RIAO Orthopedic Surgeon Leads Mission Trip to India

More than 47 people from the city of Ludhiana in northern India received life-changing joint replacement surgery thanks to a team of 45 dedicated volunteers from Operation Walk Maryland. The hip and knee replacement surgeries were performed at no cost for people who were suffering from disabling arthritis. The recipients would never have had access to this type of care if not for the team of dedicated volunteers.

Operation Walk Maryland was founded by Harpall Khanuja, M.D., Director of Hip and Knee Replacement Surgery at the Rubin Institute for Advanced Orthopedics at Sinai Hospital and his wife Maria, an orthopedic nurse. Dr. Khanuja serves as medical director and Maria coordinates the never ending list of logistical details for the organization. Cargo and supplies are managed by Dotsie Czajkowski, a nurse practioner at the RIAO. This is the group’s third medical mission trip and it included volunteers from Sinai Hospital and eight other Baltimore-area medical institutions.

The group from Operation Walk Maryland obviously touched many lives during their time in India, but Dr. Khanuja expressed how the patients they treat also have a profound effect on the lives of the surgeons, doctors, nurses and volunteers that donate their time and expertise.

“There’s no doubt we get a lot of satisfaction from taking care of these patients,” said Dr. Khanuja, “It is quite humbling to have these very, very poor people thanking God for you, for not giving up on them and for treating them and changing their lives.”

“But I also value these trips as a way to introduce new people to this sort of medical mission work and seeing it grow,” he added. “I recently spoke to one of the physicians who went with us to India. He told me that this was the most rewarding thing he’s ever done in his medical career and how he’d like to be more involved in the future. That’s perhaps the most satisfying part for me.”

While there are other Operation Walk organizations throughout the country, each one is independent and self-funded through donations. Each team talks all the supplies and personnel to perform state of the art joint replacement surgery for free for poor people throughout the world. To learn more about Operation Walk Maryland, including photo galleries from their mission trips, click here.

National PA Week: Allison Lynn and Renee Hunter, RIAO

It's National Physician Assistant Week, and we're celebrating our dedicated physician assistants at LifeBridge Health by having them share their stories .


Working at the Rubin Institute for Advanced Orthopedics
by Allison Lynn and Renee Hunter, RIAO

Allison Lynn, PA-C, International Center for Limb Lengthening: I've been a PA since 2002, and worked at the Rubin Institute for Advanced Orthopedics since 2007. There are many aspects of my job at the RIAO that I enjoy. I have the chance to work with so many different people from all over the United States and overseas. We monitor our kids throughout their childhood and have a chance to be a part of their lives and watch them grow up. Because of the unique aspect of deformity correction, the entire family is involved in the process.

Treatment frequently requires a family to move to Baltimore for weeks to months. Patients and their families are away from their own support network of family and friends going through a difficult and painful process. Therefore, we have a rare opportunity to be a part of our patients’ lives not found in other fields of medicine. This week we had a teenager whom after 25-plus surgeries came for one of his final post-operation visits. He now has two feet on the floor with equal limb lengths, walking on his own without assistance, and without a limp. He is off to college this year and wants to be a PA. That's what makes the job rewarding.

Renee Hunter, PA-C, International Center for Limb Lengthening: I've been a PA since 2006, which is when I began working at the RIAO. As my first job out of college, I didn’t really know what to expect. I have seen a lot of conditions and deformities of the bone that, without working here, I would have never heard of, let alone, see. Seeing how well our patients, both pediatric and adult, adapt and deal with these conditions has been an eye-opening experience. I love the fact that I get to work with patients from here and abroad – it makes each day unique and there is never a dull moment. Overall, this job has provided me with a great working environment, staff, a wonderful set of patients and a continuing learning experience.

Are you interested in working with Renee or Allison? Check out our open positions at LifeJobs.

Alternatives to Knee Surgery

No one is eager to have knee surgery. Luckily, there are options that can relieve pain.

Recently three orthopedic doctors from the Rubin Institute for Advanced Orthopedics (RIAO) gave a free lecture at LifeBridge Health & Fitness on the management of hip and knee osteoarthritis. Drs. Michael A. Mont, Ronald E. Delanois, and Harpal (Paul) S. Khanuja all informed their listeners about safe options to surgery. Thanks to the interactive nature of the lecture, the audience was able to address any concerns they had about their own hip and knee pains.

Dr. Mont began the lecture with an informal question and answer period. He started off by asking the audience “how would you treat joint pain?” The crowd reacted by shouting answers like “Aleve!” “Tylenol!”

“How many people think narcotics are appropriate for pain?” Few people raised their hands. “Many doctors are anti-narcotic” continued Dr. Mont, “but I have patients that think that narcotics are their best option. They take their prescribed dosages and it works great, but when the patient starts to increase their dosage, they may begin to get addicted.”

Tylenol and Aspirin can work just as well as any other medication, says Dr. Mont, but it is important that if you are taking those medications frequently, you get checked regularly because of the possible side effects on the kidney and liver. It is also important to note that when your pain level decreases, you should get off the meds!

Another alternative to surgery is a shot of cortisone. Dr. Mont says that he has given around 100,000 shots, and he notes few disadvantages.

He also recommends mild exercise, with concentration on exercises such as cycling, swimming, or using an elliptical machine. Patients should stay away from anything like a step machine or treadmill. He explained that “a typical step is 2-3 times body weight, and running puts 7-10 times body weight on your knees, which could create major pain for someone who has knee or hip osteoarthritis.”

Suggestions also included exercises to strengthen frontal muscles, hamstrings and side muscles . The RIAO also offers a detailed exercise sheet. Dr. Mont advises that 20 minutes of exercise every-other-day produces excellent results.

When people are in pain, surgery should not be their immediate thought. The physicians at the RIAO offer a variety of different treatments for pain including non-surgical methods. Over time, if the non-surgical methods don’t work, the physician will discuss the possibility of knee surgery.

To learn more or to schedule an appointment, call 410-601-WELL (9355).
-Jessica Oring

Meet Our Save-A-Limb Riders!

Editor's Note: We've asked two former LifeBridge Health orthopedic patients to do the Save-A-Limb bike ride in October. As they train, they'll be sharing their experiences here on the LifeBridge Health blog. Today, meet rider Randy Reisfeld!

A 30- or 60-mile bike ride ... What, am I crazy? Well, as a divorced mom with three teenagers, I know crazy is in my vocabulary!

Hi. My name is Randy, and I am going to tell you a bit about myself, and why I want to train for the Save-A-Limb bike ride.

First, as an occupational therapist here at Sinai, I know the benefits of such a great cause as this. Though I spend most of my work time in the Jennifer Gandel Kachura Neonatal Intensive Care Unit, I know many of the therapists who work with pediatric and adult clients that have had orthopedic surgeries or therapy. Independence in daily living skills and optimizing functional skills are goals of occupational therapy. Even though I am working with tiny babies, I am helping them achieve the highest level of function possible so that they can continue to develop those skills needed for independence down the road. The Rubin Institute of Advanced Orthopedics provides a resource to clients that have disruption in their functional skills, and this event will raise money for those that are unable to access the care.

Secondly, on a more personal note, I have experienced the disruption in my own functional skills quite a few times over the past three years. In February 2008, I underwent a 3-level lumbar fusion here at Sinai. I spent six days in the hospital, and three months at home, recuperating.

One month after finally getting back to work full time, I had a crazy fall, and fractured my right arm, again requiring surgery, and rehabilitation. More recently, I have been dealing with daily migraine headaches.

All of these things impacted my ability to function, whether short or long-term. I turned 50 this year, and I want to be healthy, active and fit for my next 50 years. I know this can happen, and my goal is to complete the 30-mile bike ride to prove to myself, and to others that age is just a number.

I will be sharing my training experiences here, and maybe motivate others to attempt to do something that might seem out of your reach or comfort zone. It's all for a great cause!
-Randy Reisfeld

RIAO Doctor Treating Injured Haitians

A team from Sinai Hospital’s Rubin Institute for Advanced Orthopedics recently arrived in the Dominican Republic to treat Haitians injured in the earthquake. Team members include Shawn Standard, M.D., a pediatric orthopedic surgeon, Marie Gdalevitch, M.D., an orthopedic fellow and James Pepple, M.D., an anesthesiologist. This team is treating severely injured Haitians who have been transported out of field hospitals in Haiti to the more sophisticated CURE International Hospital in Santo Domingo, Dominican Republic.

The Sinai team has already operated on a 22-year-old woman who has pelvic and foot fractures and is battling infection in her amputated fingers.

“Bernadine is the lone survivor of a school that had 85 students,” said Standard. “After the building collapsed, she was able to crawl out through a window.” The team will also operate on a Haitian orphan who underwent a leg amputation and now has an infection.

Several doctors from the CURE International hospital have been in Port-au-Prince since the early days of the disaster, which has forced surgery to be delayed for Dominican children with dislocated hips and other complicated orthopedic problems.

“The ward is full of children who were scheduled to have surgery and are now waiting for treatment,” said Standard. The Sinai team is filling in for the CURE Dominican team by providing care to these children as well as the Haitians who are transported to Santo Domingo for treatment.

Several months from now, the region will still need orthopedic surgeons who can treat bone infections, broken bones that failed to heal, and broken bones that healed incorrectly. Dr. Standard plans to return in March to help Haitians with these orthopedic problems.
This mission trip is funded in part by the Save-A-Limb Fund, a program of Sinai Hospital. The Save-A-Limb Fund fights to save limbs from amputation and provide hip and knee replacements to patients in need both domestically and abroad.

For more information on the Save-A-Limb Fund, click here.

Senators Tour South Tower

State Senate Minority Whip Nancy Jacobs, who represents Cecil and Harford counties, and state Senate Deputy Majority Whip Catherine Pugh, who represents Baltimore, joined LifeBridge Health Vice President for Government Relations and Advocacy Martha Nathanson to see Sinai Hospital's new environmental features as part of its south tower expansion. The three are pictured at left.

Among the topics of discussion were Sinai's green roof and environmentally friendly components such as energy-saving glass.

The senators also toured parts of the campus, including the Rubin Institute for Advanced Orthopedics. Picturered at right are Jacobs and orthopedic surgeon Shawn Standard, M.D., discussing the innovative treatments offered at the RIAO.

Sign Up for the Save-A-Limb Ride

Registration is open for the 4th annual Save-A-Limb Ride and Festival, which will be Sunday, September 13, at Oregon Ridge Park.

This event benefits the Save-A-Limb Fund, a non-profit organization established with the goal of advancing patient care and support in the fight to preserve limbs and joints from amputation, both domestically and abroad, through the research and work of the physicians and staff of the Rubin Institute for Advanced Orthopedics (RIAO) at Sinai Hospital.

Options for riding include a 6-mile Family Ride, which starts at 10 a.m., a 30-mile ride, which starts at 9 a.m., or the Metric Century ride, which is 62.60 miles and starts at 8 a.m.

The event features professional cyclist Floyd Landis. The post-ride festivities include a picnic and carnival with live music, face painting, costume characters, demonstrations by the police K-9 Unit, carnival games, water balloons, egg races, a Dunk the Doctors tank and much more.

For more information, click here.

Rubin Institute for Advanced Orthopedics Physicians Train Orthopedic Surgeons

In early September, the Center for Joint Preservation and Replacement and the International Center for Limb Lengthening (ICLL) will host two educational events: the Third Annual Hip Joint Preservation and Resurfacing Arthroplasty Course and the 19th Annual Baltimore Limb Deformity Course.

Dr. Michael Mont of the Center for Joint Preservation and Replacement will be co-directing the Third Annual Hip Joint Preservation and Resurfacing Arthroplasty Course along with Dr. Thomas Schmalzried of Los Angeles, Calif. Drs. Mont and Schmalzried are two of the most respected joint replacement surgeons in the United States. In fact, Dr. Mont has performed more than 2,000 hip resurfacing procedures. This year’s course will feature a world-renowned faculty that will be discussing the latest research and treatment options.

The ICLL physicians conduct the Baltimore Limb Deformity Course, which provides a forum for physicians from all over the world to be able to share knowledge, innovative techniques and new treatment options. Drs. John Herzenberg, Janet Conway, Shawn Standard and Bradley Lamm will be conducting hands-on labs and lectures on topics such as external fixation for the foot and ankle, deformity correction techniques, osteomyelitis and segmental bone defects. Last year’s course attracted more than 235 attendees from almost 40 countries and 25 states.

More information about each course is available online at www.hipresurfacingcourse.com and www.deformitycourse.com.

Ballerina's career saved by pioneering surgery at Sinai Hospital of Baltimore

Inspired by an older sister who danced, 32-year-old ballerina Kara Bruzina began her training when she was 8. Over the years, she learned to manage the pain from twisted ankles, shin splints and other minor, nagging injuries. But two years ago, Bruzina began experiencing severe hip pain while performing with Ballet Memphis. After a season ending performance, she could barely walk off the stage.

When a Nashville doctor diagnosed a torn labrum in her left hip, Bruzina realized her career was in jeopardy. She turned to the Internet for help and found Barry Waldman, M.D., of Sinai Hospital in Baltimore, a leading expert in the field. Dr. Waldman recommended Bruzina undergo a pioneering form of hip arthroplasty surgery.

Once considered an option of last resort reserved for seniors living with severe arthritis, young people are increasingly turning to joint replacement surgery to end their chronic pain and regain lost mobility.

Click here to read more about joint replacement surgery and Bruzina's story.

Dr. Barry Waldman featured in the Baltimore Sun today

The Baltimore Sun this week featured a question-and-answer column on arthritis with Barry Waldman, M.D., co-director of the Center for Joint Preservation and Replacement at the Rubin Institute for Advanced Orthopedics at Sinai Hospital in Baltimore. The column also appeared in the Cape Cod Times.

Here's a transcript of the conversation:

Question: What is arthritis?

Answer: The word means inflammation of the joint. This inflammation causes the cartilage in the joint to wear out. As it wears out, it causes four problems: pain, redness, swelling and deformity.

Q: Are all those symptoms usually present?

A: No. They don't have to be. And there are all kinds of arthritis. The one we're most familiar with is osteoarthritis, the premature wearing out of the joints. There are other kinds caused by a number of diseases called inflammatory arthritis.

Q: Who is most susceptible to osteoarthritis?

A: Past trauma and family history can play a role. But the vast majority of people just get it, and we don't know why.

Q: How is it diagnosed?

A: Generally by X-ray.

Q: What are the most common symptoms?

A: Pain and swelling. The pain tends to be worse when sedentary. With activity, the joint hurts less.

Q: Why?

A: We don't know, but cartilage tends to be healthier when it's moving.

Q: When should someone seek treatment?

A: When the symptoms are interfering with things they want to do, whether it is walking or exercising.

Q: Does delaying treatment make the condition worse?

A: We encourage people to see a doctor because there are some kinds of arthritis that can be slowed with medication.

Q: Some people say weather makes their arthritis worse. Does research support that?

A: There have been a lot of studies done on arthritis and weather, and it seems that weather doesn't make a difference in arthritis pain.

Q: What are the treatment options for osteoarthritis?

A: The best early treatment is exercise. Getting the muscles stronger around the joint will help. The next thing we try is acetaminophen, otherwise known as Tylenol. Then we move on to anti-inflammatory medicines like Motrin or Aleve. If that doesn't work, there are medicines we can inject into the knee or shoulders. We can try anti-inflammatories like cortisone. We have one injectable medicine made of cartilage that can act as a cushioning agent.

Q: Do over-the-counter remedies such as glucosamine help?

A: There was recently a large study that National Institutes of Health did that found that glucosamine and chondroitin didn't help. The American Academy of Orthopedic Surgeons now recommends against taking it.

International Center for Limb Lengthening at Sinai Hospital of Baltimore

The International Center for Limb Lengthening (ICLL) is widely recognized as the most experienced center for limb lengthening and reconstruction in the world, committed to providing the most comprehensive and technologically advanced treatments available for children and adults with upper and lower limb length discrepancies, short stature, limb deformities, nonunions, bone defects, bone infections, joint contractures, and arthritis.

In addition, the ICLL has become a major referral center for the Ponseti method of clubfoot treatment and distraction treatment of Perthes disease, two new methods for the treatment of two common pediatric disorders. The ICLL also offers a state-of-the-art gait laboratory for motion and function analysis and other specialized studies. With an international reputation for excellence, the Center's physicians have treated patients from all 50 United States and more than 50 countries from six continents around the world.

The ICLL, part of the Rubin Institute for Advanced Orthopedics (RIAO), opened at Sinai Hospital of Baltimore in July 2001 in a brand new six-story facility designed by the Center's co-founders, Dror Paley, M.D., John E. Herzenberg, M.D., and Michael Mont, M.D. Paley and Herzenberg were the first team in the United States to dedicate their practices to limb lengthening and deformity reconstruction. Janet D. Conway, M.D., and Shawn C. Standard, M.D., and a podiatrist, Bradley M. Lamm, DPM, F.A.C.F.A.S., complete the team.

International Patients
Because many of our patients come from overseas, we offer special services. Each year, many patients from more than 40 countries come to the ICLL for special medical treatment. Our patients benefit from proven expertise, state-of-the-art research, and cutting edge treatments offered by the orthopedic specialists at the RIAO.

For more information about the International Center for Limb Lengthening, call 410-601-WELL (9355).

Sinai Hospital doctor treats clubfoot patients from around the world

Every year in the United States alone, it is estimated that 4,000 to 8,000 babies are born with idiopathic clubfoot, a foot deformity that effects otherwise healthy babies.

Clubfoot is one of the most common birth defects. The heel and toes turn inward to the extent that it looks like the feet are upside down, with the soles pointed upward. Frequently, the blood supply to this area is abnormal. During infancy clubfoot does not cause pain. However, a child who is not treated will grow up to have a severe functional disability. They will not be able to wear shoes and the foot will eventually become painful, prohibiting participation in most sports and even certain forms of employment.

For decades, the long-standing medical solution has been surgery. But there is a better way.

John Herzenberg, M.D., is head of pediatric orthopedics at Sinai Hospital of Baltimore where every Friday is Clubfoot Clinic and where almost every child is treated with a non-surgical technique called the Ponseti Method, named for the Spanish pediatric orthopedic surgeon, Ignacio Ponseti, M.D., who invented it.

One of Dr. Herzenberg's patients is Richard Jr., son of Richard and Amparo of the Dominican Republic. When their local doctor recommended surgery to correct their son's bilateral clubfoot, the couple hesitated, thinking there must be a less traumatic option available. They turned to the Internet where they discovered the Ponseti Method.

Not one orthopedist in the Dominican Republic practices or has heard of this method. Fortunately, Richard had family on the east coast and driving distance from Dr. Herzenberg's clinic. Family and relatives donated to the cause and in a few weeks, they were on a plane for their first consultation and Ponseti casting at Sinai Hospital.

Over the next weeks, Richard Jr.’s parents saw a dramatic difference in the position of their child’s feet. After a few weeks of casting, a tenotomy was performed and Richard was put in final casts for three more weeks. Once he was ready for shoes, the family was able to return to their home in the Dominican Republic.

Richard and Amparo feel fortunate to have discovered the Ponseti Method just in time to avoid surgery. Now, two years later, their son is walking and running just like any other child his age that was born with normal feet.

The family recently returned to Sinai Hospital for a two-year follow-up with Dr. Herzenberg. Richard Jr.’s feet are perfect. He has to wear his special shoes with the bar at night-time for another year, but there are no complaints. Richard Jr. is a very active toddler who loves to play and make his feet take him everywhere he wants to go.

Click here to watch a 10 minute video featuring Sinai clubfoot patients and their families. To learn more about Dr. Herzenberg and the Ponseti method for treating clubfoot, visit our Web site and order a free DVD.

Daily Record announces finalists for Health Care Hero Awards

Several LifeBridge Health employees and programs are finalists for the 2009 Daily Record Health Care Heroes Awards. The winners will be announced at an awards breakfast on Tuesday, March 17. The finalists are:

• Respiratory Therapist Lee Chiat, clinical educator for Northwest Hospital's Respiratory Therapy department, Health Care Professional category
• Youth Development Specialist Garrick Williams, Sinai Hospital, Health Care Professional category
• Project Light, Levindale, Community Outreach category
• Lynn Harris, R.N., Sinai, Nurse Hero category
• Donald Abrams, M.D., chief of Sinai's Department of Ophthalmology based at the Krieger Eye Institute, Physician Hero category
• Shawn Standard, M.D., Sinai's Rubin Institute for Advanced Orthopedics, Physician Hero category
• Susan Golden, Northwest, Volunteer category
• Harry Zemel, Sinai, Volunteer category
  

Congratulations to all! So who are your health care heroes? Has there been a doctor, nurse or health professional who has touched your life in a positive way?