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-

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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.

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Dr. Burgess and Lisa Babel, PA-C, returned to El Fuerte in Sinaloa Mexico for another LIGA trip in early March

Dr. Burgess and Lisa Babel, PA-C, returned to El Fuerte and the clinic of San Blas in Sinaloa Mexico for another LIGA trip in early March.  Each trip back to Mexico has allowed this team to reconnect with staff and gain continued familiarity with their surroundings.  As always, the complexity and great need for care humbles and overwhelms those medical personnel who travel from different parts of the country to treat these patients.

This trip brought along some new volunteers from the Phoenix area.  An anesthesiologist and surgical nurse from the valley added to the San Blas team and were a great help to Dr. Burgess and Lisa.

Dr. Burgess was able to follow up with some of his previous surgical patients and was kept busy with surgeries his first evening in clinic and throughout the day on Saturday.  “It’s always a thrill to see previous patients and how they are progressing.  I was especially excited to see the patient I treated last fall who was highlighted in the MundoFox video segment.  He has been able to recover good finger and thumb movement despite not having access to a therapist,” said Dr Burgess.

Their first patient, Carmen, is a 53 year old female who had an explosive detonate in her hand in 2012.  As a result of this injury she lost her ring and small fingers while deforming the other remaining digits on her dominant right hand.  She is a florist and has to work in order to provide food for her family.  One of the local translators who assists with the clinic watched as she arranged flowers with her hand and was able to hear her story.  Carmen struggled with scar tissue in her hand making it difficult for her to reach or grasp objects.  Dr. Burgess was able to help her by surgically releasing the contractures giving her more space between her thumb and index finger improving pinch, grasp and grip. Carmen is recovering well and the translator was able to pass on she is pleased with her recovery and early outcome.

Carlos is a 3 year old male who suffered a high voltage cable accident in 2013 that left him with a contracted long finger in his right hand.  The initial treatment he received simply sewed the finger down onto itself rendering it useless and also preventing normal use of the rest of his hand.  As it turned out, do to his initial tendon, nerve and vessel injury, the only option was to remove the contracted segment of the digit.  He is now able to fully open and close the rest of his hand significantly improving his function. 

Edwin is a 7 year old male patient with Down’s syndrome.  He sustained burns to his hand after picking up a red hot coal from a fire when he was 3 years old.  As a result he had scars throughout his hands that prevented him from being able to flex or extend his fingers.  The fingers were stuck together creating a webbed hand which continued to progress as his hand tried to grow with his advancing age.  His surgical challenge was to separate the digits from one another and then lengthen scar in the palm in an effort to allow him to extend his fingers.  He has a very complex condition and Dr. Burgess expects to see and treat him in the future as his condition required progressively staged operations.

Roberto is a 44 year old male who suffered a severely broken wrist and severed tendons when he came upon thieves trying to steal his electrical tools.  He was beaten with a machete.  As a result, he has lost the use of his hand due to the severed tendons, he has developed contractures and scar to the hand and he has poorly aligned bone healing restricting joint movement.  The injury changed his life and has prevented him from doing his job.  Dr. Burgess operated on Roberto to release the scar tissue and to try and improve the tendon function of his wrist and hand.  His next procedure in the fall will be to release more of the joints in his hand and possibly transfer more tendons to increase strength.  Eventually he will require work on the bone to correct the joint destruction.  Dr. Burgess was deeply moved by Roberto.  “Roberto is a man of faith.  He harbors no resentment to those who harmed him and he has accepted his disability.  He was grateful I was willing to try anything to help him and said he accepted the outcome, good or bad, as God’s will,” said Dr. Burgess.  “You hear those words and it makes you want more than anything to make a positive difference in this man’s life,” reflected Dr. Burgess.

The total number of patients treated at the San Blas clinic in March for the weekend was 234.  These included specialties in general medicine, podiatry, plastic and general surgery, and hand surgery.  Dr. Burgess and Lisa are looking forward to returning again in the future.

You can learn more about LIGA on their website, at www.ligainternational.org.

#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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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


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Liga International, The Flying Doctors of Mercy (Dr. Burgess)

(click above to view the video)

In the Spirit of Thanksgiving; a big thank you to Dr. Burgess, PA-C Lisa Babel and all the volunteers who contribute their time and talents to Liga International, The Flying Doctors of Mercy.

Below is a link from MudoFox, the Spanish version of FOX News. This second part of the special series "I Want to be a Better Person.", is the story of Dr. Burgess Phoenix Arizona, who makes magic with his hands. He is one of the league volunteers flying doctors who volunteer on medical missions down to El Fuerte, Mexico

The LIGA is still in great need help getting supplies and those supplies into Mexico. There will be 12 segments airing every night for the next several days. This broadcast is out of LA and will be converted to English for the sister networks sometime in the future. Click the link to learn more about Liga International, The Flying Doctors of Mercy.

Serie especial: I Want To Be a Better Person [Parte II]
http://www.noticiasmundofox.com/node/6429


TOCA
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LIGA trip November 2013 (Dr. Burgess & PA-C Lisa Babel)

LIGA trip Nov 2013

This November Dr. Burgess and his Physician Assistant Lisa Babel returned to the state of Sinaloa Mexico to continue their work with LIGA International.  They, along with 107 volunteers from around the United States, were able to touch the lives of hundreds of patients in the cities of El Fuerte and San Blas. Traveling with them and helping to provide much needed equipment to treat the patients was a local orthopedic representative, Jarred Martincic.  This November clinic was a busy one, treating 640 patients including adults and children.  Several specialty areas were represented including podiatry, neurology, ophthalmology, ENT, dentistry and orthopedic hand surgery.

Traveling back to El Fuerte was something Dr. Burgess and Lisa had been looking forward to since their last visit back in April.  They were able to connect with some of the patients they had surgically treated and follow-up on their progress. Going back also meant familiarity; having their prior experience allowed them to dive back in and get right to work.  “Knowing what you have, but also knowing what you need makes a big difference in how affective you can be in the time you are there.  I was able to prioritize patients and provide surgery to all we could, but also plan for future trips where I hope to secure much needed orthopedic implants,” said Dr. Burgess. 

“Without question, the hardest part of the trip is the look of disappointment in the eyes of a patient when I have to tell them there is nothing I can do, or at least until I get the proper equipment.  These people come to you with hope.  Many of them are suffering from chronic conditions from injuries sustained years ago.  That painful look of disappointment is contrary to the look of joy and appreciation when they feel their hope turn to reality.  It’s contagious and it keeps me going back.  Even my wife is planning to help on the next trip.  There is no question, it can be an emotional experience with many ups and downs,” reflected Dr. Burgess. 

Unique to this trip was a news team capturing the story of LIGA.  Rolando Nichols, lead news anchor and reporter for MundoFox, the Spanish-language broadcast network and sister station to Fox News, along with his cameraman and pilot traveled from California down to El Fuerte.  They highlighted both El Fuerte and San Blas clinics, and hope to help spread the news about what the volunteers are accomplishing, along with the tremendous need for more help and equipment that still exists.  Dr. Burgess notes, “One of the more frustrating roadblocks to our success can be the very Government of the people we are trying to serve.  We have philanthropic companies and organizations here in the States willing to donate equipment but when it gets confiscated at the border or fined so heavily you have no choice but to turn back, it’s deflating.”  Dr. Burgess is hopeful the awareness MundoFox brings, may help pry some of these “closed political doors” open and allow LIGA to fulfill its mission.

Dr. Burgess says he is commonly asked how safe it is in this region of Mexico.  “I can say so far, I have felt completely safe.  You can’t be naïve and you have to take precautions.  The people of Mexico have opened their hearts with thanks and many local women will cook for hours on end to keep us fed while we work.  Admittedly, it was strange to see DEA agents in small squads loaded into the back of pick-up trucks carrying automatic weapons, all dressed in black and wearing ski masks to protect their identity from drug cartel soldiers.  It was another sobering reminder how lucky we are to live in the United States of America.”   

For more information on how you can become involved, please go to www.ligainternational.org
For more photos go to: www.facebook.com/TOCAMD

Meet Dr. Burgess!

Meet Dr. Kraig Burgess

 

 TOCA would like to introduce you to Dr. Kraig M. Burgess. Dr. Burgess has distinguished himself as an expert in the field of Orthopedic Hand and Upper Extremity Surgery. Dr. Burgess received his Bachelor’s degree from The Ohio State University. His medical school training was completed at the Ohio University College of Osteopathic Medicine in Athens, Ohio. 

Upon completion of his Internship and Residency in General Orthopedics, Dr. Burgess performed an additional year of Fellowship Training. This fellowship specific training in hand and upper extremity surgery included an enormous variety of reconstructive procedures and extensive trauma training at the Cleveland Clinic Foundation. U.S. News and World Report consistently rank The Cleveland Clinic as one of the nation’s best overall hospitals and the Orthopedic Surgery Department is among the top 5 year after year. Dr. Burgess has also successfully completed a Certificate of Added Qualification in Hand Surgery.



TOCA
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Meet Dr.Haber

Dr. Haber is an expert in the treatment of all hand and wrist conditions. He has Certificate of Added Qualification in Hand Surgery and is Board Certified in Plastic and Reconstructive Surgery. He serves as a hand surgery consultant for Arizona State University athletes, Phoenix Suns and Phoenix Mercury. Dr. Haber has special interest in golf related hand and wrist conditions. He has been an investigator for an international study for collagenase injection for Dupuytren’s Disease. He treats all severities of arthritis, nerve compressions and repetitive hand disorders. Dr. Haber has presented his research and has been published in leading medical journals. 

TOCA
602-277-6277
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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

Carpal Tunnel Syndrome

Carpal tunnel syndrome is a term that is well known. Unfortunately, given this widespread familiarity, people often attribute any discomfort or pain in the hand or wrist to carpal tunnel syndrome. Carpal tunnel syndrome is quite common, affecting 4-10 million Americans, and usually very treatable. However, there are many other conditions which can cause similar complaints. It is important to know the difference.

Fast Facts:

• The main symptom of carpal tunnel syndrome is numbness of the fingers.
• Carpal tunnel syndrome may interfere with hand strength and sensation, and cause a decrease in hand function.
• Carpal tunnel syndrome can be treated effectively with medications, splinting, steroid injections in the wrist and/or surgery.

What is Carpal Tunnel Syndrome?

Carpal tunnel syndrome is pain, tingling, and other problems in your hand because of pressure on the median nerve in your wrist.

The median nerve and several tendons run from your forearm to your hand through a small space in your wrist called the carpal tunnel. The median nerve controls movement and feeling in your thumb and first three fingers (not your little finger).

What causes Carpal Tunnel Syndrome?

Pressure on the median nerve causes carpal tunnel syndrome. This pressure can come from swelling or anything that makes the carpal tunnel smaller. Things that can lead to carpal tunnel syndrome include:
• Illnesses such as hypothyroidism, rheumatoid arthritis, and diabetes.
• Pregnancy.
• Obesity.
• Making the same hand movements over and over, especially if the wrist is bent down (your hands lower than your wrists), or making the same wrist movements over and over.
• Wrist injuries and bone spurs.
• Smoking, because it can reduce blood flow to the median nerve.

How is Carpal Tunnel Syndrome diagnosed?

The diagnosis of carpal tunnel syndrome often is made by the physician based on an accurate description of the symptoms. During physical examination, testing may identify weakness of the muscles supplied by the median nerve in the hand, including some thumb muscles affected by the syndrome. There may be decreased sensation in the hand to pin prick or light touch. Bending the wrist to 90 degrees for one minute may cause symptoms to appear in the hand (Phalen test) or tapping on the wrist with a reflex hammer may cause an electric shock-like sensation (Tinel Sign). Late in the disease, there may be thinning of the muscles or muscle atrophy at the base of the thumb.

Your doctor may suggest tests, such as:
• Blood tests to see if any health problems might be causing your symptoms.
• Nerve testing to find out if the median nerve is working as it should.



TOCA
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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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