19-Year-Old Para-Athlete + Rush Ortho Team = #3 Ranking in U.S.
Mary Kate Callahan is a 19-year-old wunderkind…a para-athlete who recently undertook her first marathon. Gregory Nicholson, M.D. and Midwest Orthopaedics at Rush (MOR) helped her get there. Callahan, who was sponsored by Rush for the Chicago Marathon, is the number three ranked para-triathlete in the country. Dr. Nicholson, a family friend of the Callahans, tells OTW, “Mary Kate is a terrific athlete and has done a good job of not getting injured. Her arms take a lot of abuse because when she competes in a marathon she uses them to power her wheelchair. Given that, it is especially important that we monitor her health status. She is strong in the upper extremity area, but that means she is susceptible to overuse issues. In her case we must monitor scapular strength and positioning so that she does not experience rotator cuff problems, elbow tendonitis, or soft tissue injuries.”
To those treating para-athletes, Dr. Nicholson says, “Encourage your patient to come to you early on if she or he is having pain or discomfort. Yes, all athletes push themselves, but if something is causing pain it is important to have an early evaluation because these athletes have a smaller margin for recovery. And if someone injures the shoulder we tell them to avoid lifting, swimming, and running (pushing a wheelchair).”
As for Mary Kate Callahan, she said in a recent post on the MOR website that she was pleased with her 2:38 performance in the Chicago Marathon. “I ran much faster than my coach and I anticipated.”
NASS and Gates Foundation: Spine Impairment #1 Global Disease Burden!
The leaders of the North American Spine Society (NASS) cited a recent Gates Foundation report as they announced the new North American Spine Foundation (NASF). Says Michael Reed, the executive director of the newly launched the foundation, “The #1 disease burden, worldwide, with respect to economic and social impact, is now low back pain (neck pain is #4). Combined, low back pain and neck pain outpace diabetes, cancer, cardiac, and mental health problems with respect to years lived with disability. Care fragmentation and this growing spine disability crisis have created an imperative for change; an imperative that will require widespread collaboration and unified action.”
The NASS leadership decided that something needed to be done. And so it was. Reed tells OTW, “The idea of NASS starting a nonprofit public charity has been under discussion for a decade. With issues in spine care piling up, we knew it was time to act. The incidence of spine-related symptoms has not changed in the last 50 years, but, amazingly, the degree of spine-related disability has increased and continues to do so. Why? Because spine issues are not solely a medical problem…they emanate from a combination of occupational, psychological, social and medical factors.”
We decided to ‘attack’ spine disability because it is a public health issue that encompasses patient engagement, the work environment, relationships between patients and employers, and psychosocial issues. The NASS membership was surveyed on this issue and the vast majority of respondents indicated that functional capability ought to be our primary emphasis in spine care. It was time for all stakeholders, medical and nonmedical, to hold hands and collaborate with the unified goal of reducing spine disability.
“There were a number of things we saw happening that needed to be addressed. Woven into the issues previously mentioned, the leadership of NASS was primarily concerned about fulfilling the mission to favorably impact patient outcomes. The 2010 Global Burden of Disease Study funded by the Gates Foundation found—much to the surprise of many—that neither cancer nor diabetes were the biggest problems as far as the global burden of disease…it was spine impairment.”
“Not only have payor restrictions, legislative changes, and care fragmentation issues been influencing our ability as providers to access needed resources and to remain autonomous in our decision-making processes, but they are affecting our ability to raise funds for much needed research. In the U.S. we spend $110 billion annually on spine disability claims. Then there is the cost to employers in absenteeism and productivity losses—those amount to $30 billion per year. The cost of direct care is $90 billion. All together that is $230 billion a year.
“Our goal is to raise awareness, create a multi-stakeholder coalition, redefine the targets, and create a national imperative on which to act. We are not referring to improved Oswestry scores; rather, we are after a reduction in spine-related disability as measured by return to work rates and meaningful functional engagement.”
“We will be teaming up with large employers and drilling down on their data in order to better understand spine disability and who it is affecting the most. The current disparate, disconnected and fragmented environment in spine care is getting us nowhere. We will work hard to pull different parties together and eliminate any adversarial obstacles in the way of impactful, cost effective care. We believe that, one day, the creation of NASF will be regarded as one of the more important events in the history of this specialty field of medicine; an event that galvanized and unified our spine provider, industry and public communities toward significant positive change.”
Harvard Medical School Prof Promotes Volunteering
As any orthopedic surgeon who has volunteered knows, it is better to give and teach than just to give. Jeffrey N. Katz, M.D., M.Sc. is Professor of Medicine and Orthopedic Surgery at Harvard Medical School. For several years, he has had the honor of traveling to the Dominican Republic to help and learn. Dr. Katz tells OTW, “Operation Walk Boston, led by Thomas Thornhill, M.D., started in 2007 and is unique in that from the start it has had a research component. We have an ongoing project in the Dominican Republic where we perform joint replacement on financially vulnerable Dominican patients with advanced hip or knee arthritis. We work at a respected hospital and we help our excellent Dominican surgical colleagues perfect and their nursing and physical therapy teams to perfect these procedures and care of these patients.”
“On the research side, the Harvard medical students who accompany us perform data collection using questionnaires that contain standard self-report measures of pain, function, quality of life and satisfaction with surgery.”
“Despite being severely disabled these patients do beautifully. This was surprising because many papers from developed countries show that patients who start with more disability tend not to catch up with those who start out in better shape. We’re not sure why these patients in the Dominican Republic fare better, but it may be that they are so incredibly motivated by the unique opportunity afforded by Op Walk Boston. In addition, we have noted that they work exceptionally hard at rehabilitation.”
“Regarding postop care, half of the patients come from Santo Domingo and half from elsewhere on the island. All patients are asked to stay in the city for two weeks so they can have follow-up visits and outpatient PT. They then return to their homes and engage in physical therapy exercises.”
“Religion plays a significant role in the life of Dominicans. We found that patients perceive arthritis as being God’s will; and, those who had the opportunity to do Operation Walk also perceive that as God’s will. Perhaps this is related to a particularly interesting phenomenon we observed: these patients use much less pain medication than our patients in the U.S. They are very stoic.”
“We want to contribute to the documentation showing that it is possible to obtain good outcomes in the Dominican Republic. With help from our Dominican colleagues, and more research on our part, this will be possible.”
