Hand Surgery and Breast Cancer Patients - Dr. Josh Vella

Hand Surgery and Breast Cancer Patients - Dr. Josh Vella

One of the more troublesome issues surrounding breast cancer surgery and lymph node dissection is the development of lymphedema in the arm. Traditionally these patients have been warned against having blood pressures taken, IV’s placed and surgery performed on the same side as lymph node dissection. However, recent research suggests that surgery is safe in patients who have previously had mastectomy and lymph node dissection.

A 2007 article studied 25 women who previously had mastectomy and lymph node dissection. Four of these women had a history of lymphedema. All of these patients underwent hand surgery on the same side as their lymph node dissection. There was no increased risk of infection in this group. Only 2 had a temporary worsening of their lymphedema. Of the women who never experienced lymphedema in the past, none of them developed it after hand surgery.

Another study in 1995 studied 15 women who had lymph node dissection and hand surgery. Seven of these women had a history of lymphedema. All of these women had hand surgery and none of them developed any symptoms of lymphedema after surgery.
While there is a perception, mainly among breast care nurses and breast surgeons, that hand surgery should not be performed after lymph node dissection, literature supports that it is safe. These articles suggest that hand surgery after lymph node dissection does not increase risk of developing lymphedema after surgery. Hand surgery is safe for women who have had mastectomy and lymph node dissection.

My hands helping your hands.

Josh C. Vella, M.D.

Breast J. Hershko: Safety of Elective Hand Surgery following axillary Lymph node Dissection. 2007;13(3):287-90
Ann Surg Onc. Dawson:Elective Hand Surgery in Breast Cancer patient with prior ipsilateral axillary dissection. 1995; Mar;2(2): 132-7
Ann R Coll Surg Eng: Fulford: Hand Surgery after Axillary Lymph Node clearance. 2010; Oct:92(7):573-

RECOVERY. RESULTS. RELIEF.

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Dr. Burgess Speaks to Fellow Hand Surgeons!

Dr. Burgess Speaks to Fellow Hand Surgeons! 

Dr. Kraig Burgess, one of the hand and upper extremity specialists here at TOCA recently delivered a talk to area hand surgeons, physician assistants and orthopedic residents on an exciting new form of treatment for scaphoid nonunions. “A scaphoid nonunion is a difficult to treat broken bone in the wrist that fails to heal and has continued to challenge hand surgeons for decades,” said Dr. Burgess. Current treatment has been placement of bone graft and a central screw. “This new treatment involves placement of a highly specialized plate and the early results have been very encouraging,” said Dr. Burgess. Dr. Burgess is coordinating efforts with two other valley hand surgeons to investigate the biomechanical properties of the device and they also intend to publish there results upon completion of the data collection. “This is something that could revolutionize the care of these injuries and create a complete paradigm shift for the future,” commented Dr. Burgess. Dr. Burgess is one of three hand surgeons here at TOCA specializing in the surgical and nonsurgical treatment of disorders affecting the hand, wrist and elbow. Visit our webpage at www.tocamd.com to learn more about the hand surgeons at TOCA serving your community.

#RESULTS.RECOVERY.RELIEF.

TOCA
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Hand Therapy Week 2014: June 2-8, 2014

Hand Therapy Week 2014 Starts Today! June 2-8, 2014

Hand Therapy Week (previously known as Healthy Hands Week) is an integrated national program sponsored by ASHT (American Society of Hand Therapists). For one week, ASHT members sponsor and organize events in their communities, promoting the benefits of the hand therapy specialty and the services they provide.

Hand Therapy Week brings the benefits of the hand therapy specialty to new audiences – demonstrating the advantages of prevention and treatment procedures for patients who have been affected by an accident or trauma, and educating the public.

TOCA

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Meet Gretchen Bachman - Hand Therapy Manager at TOCA

Gretchen Bachman is the Hand Therapy Manager at TOCA.  Hand Therapists, through advanced study and experience, specialize in treating disorders of the entire upper extremity. All hand therapists at TOCA are Certified Hand Therapists, certified by the Hand Therapy Certification Commission.  Hand Therapists help bridge the gap between medical management with a physician and facilitate patients return to their daily work, leisure and life activities.

Gretchen graduated with her Bachelor’s Degree from Saginaw Valley State University in her home state of Michigan. She became a practicing occupational therapist in 1998, then in 2001 went on to earn her Master’s in Business Administration in Health Care Management. In 2007 she completed her Doctorate in Occupational Therapy in a Hand Therapy cohort. She has been working with TOCA since 2010.

Gretchen has peer reviewed publications in the Journal of Hand Therapy and wrote a chapter on fracture management and dislocations of the upper extremity in the book, Advanced Concepts of Hand Pathology and Surgery: Application to Hand Therapy Practice. She has presented nationally and internationally on the topics of fracture management, digital replantation, rheumatoid arthritis, custom splinting/orthosis fabrication, and various topics related to evidenced based practice.

Nationally, Gretchen has served on the Board of Directors for both the American Society of Hand Therapists (ASHT) and American Association for Hand Surgery (AAHS). She has been intimately involved on various committees, task forces, and special projects within these associations. Gretchen has also served on the Editorial Board for HAND, the official peer-reviewed journal for the AAHS.

Internationally, Gretchen has served on the Education Committee for the International Federation of Societies for Hand Therapy (IFSHT) since 2008. She has also served as the IFSHT Special Events Chair for the 2010 International Meeting when hosted in Orlando, FL.

Gretchen was granted an award through the IFSHT in 2009 and organized a multi-discipline educational conference related to disorders of the upper extremity in Lima, Peru. The Peruvian therapist who hosted this conference won a subsequent award and grant from the IFSHT to travel to the USA, contributing to further educational outreach brought back to her home therapy community in Lima.

Gretchen is passionate about a non-profit organization called the Guatemala Healing Hands Foundation. She has been supporting and traveling on medical mission trips with this organization since 2005.  The GHHF is a nonprofit organization dedicated to improving the quality and availability of health care in Guatemala through education, surgery, and therapy.

There is a Venn diagram of 3 primary areas of service:  Direct patient care, education, and community outreach. Direct service care primarily specializes in the treatment of congenital and pediatric hand injuries.

Direct patient Care:  Following a mandatory screening day, where upwards of 200 children are evaluated to determine their best treatment plan:  surgery, therapy, or other intervention.  Due to GHHF’s unique infrastructure GHHF is able to monitor children year after year to insure they receive the best possible consistent care. Depending on the severity and length of each case, surgical patients are provided with both in and outpatient care with costs covered 100% by GHHF.

Education: Each mission, a two day educational conference is organized annually, and integrates the Guatemalan provider community. GHHF has a unique relationship with the Guatemala Hand Associations, and they are a trusted teaching source and a vital American group providing cutting- edge hand education to both the surgical and therapy communities to over 2,200 doctors, therapists, and students to date.

Community Outreach: The heartbreaking reality and reasons why we meet so many children with serious hand conditions and injuries of the people in this nation cannot be ignored and disregarded. GHHF is committed to addressing the sources behind the problems seen. GHHF has teamed up with the village of Chichoy Alto, in the region of Patzun, Chimaltenango, to improve sanitation, health, education, and the overall quality of life for these 120 families. Community members of Chichoy Alto are required to collaborate and provide a portion of the labor necessary to implement these improvements. Within this community, GHHF has sponsored and constructed 55+ latrines, sponsored and constructed 21 efficient ONIL stoves, distributing crucial fertilizer needed to replenish Chichoy Alto’s barely existent crops, distributed emergency maize to families struggling with malnutrition, helped dig hillside trenches to lay piping to supply fresh water throughout the village, purchased school supplies to the 100+ elementary aged children, and have sponsored many children to attend high school and education beyond. 

In her free time, Gretchen enjoys traveling; camping, reading, and watching her son grow. She enjoys volunteering at his elementary school, and she and her family all recently started volunteering with the Special Olympics, another organization Gretchen has supported for a long time. 

TOCA

602-277-6211

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Dr. Burgess on the Bunker to Bunker show!

Dr. Burgess was a guest on the Bunker to Bunker radio program (AZ Sports 620 KTAR) on March 29th, 2014. We invite you to take a few minutes and listen to his interview by clicking the link below! 

http://tocamd.com/Burgess%20Interview.mp3?_subject_uid=142280683&w=AAC1WnBT5mt9Zc7JvrmRJd33u6KdVxFeaZ7SderlyDcnVQ


TOCA
602-277-6211
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ARTHRITIS AT BASE OF THUMB: Dr. JOSH VELLA

WHAT IS ARTHRITIS?

Any condition that irritates or destroys a joint is referred to as arthritis.  The most common form is osteoarthritis, or as it is sometimes known, degenerative joint disease.   In a normal joint, cartilage covers the ends of the bones and permits their smooth, painless movement against one another.  In osteoarthritis, the cartilage layer wears out, allowing bone to make contact against bone.  As the process worsens, the signs and symptoms of arthritis develop.

The basilar joint, or the first carpometacarpal joint of the thumb, is formed by a small wrist bone called the trapezium and the thumb metacarpal bone.   The unique shapes of these bones permit the thumb to move in and out of the plane of the palm, as well as bend across the palm to oppose the other fingers.  Arthritis involving the base of the thumb is far more common in women than in men, and typically occurs after the age of 40.  A prior history of fracture or other injury to the joint may increase the likelihood of developing arthritis.

WHAT ARE THE SIGNS AND SYMPTOMS?

The earliest symptom of basilar joint arthritis is pain with activities that involve pinching.  These include opening jars, doorknobs, car door and turning keys.  Prolonged or heavy use of the thumb may produce an aching discomfort at the base of the thumb.  Changes in the weather may produce similar symptoms.  As the disease progresses, less stress is required to produce pain.  Pinch strength diminishes.  Activity-related swelling may develop.  Later, any motion of the thumb, even without stress, may become painful.  Eventually the joint begins to appear larger and out of place.  This is usually accompanied by decreased thumb motion.  Often the most difficult maneuver is grasping objects.

HOW IS THE DIAGNOSIS MADE?

A careful history by the physician will give a high index of suspicion of basilar arthritis.  Inspection of the thumb will sometimes reveal a tender prominence at the base of the thumb.  As a diagnostic test your physician may press the thumb metacarpal against the trapezium and move the joint.  This grind test will usually reproduce the symptoms of pain, and may produce a gritty sensation called crepitation.  This represents bone on bone contact, which also may show up on x-ray.

HOW IS TREATED?

Initially, the symptoms of basilar joint arthritis will respond to limited activities and rest.  If this fails, use of an anti-inflammatory medications and a protective splint may be of benefit.  Additional relief of symptoms can sometimes be achieved by a cortisone injection into the joint.  When conservative methods of treatment no longer provide benefit, surgery may be warranted.

The goal of surgery is to decrease pain and preserve motion in the thumb. This is accomplished by removing the destroyed joint and creating a substitute joint called an arthroplasty.  Unrestricted use of the thumb is usually allowed at 12 weeks from surgery.

TOCA

TOCA Physician Gives Back: Flying Doctors of Mercy

Dr. Kraig Burgess and his Physician Assistant, Lisa Babel traveled to the state of Sinaloa Mexico with LIGA International this April to serve the communities of San Blas and El Fuerte on a medical mission’s trip.  Dr. Burgess and Lisa are members of LIGA International, “Flying Doctors of Mercy”, an organization providing medical and surgical care to the under-served communities of rural Mexico since 1934.  LIGA mission trips occur the first weekend of each month from October through June.  On average 15-20 pilots donate their time and 4-6 passenger planes to transport the Doctors and other health care providers with donated medical equipment to a remote single runway airfield in El Fuerte.

The April trip provided Dr. Burgess a unique opportunity to care for patients in his area of expertise, hand and upper extremity surgery.  The trip includes screening surgical candidates and treating nonsurgical patients in a clinic setting.  Once screened, the remaining time is spent performing the surgical reconstructions. “I was immediately overwhelmed by the need these people have for health care.  Many of the patient conditions have progressed to levels you would never see here in the States where treatment would have been performed much earlier,” said Dr. Burgess. 

This particular trip over 340 patients were treated, including surgeries performed in general, orthopedic hand, podiatry, ophthalmology, OB/GYN, and cardiology.  Dr. Burgess and Lisa were able to see dozens of clinic patients and treat conditions varying from pediatric congenital abnormalities, traumatic injuries, tumors, tendinitis, arthritis and nerve injuries.  These surgeries included a 19 month old boy with a condition called syndactyly, which presents with a webbed hand appearance.  They also cared for a young girl who had been badly burned and developed an infection, resulting in a partial amputation and scar contractures to her hand.  Another gentleman had been injured by a machete, resulting in multiple tendon lacerations and permanent nerve deficits.  Dr. Burgess recalls, “You have to get pretty creative and be willing to adapt to the supply limitations in order to get things done.  It’s pretty much self-service when it comes to finding equipment, prepping the rooms and setting up for surgery.  I could not have imagined accomplishing what we did without my PA, Lisa’s help.”

As they recall the trip, what stood out more than anything was how grateful the patients were and how accommodating the local people were to the volunteers.   “Patients traveled for hours, many by bus, to sit and wait for hours just for hope, hope that something could be done to help them.  It was heartbreaking to not have the equipment and time to help everyone,” Dr. Burgess said.  Through the generosity of companies Dr. Burgess works with; he has been able to obtain supplies which will allow him to care for some of these patients on his next trip.  Dr. Burgess and Lisa are planning their next trip for this fall.  To learn more about this incredible organization, “Flying Doctors of Mercy”  go to www.ligainternational.org.  

Lisa Babel, PA-C

Dr. Burgess

Dr. Burgess scrubbing up

Dr. Burgess & Lisa Babel, PA-C operating 

“Patients traveled for hours, many by bus, to sit and wait for hours just for hope, hope that something could be done to help them...,” - - Dr. Burgess

TOCA

612-277-6211

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