Dr. Seth S. Greenky Blog

 

Operation walk syracuse kicks off first annual mission

February 27, 2013

Seth Greenky, MD

As the date for departure inches closer, our excitement mounts. Months and months of preparation have come together and next week we will embark on the journey to the other side of the world. We enthusiastically look forward to working with the physicians at Nepal Medical College have havemore than 60 patients waiting to receive our services.

Our team of 36 volunteers comprised of surgeons, anesthesia providers, nurses, surgical technologists, physical therapists, and other team members are amazing. We can’t thank them enough for assisting us to make this mission trip a reality. We will be joined by 12 members from Operation Walk LA who will provide guidance to us in our inaugural missionexperience.

In Kathmandu, the country’s capital, many individuals cannot provide for their families due to the disabling physical limitations of degenerative arthritis. Others cannot walk around their homes because they lack basicmobility equipment such as canes and walkers.

Our supplies (approximately 40,000 pounds of cargo) were shipped at the end of September. We eagerly await confirmation of its arrival so that we can begin our travel next week with the confidence that all will be ready and waiting when we arrive. We are all eager to begin working to restore the quality of life for many new people in Kathmandu, as well as to providefollow up care for patients from previous missions.

The group leaves November 8th. Read daily updates and view photographs from the mission on the Operation Walk Blog at www.operationwalksyracusecom. Posts will occur dailybeginning on Tuesday, November 8th.

Operation Walk Syracuse Nepal Closes

February 27, 2013

Seth Greenky, MD

During the long return trip to Syracuse, Dr. Seth Greenky penned his thoughts about our just completed surgical mission at Nepal Medical College:

How do you describe a life changing experience to someone else and capture the spirit of the event- especially when one lacks the skills of writing. A group of ragtag "Syracusians" with a sense of adventure and a desire to tackle major hurdles, altruistic to the extreme, traveling literally to the other side of the world to help people. A dream that started with casual conversation and morphed into reality mostly by extremely hard work and some luck. Sometimes the stars just come together and magic occurs. I feel like we were the Olympic hockey team that tackled a task and succeeded beyond all of our expectations.

The group was not a team that regularly worked together. We were composed of individuals who come from different hospitals, different outpatient facilities, different cities, different religions, different motivations, different ages, different stages in life, and I could go on and on. All received nothing but the potential satisfaction of doing something special for someone else. No one got paid, no one got "comped" time off and therewas a minimal hierarchy at best.

This was our inaugural visit sort of a "try out" for the Operation walk team so to speak. We were being judged by the Operation walk LA division-the originators and supervisors of the 13 sites. Four rooms, the lead organizer, three PA’s, six surgeons (thank God because I was sick as a dog for the first two days), two anesthesiologists, two nurse anesthetists, circulating nurses, OR techs, floor nurses, Physical Therapists, an instrument tech, a representative from the company that donated all the prosthesis, a Mr. fix it/ engineer, a supply coordinator, our translatorand cultural guide, and I probably forgot someone.

Let me just sum up how we did- we kicked ass! Not one single complaint the entire time; despite heat, exhaustion, GI issues, communication issues and more. We had incredible mentoring from our LA counterparts, but we were seamless in our ability to run with guidance and soon mesh with them and ourselves. Compliments from our LA mentors, our Nepalese friends(physicians, nurses, housekeeping staff, etc) were over the top.

I think I can say without reservation one of the top experiences of my life and of all those of us who participated. There is no substitute for thefeeling you get from a selfless act of good.

I am beyond proud of our team, and feel that the hand of God was with all of us. The faces of the patients and their families is ingrained in all of our minds. There were no stars, there was essentially one unit that won theultimate victory. Hurrah for all of us.

We will be doing this again, and again, and again…

Seth Greenky

From Farland to Homeland:

As thoughts of Dr. Brett Greenky’s Nepalese patient Pramrod, the 25 year old hip replacement patient linger in our minds, merely two weeks later we repeated the program this weekend for our own local community thanks to the support of St. Joseph’s Hospital Health Center, Syracuse OrthopedicSpecialists, and Anesthesia of Onondaga.

Seven patients. Eight joint replacement procedures. A multitude of grateful patients and countless family members and friends. Nena, a fifty-three year old hair stylist, has been severely limited by increasing pain and decreased mobility. Not eligible for Medicaid, yet unable to afford insurance since the loss of her husband’s job, she had resigned herself to her circustances. The initiative this weekend changed everything for her and her husband. We appreciate the support of Central New York in Operation Walk USA-it would not have been possible without thegenerosity of all of you! Until next year

Back to Boston

Seth Greenky, MD

As you drive up to the New England Baptist Hospital in Boston the origins of the facility as a turn of the 18 th Century Tuberculosis Asylum is evident. The hospital is perched on a hill overlooking the then farmland of Brookline, now a bustling extension of the classic New England Metropolis. The architecture is classic New England brick and stone with waves of more modern extensions. One could easily mistake the campus for an internal quad of one of the Hospital’s affiliated nearby academic institutions of Harvard and Tufts Universities. A banner over the front entrance announces the institution’s recentdesignation of one of the nation’s best Orthopedic medicine providers.

Entering the building I immediately flashback to my interview for the prestigious Aufranc Fellowship in Joint Replacement Surgery in 1988. We all entered at 8am, myself and the other 39 applicants who competed for the 2 positions. We were the survivors of the initial screening process of a much larger candidate pool. The interview process consisted of a series of three interviews that mirrored the oral component of Orthopedic Surgery Board examination. We all rotated through three conference rooms each with eight Attending Surgeons. We were asked typical interview questions, but also grilled on treatment options for carefully selected case presentationsaccompanied by X rays.

Back in Syracuse some 5 days later I was both pleased and humbled by the call notifying me I had been selected for one of the two fellowship positions. Thus began my real education in both the art and the science of Joint Replacement. In medicine you never stop being a student. The process of education is life-long as the obligation to our profession and our patients requires continued learning. Even as the tradition has passed to Seth and me to be the teachers and professors, we continue to bestudents.

As such myself and the team (Betsey Caiello, Dave Grygiel, Lynn Leo, Kim Murray, Diane Waldon, and Tammi Walker) left the Baptist with a more complete understanding of the equipment available to bring our hospital tothe cutting edge with respect to efficiency in instrument processing.

More on Baptist recollections in future blogs.

Nuts and Bolts of Our Visit

Seventeen Operating Rooms, 40,000+ square feet of clinical and support space, state of the art/cutting edge technology, advanced telecommunications, and enhanced care delivery systems describe the surgical suite design that has been created as the result of more than two years of work by a multidisciplinary team comprised of nurses, physicians, and other clinical representatives. A daunting task to say the least, but as this design phase draws to a close, we continue to review and refine specific elements to ensure that no stone has been left unturned when it comes to meeting our goals of optimized safety, efficiency, and careprocesses.

The fixed and mobile equipment necessary to deliver patient care is both expansive and complicated. Amongst other challenges, selecting equipment that has a proven track record, will remain functional for years to come, and is not cost prohibitive is critical to a successful project and to meet the desired outcomes. Item by item we have researched, investigated, andvalidated each item that will be introduced into the new OR’s.

A particular challenge is the equipment that is necessary to render surgical instrumentation sterile. Instruments, drills, retractors, and other specialty surgical implements become grossly contaminated with blood, tissue, and bone during surgical procedures. Effective decontamination, cleaning, and sterilization equipment which minimizes the need for hand cleaning/preparation is necessary and is a critical step in the preventionof surgical infections.

A recent site visit to New England Baptist Medical Center, an orthopedic hospital in Boston, Massachusetts, provided us the opportunity to witness firsthand the advances in cleaning and sterilization processes and equipment. A tour through the central sterile/processing area introduced us to a high performing service with state of the art equipment. Our research had suggested to us that the equipment in use at The Baptist, as well as the processes and procedures that they have developed, are considered best practice. Although inconvenient and time-consuming, our team of seven that travelled to the hospital found that validation that we were seeking. Taking the time and exerting the effort for critical decisions such as this is well worth the inconvenience and hassle. We left confident that we had discovered the best equipment for our new surgical suite. This is a process that has been done, and will berepeated, over again until all equipment decisions have been finalized.

Reflections on my first day

Seth Greenky, MD

Amidst the clutter of half-opened shipping boxes and the chaos of three young boys ages one, three and five happily romping in the configuration of boxes, furniture and other odds and ends as if they were secret tunnels deep within an enemy fort, I took a moment to reflect on what had been and what was yet to be. Years and years of education, training and refinement of my clinical and diagnostic skills were now behind me, and I began to envision what the years ahead as an attending surgeon would bring. I had just completed a yearlong fellowship in adult reconstructive surgery (joint reconstruction surgery) at the Cleveland Clinic and returned to Syracuse where I attended medical school and completed a residency program at the Upstate Medical Center. Joining an established and diverse group of orthopedic surgeons here in Syracuse would afford me the opportunity to learn from experienced colleagues while launching my own practice as a joint replacement surgeon. I was grateful that I had a full week to make that mental and physical transition before I actually started with my newgroup.

My thoughts were interrupted by the persistent ringing of the telephone. I searched for the source of the ringing until I successfully unearthed the phone from beneath a mound of action figures, stuffed animals, and miniature cars buried in the corner of the room. As I shouted "hello", afraid that I hadn’t reached the phone in time, I heard the voice of one of my new partners at the other end of the phone. "Seth" he quickly replied to my greeting, "welcome to Syracuse. Can you do me a favor? I need you to cover the ER for me today. Something unexpected has come up. Don’t worry, I checked with the Emergency Room and nothing is going on." Withthat, the phone call ended.

A small wave of anxiety swirled inside me but I pushed it aside, recognizing that the likelihood of actually having to respond to anything was minimal. When the phone rang again less than five minutes later, the thought that it could be the St. Joseph’s Emergency Room couldn’t have been further from my mind. I heard the words multiple trauma, motorcycle accident, young guy, and open tibia fracture (the hallmark injury of high velocity trauma accidents). Open fractures are surgical emergencies that require immediate surgical intervention to prevent infection and vascular compromise. As a pit formed in the center of my stomach, I was out the door immediately and enroute to a hospital in which I hadn’t stepped footin more than four years.

The 12 minute drive to the hospital was surreal, seemingly lasting an eternity, while simultaneously flying by in what seemed to be mere seconds. For the first time ever, I am the surgeon. Alone, on my own, and completely the end of the line. The reality of the phrase "the buck stops here" slowly sunk in. It’s not that I hadn’t done a large number of these types of procedures; however, in my residency and fellowship I had been functioning under the comfort and reassurance that there always was someone else nearby to advise or assist me if needed. Not in this situation. I was headed to a new hospital in a new city to render emergency care to anindividual who would be counting on me to make him whole again.

After parking in what I later learned was a patient parking lot, I made my way into the building and was greeted by a guard who escorted me to the ED, undoubtedly wondering if I really was the doctor I presented myself to be. The fact that his eyebrow arched as he introduced me to the charge nurse in the Emergency Room as well as the unspoken exchange between them signaled
to me that they were more than slightly skeptical of my identity and myintent.

I next found myself looking into the eyes of a young male patient writhing in pain and surrounded by concerned and anxious parents. I would later learn that he was a college freshman and a baseball star on the verge of greatness, but for that moment he was a terrified kid in requiring my immediate aid. The intensity of his pain filled eyes begged me to reassure him that everything would be fine. We needed to get to the Operating Roomas soon as possible.

The next several hours passed in a blur of activity and uncertainty. We were in the Operating Room in a matter of minutes but the real challenge lay before me. What we have in the present day Operating Room is the quintessential definition of the word "team". The individuals assembled on the orthopedic team in the OR today work together in a committed way, displaying a clear sense of camaraderie, and a shared sense of accountability and responsibility for the outcome. The staff assembled for this case was comprised of competent individuals with a common goal to care for this man; however, we were unknown to each other, and the additional burden of this lack of familiarity further compounded the already tensesituation.

Not only was I in an unfamiliar environment with unfamiliar staff, I had the additional challenge of unfamiliar equipment and instrumentation. Although remarkably similar, the metal pieces and parts that I would use to reconstruct his shattered tibia were worryingly dissimilar as well because they vary greatly depending on the manufacturer. Not surprisingly, the instrumentation and items available at St. Joseph’s were different than any I had used before. This was yet one more star that fateful night thatseemed not to be aligned in a positive path.

After rifling through the sterile supply area, I assembled the items that would best help me reconstruct the contorted leg. The best approach to this scenario was to use external fixation to rebuild and immobilize the bones, affording the broken bone the best opportunity to heal without residual damage. The surgical application of an external fixation device is strikingly similar to the technology used by a child when constructing an erector set. The popular childhood toy consists of metal beams, nuts, bolts, screws and other such mechanical parts that can be used by innovative and imaginative children to construct endless objects such as robots, mechanized cars, buildings, and other limitless creations of the mind. Similarly, external fixation is a surgical technique used to immobilize bones by placing pins and screws into various locations along the fractured bone. They are then attached by bars, sprockets, clamps, and hinges to a main device or frame outside of the skin where it can be controlled and adjusted to attain proper anatomical alignment of the bone.During the course of the next several hours, I used this "operative" erector set to reconstruct the bone.

Never far from my mind was also the concern that he displayed signs of peroneal nerve injury. The peroneal nerve is a portion of the sciatic nerve located near the knee. It is responsible for controlling the muscles that move the foot and toes. Especially worrisome is that damage to this nerve can result in foot drop and other long term problems that could plague him throughout life despite an effectively healed fracture. Addressing this problem during the surgical procedure added anotherdimension of complexity.

The surgical procedure was successful. The patient steadily improved, was discharged, and gradually resumed the life of a college student. I returned to the process of integrating myself into the Syracuse Community and my new medical practice. He, his family, and I were all infused with an extreme sense of gratitude. They, for the successful outcome and his promised favorable recovery; me, for the fact that my first surgical case at my new hospital was challenging, but extraordinarily rewarding. All the time, never far from my mind during that fateful night, was the fact that my
performance and the outcome for this young man would be the first impression that I would make on the patient, his family, staff at the hospital, and the community in which I hoped to spend the next fortyyears.

Many long-lasting bonds were forged that night. My initiation into the St. Joseph’s family was a fait accompli and a positive experience. More than twenty years later I remain close to the patient and his family. In essence, we grew up together. I have continued to care for him as needed, as well as for his parents and other extended family members. I recently mentally returned to the events of that night when I received a call from this man. He required medical care for a non-orthopedic ailment and contacted me to ask my advice and opinion on this matter. How very remarkable that more than twenty years later, the connection between usremains strong.

This case left a lasting impression on me. The true test in life doesn’t occur when all is going well and the next moment can be predicted and therefore planned. The truest life test occurs when we are faced with unexpected challenges and are able to meet and rise above them, elevating us to achieve great things. Orthopedic surgical challenges are a part of what every surgeon experiences. The story lines differ and the characters differ, however, what we all have in common is that it is stories like thisthat weave the fabric of our lives.

Richard Zogby, M.D., 6/25/58 – 2/14/2013

March 21, 2013

By: Seth Greenky

There are some people who are truly special – I was fortunate enough to personally know one. Rick and I were more then acquaintances, but less then close friends. I have known him for over 30 years. We shared the same medical school; the same Orthopedic residency; we practiced in the samecity; and ultimately in the same practice.

Rick had many strengths and some are so obvious that they almost don’t merit talking about – his surgical prowess being one. There are other traits that truly made him exceptional. TS Eliot wrote, "I never saw a wild thing sorry for itself. A bird will fall frozen dead from a bough without ever having felt sorry for itself." Through out his illness that extended over 10 years he never complained. It wasn’t for lack of pain; it wasn’t lack of emotional turmoil; it wasn’t because of lack of frustration – itwas his inner strength, his grasp of the important aspects of everything.

He took time to "smell the roses" and share the smell with those aroundhim. He would greet his patients, his colleagues, office staff, hospitalstaff, even strangers with equal respect and warmth. He was a mentor in somany ways to so many people – surgical to residents, a visionary and leaderfor our group (Syracuse Orthopedic Specialists), and a courageous exampleto all of us. His family was the epicenter for him and the strength thatsustained him.

What begins as a ripple when a small pebble is dropped into a pond quickly grows into larger ripples that cascade outwardly until they reach the confines of the shoreline. Such was the impact that Rick Zogby had on the lives of everyone with whom he interacted. His actions impacted individuals far beyond those he physically touched through this ripple effect; the epitome of the Butterfly Effect. Every single thing he did mattered; to those who knew him personally, as well as to those whoexperienced a ripple of an action from him.

A beautiful and wonderful man is no longer with us in body, but in spirit he will live on in the hearts of all who knew him. I myself feel mostfortunate that I took the time to become his colleague and his friend.

How appropriate it is that the beam that supports the new St Josephs OR was signed in memory of Rick Zogby – a physical representation of a life ofstrength and accomplishment.

Road Trip to Boston

Back to Boston

Seth Greenky, MD

As you drive up to the New England Baptist Hospital in Boston the origins of the facility as a turn of the 18 th Century Tuberculosis Asylum is evident. The hospital is perched on a hill overlooking the then farmland of Brookline, now a bustling extension of the classic New England Metropolis. The architecture is classic New England brick and stone with waves of more modern extensions. One could easily mistake the campus for an internal quad of one of the Hospital’s affiliated nearby academic institutions of Harvard and Tufts Universities. A banner over the front entrance announces the institution’s recentdesignation of one of the nation’s best Orthopedic medicine providers.

Entering the building I immediately flashback to my interview for the prestigious Aufranc Fellowship in Joint Replacement Surgery in 1988. We all entered at 8am, myself and the other 39 applicants who competed for the 2 positions. We were the survivors of the initial screening process of a much larger candidate pool. The interview process consisted of a series of three interviews that mirrored the oral component of Orthopedic Surgery Board examination. We all rotated through three conference rooms each with eight Attending Surgeons. We were asked typical interview questions, but also grilled on treatment options for carefully selected case presentationsaccompanied by X rays.

Back in Syracuse some 5 days later I was both pleased and humbled by the call notifying me I had been selected for one of the two fellowship positions. Thus began my real education in both the art and the science of Joint Replacement. In medicine you never stop being a student. The process of education is life-long as the obligation to our profession and our patients requires continued learning. Even as the tradition has passed to Seth and me to be the teachers and professors, we continue to bestudents.

As such myself and the team (Betsey Caiello, Dave Grygiel, Lynn Leo, Kim Murray, Diane Waldon, and Tammi Walker) left the Baptist with a more complete understanding of the equipment available to bring our hospital tothe cutting edge with respect to efficiency in instrument processing.

More on Baptist recollections in future blogs.

Nuts and Bolts of Our Visit

Seventeen Operating Rooms, 40,000+ square feet of clinical and support space, state of the art/cutting edge technology, advanced telecommunications, and enhanced care delivery systems describe the surgical suite design that has been created as the result of more than two years of work by a multidisciplinary team comprised of nurses, physicians, and other clinical representatives. A daunting task to say the least, but as this design phase draws to a close, we continue to review and refine specific elements to ensure that no stone has been left unturned when it comes to meeting our goals of optimized safety, efficiency, and careprocesses.

The fixed and mobile equipment necessary to deliver patient care is both expansive and complicated. Amongst other challenges, selecting equipment that has a proven track record, will remain functional for years to come, and is not cost prohibitive is critical to a successful project and to meet the desired outcomes. Item by item we have researched, investigated, andvalidated each item that will be introduced into the new OR’s.

A particular challenge is the equipment that is necessary to render surgical instrumentation sterile. Instruments, drills, retractors, and other specialty surgical implements become grossly contaminated with blood, tissue, and bone during surgical procedures. Effective decontamination, cleaning, and sterilization equipment which minimizes the need for hand cleaning/preparation is necessary and is a critical step in the preventionof surgical infections.

A recent site visit to New England Baptist Medical Center, an orthopedic hospital in Boston, Massachusetts, provided us the opportunity to witness firsthand the advances in cleaning and sterilization processes and equipment. A tour through the central sterile/processing area introduced us to a high performing service with state of the art equipment. Our research had suggested to us that the equipment in use at The Baptist, as well as the processes and procedures that they have developed, are considered best practice. Although inconvenient and time-consuming, our team of seven that travelled to the hospital found that validation that we were seeking. Taking the time and exerting the effort for critical decisions such as this is well worth the inconvenience and hassle. We left confident that we had discovered the best equipment for our new surgical suite. This is a process that has been done, and will berepeated, over again until all equipment decisions have been finalized.