family problems that could develop? And into the delightful young man he is today has what about those charitable organizations he been a joy. Tanner is an example of why many supported? What about Shriners Hospitals for of us work at Shriners Hospital. It’s not all about a paycheck but is all about the kids! We eight weeks prior to the hospital admission. The all have our stories, Tanner is one of mine. He’s admission takes place the day before surgery now officially our “Hero of the Month”. and includes an x-ray, lab work, anesthesiology assessment, tour of the special care unit and a Congratulations Tanner! meeting with the Child Life Specialist for As Hero of the Month, Tanner will receive a $500 gift card pre-operative teaching. from Wal-Mart, a tee-shirt and a certificate. The procedure begins when the neurosurgeon makes a narrow incision down the center of the lower back, and opens the vertebral bone making a “window” into the spinal canal. This allows the surgeon to identify and reach each of the 14 sensory nerves to be tested. They Spasticity (abnormal muscle tone) in children separate these nerves into smaller rootlets. with cerebral palsy is treated with physical therapy, bracing, certain medications and Each rootlet is then individually electrically sometimes orthopaedic surgery. A neurosurgical stimulated in order to test which rootlets are procedure called Selective Dorsal Rhizotomy was carrying the spasticity messages to and from developed to reduce spasticity. When spasticity is the legs. If the reaction produces an abnormal reduced, muscles can be strengthened and reaction, the rootlet is cut. If the nerve rootlet retained to demonstrate more normal movement reacts normally it is left intact. Approximately patterns. The amount and rate of progress 30-40 percent of the spinal nerve rootlets are varies with each child. It is important to realize cut. The surgery usually takes 3 to 4 hours. that Selective Dorsal Rhizotomy is only one step Following surgery, the child must remain flat in in the overall management of difficulties bed for three days to allow proper healing associated with cerebral palsy. Abnormal without stress to the surgical site. Positional movements, persistent reflexes, and balance changes take place every two hours with problems cannot be completely corrected. How- emphasis on limiting spinal motion. ever, they can be less of a problem after surgery The therapeutic rehabilitation program includes and a program of intense physical therapy. intensive physical and occupational therapy. Candidates for rhizotomy surgery are chosen Inpatient rehabilitation is typically 4 weeks for very carefully. Not all children with spastic children working on ambulation, strengthening, cerebral palsy can benefit from a selective dorsal range of motion, sitting balance, and gait. rhizotomy. Correctly identifying candidates for The rehabilitation program is a very important selective dorsal rhizotomy requires a hospital part of the success of selective dorsal rhizotomy admission for careful evaluation before a child is surgery. An individualized therapy program is selected. designed for each child following surgery. Family members are encouraged to stay actively A team approach to determine candidates for involved in therapy and share the child’s rhizotomy surgery consists of a neurosurgeon, an enthusiasm as new skills are achieved. orthopaedic surgeon, two physical therapists, an occupational therapist, a social worker, and a Physical therapy begins with the application of nurse coordinator. After an examination by team knee immobilizers after surgery. This helps to members, parents have an opportunity to visit maintain the legs in a relaxed position. Gentle with them. After careful examination, a decision passive range of motion begins on post- will be made about the child’s suitability for operative day three, while the child is still in surgery. It is important to note that all rhizotomy bed. A prone cart is used for mobility until the team members must agree that the child is an child can sit in a wheelchair. Children receive appropriate candidate before surgery is physical therapy twice a day during the week recommended. and one time on the weekend. Activity is gradually resumed as strength is gained and The rhizotomy program at the Twin Cities more normal movement patterns are hospital began in 1991 and the first rhizotomy established. Walking begins on the parallel bars took place in June of that year. To date, more and progresses to walking with an assistive than 95 children have successfully undergone device. Therapy also focuses on strengthening selective dorsal rhizotomy surgery. and stretching the lower extremities. Children are usually scheduled for surgery six to Occupational therapy focuses on upper body strength and coordination and includes working on school skills and activities of daily living, such as getting dressed. Children typically In 2009 Shriners Hospitals for Children®-Twin receive occupational therapy once a day, five Cities’ outpatient services percentile ranking days a week. within the Shrine system was in the 50th An intensive home therapy program is required percentile range for all three key indicators: three to five days a week for 4 to 6 months. • Average for all questions Children return to the rhizotomy clinic at 3, 6, • Overall assessment of services received 12, and 24 months after surgery and are seen • Would the family recommend our hospital by the interdisciplinary team. Their progress is Percentile ranking is a way to see how well we are assessed and recommendations are made for doing compared to our peers. Our percentile rank each child. shows the percent of hospitals that scored lower A functional mobility video tape is completed at than our hospital’s scores. A percentile of 90 6, 12 and 24 months. At 18 months post- means that 90% (or 20) of the other Shrine hos- operatively, the child is additionally seen by the pitals scored lower than the Twin Cities hospital. primary orthopaedist. At 12 and 24 months Shriners Hospitals for Children® consistently after surgery, the child participates in a gait scores much higher than hospitals outside of our analysis. After the 24-month post operative system. To be within the upper percentile of follow-up visit, the child will be discharged from Shriners hospitals is to be the best of the best! the rhizotomy clinic and receive ongoing care by Outpatient ServicesPercentile Rank an orthopaedic physician. Press Ganey 90 It is important to realize that rhizotomy surgery 80 80 is only a partial solution to the difficulties 75 associated with cerebral palsy. Balance 70 impairment, loss of selective motor control, 60 59 54 abnormal reflexes and/or weakness are not 50 44 directly affected by rhizotomy surgery. 40 42 Therefore, how the child functions after surgery 30 depends on all of these factors plus the child’s physical therapy and how cooperative and 20 motivated the child is for therapy. 10 Rhizotomy surgery will not enable a child to 0 Rating Assessment Recommend walk unless he or she has demonstrated good 2009 2010 potential for walking before surgery. It will, however, enable the child to improve head control and upper extremity function. Some- times improved speech is achieved as well. See for yourself or just ask Womens General Selective dorsal rhizotomy does not eliminate Auxiliary Chair Darlene Kincaid who, along with the need for further orthopaedic surgery. A members of the NE Minneapolis Lions club, and combination of selective dorsal rhizotomy to staff from the Twin Cities Hospital, recently reduce spasticity and orthopaedic surgery to delivered over 2,400 pounds of aluminum can pull correct deformities of the muscle or bone tops to the recycling center. It generated over produces a better overall outcome than either $1,500, which the WGA will use for our kids! procedure done alone. Thus far, no long-term problems have been identified. Dr. Warwick Peacock, MD, who developed the present surgical technique, has followed a group of 50 patients since 1979. He reports no return of spasticity and no increased incidence or worsening of scoliosis (curvature of the spine) following surgery. In October while most of us are thinking about beautiful fall weather, pumpkins and Halloween, Dr. Mielke packs his bags with insect repellant, Recently, Mary Eichmiller, scrubs, and a passport, and thinks…in Spanish? Director of Inpatient Care, came up with a unique Dr. Mielke will once again accompany a group of approach for families whose about 40 volunteers sponsored by Hearts in children require halo Motion on a mission trip to Zacapa, Guatemala. traction 24/7 for 6-8 weeks. An annual trip whose genesis for Dr. Mielke began 11 years ago…a trip where his love of the Working with engineering country, mission and people grows each year staff, they recently designed during his week-long stays. While in country Dr. a method for attaching the Mielke works mainly with pediatric patients, but halo traction apparatus to a the group sees both adults and children. The tricycle, a walker and wheelchair so patients orthopedic team will evaluate patients the first wouldn’t have to stay in their beds all day. Now day and then operate the rest of the week. they wanted to design a “portable” halo traction Many children in Guatemala are born with club system that would allow kids to go home while feet and other deformities, and others develop still getting the required amount of traction. deformities from the lack of adequate treatment Starting with the portable system they had of injuries. Hearts in Motion works to previously developed for children in perthes complement resources already in place while traction, they made revisions which would work respecting the culture of those whose lives it for halo traction. touches. They accomplish this with Families assisted in helping to determine how to compassionate volunteers who unite their achieve the correct pull with the height of the bed efforts and talents. Others in the October group that the child would use at home. Each family see medical patients, do building projects, feed and each bed is a little different, but it has been children, and train firefighters in paramedic used on twin, double and king sized beds with skills. Dr. Mielke finds this trip both rewarding only minor issues that were easily resolved. Ms. and humbling. Dr. Mielke will provide us with a follow-up on his return Eichmiller then worked out an individualized calendar for increasing weights on a daily basis. The families each took the frame home, tried it out and appreciate the convenience it affords them. Ms. Eichmiller reported that we have since used it for a family who uses it on weekends so their child can be home for 3 days every week. Five people recently “Necessity is the mother of invention” represented the Twin Cities hospital at the 1st Annual Go Commando 5K Adventure sponsored by Team According to the driver’s lounge registry, the Ortho. following Shrine Centers made the most trips to the Twin Cities hospital during third quarter! Team members (L-R), Andy Hanse, Robert Safack, Nate Sullivan, Janell Royce, and Kendra • Zor Shrine Center 39 Trips Schultz completed a 5K run in addition to doing • Sesostris Shrine Center 24 Trips an obstacle course that included climbing bales • Tangier Shrine Center 23 Trips of hay, logs, and sliding down fast tubes of • El Kahir Shrine Center 16 Trips water that took runners into a pit of mud! After • Naja Shrine Center 16 trips the event, the team was able to hose off, enjoy Thanks to all Shrine Drivers for their dedication to a hot dog, and show off their dog-tag medal. Shriners Hospitals for Children®. Congratulations ‘Go Commando’ Team Energize Your 403(b) Retirement Savings Plan Raising your contributions by even a small amount can make a huge difference. Everyone Eighty football players from Augustana College knows that investing in a retirement savings plan in Sioux Falls, South Dakota visited the Twin is a good idea. Your contributions are pretax, Cities hospital on October 1. The players had your money is allowed to grow tax-free until you lunch at the hospital and listened to former withdraw it and your plan offers an employer Minnesota Vikings football great Joey Browner match. What’s more, the earnings your money talk about playing college ball at USC and then generates are automatically reinvested as you his career as a Minnesota Viking. receive them, which can have a powerful Following the Joey Browner presentation, the snowball effect on the size of your nest egg over players were put through a series of obstacle time. So save more! courses where they were not allowed to use Consider the options their dominant hand or foot. They discovered If you think you can’t afford to increase your quickly what it is like to be a child who must saving rate, consider this: A leading study adapt to using only one hand! estimates that retirees need from 77% to 94% Life Touch Media of Eden Prairie followed the of their pre-retirement income to maintain their team throughout the day, capturing the visit on standard of living in retirement. In 2009, the film, interviewing members of the Child Life average annual Social Security benefit was staff as well as a patient who happens to be a $13,968. How close is that to 77% of your football player himself! The visit will be salary? featured on an upcoming segment of “Life to You can go to www.divinvest.com or contact our the Max” on WCCO television. call center at 888-676-5512 to increase your contribution amount. Save the Date Sat, Dec. 11, 2010 “Breakfast with Santa” 9:00am—1:00 pm Main Lobby of the Hospital Reservations are Required Space is limited so call now Employees are invited to bring their children, grandchildren, nieces and nephews to visit Santa. In addition to the continental breakfast, two professional photographers have offered Again this year, the Zuhrah Antique Car Club their time to make this year’s event a success. stopped by the Twin Cities hospital for brats Photo sessions will be scheduled in half-hour and fun before taking part in the University of time increments between 9:00 am and 1:00 Minnesota Homecoming parade. pm. Walk-ins are discouraged. Pictures will be available on December 11 and an electronic version will be sent by e-mail during the week of December 13. Call 612.596.6112 to reserve your time with Santa!
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