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The Pulse The Pulse Twin Cities Pediatric Specialty Care Orthopaedic Volume


									                                 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
“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
                                                       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

It is important to realize that rhizotomy surgery                                                          80
is only a partial solution to the difficulties                                                                               75

associated with cerebral palsy. Balance               70

impairment, loss of selective motor control,          60

abnormal reflexes and/or weakness are not             50
directly affected by rhizotomy surgery.               40

Therefore, how the child functions after surgery
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
                                  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 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
                              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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