Mission Moments: Responding to the disaster in Puerto Rico

Tucson Medical Center earlier this year adopted a new mission statement. To celebrate, we will share an ongoing series of “mission moments.”

What are mission moments? They aren’t necessarily dramatic stories of heroism, although our medical staff saves lives every day. These are moments that breathe life into words – moments that are profound or powerful or touching and that remind us why we do the work we do.

Hundreds of these reminders happen every day. Thank you for letting us share some with you.

Dr. Monica Guzman Zayas

Dr. Monica Guzman Zayas watched helplessly as news reports showed her childhood home in Puerto Rico being decimated by hurricane winds and rain.

Her parents still live in her small hometown of Villalba, in a remote central area high in the mountains. For 16 days, she couldn’t reach them to find out if they were in a refugee center or if they were OK.

When the anesthesiologist at Old Pueblo Anesthesia finally was able to connect with them, she was relieved that they were OK. But she heard terrible stories of people on dialysis or in need of oxygen tanks struggling for any kind of routine medical services given the damage across the island to road networks, communication channels and power services.

“It just all seemed so desperate and I could not believe what I was seeing. I knew I had to help somehow.”

Dr. Guzman decided to ask if TMC might be able to assist with medications. The Pharmacy rapidly identified drugs that could make an immediate impact in the disaster, including those needed to treat infections and provide relief from symptoms.

“I cannot tell you how happy I was,” she said. “I asked because I feel that TMC is very involved in the community to make a difference. They don’t just say it, they do it. Their goal is to help the community to make things better, and that was true when another part of this country was in great need,” she said.

Guzman partnered with an aid group comprised of other doctors from Puerto Rico who banded together to secure desperately needed medicine, equipment and supplies. Dr. Guzman drew strength from seeing the photo (above) of the medical staff on the ground in Puerto Rico opening the boxes.

“It feels great to be able to help, especially being originally from there and seeing the destruction and knowing that what you remember is not there,” Dr. Guzman said. “You feel you are so far away and not able to reach them, so to be able to make some difference, I just don’t have the words to describe it.”

Do you have a TMC mission moment you’d like to share? Send it to Communications@tmcaz.com.

Physicians and patients taking on the opioid crisis together

The practice of prescribing opioid drugs to patients following surgery has been the go-to standard in an environment where zero pain in recovery is the expectation. But with the fallout of opioid drug overuse painful to communities across the nation, both providers and patients are looking for alternatives.

Anesthesiologists from Old Pueblo Anesthesia, who practice at TMC, have been working to enhance their regional anesthesia program to provide additional options for patients.  If patients can keep opioid use to a minimum in those crucial first days after surgery, while reducing their pain and inflammation, the hope is that they can use fewer narcotics through their recovery period.

Opioids and Older Adults free seminar

Shoulder surgery, for example, is notoriously uncomfortable for some patients because the shoulder is engaged when a patient is standing or when laying down. Traditional anesthesia only lasts about 24 hours.

Now, in addition to direct injections to numb the area and block pain during surgery, physicians can place tiny catheters near the nerves that supply the shoulder with a local anesthetic to provide greater comfort for up to 3 days. The patient can care for the pump at home and throw it away when the anesthesia is depleted.

Dr. Robin Kloth said that Old Pueblo performed a comparison of patients with total shoulder replacement who used traditional pain relief and those who used interscalene catheter placement. “Over the course of the full 3 days, the catheter patients took less than half the narcotics that our compared group took in just a single day,” she said, adding patients also reported far less nausea.

Dr. Neesann Marietta concurred. “These techniques can really extend a patient’s pain relief, which greatly increases patient satisfaction. They can go home and sleep comfortably, which is so important for the healing process.”

And that’s just one example. For abdominal surgery, patients relied previously on epidurals that could only be used during their hospital stay. Now, anesthesiologists can do a block that provides local relief in the abdominal wall that will last up to 24 hours, and patients may be sent home the same day.

Colorectal and gyn-oncology surgeons are increasingly using a slow release local anesthetic that lasts up to 72 hours.

The colorectal program reports that between greater patient education, early ambulation and regional anesthesia, patients are seeing a decrease in patient length of stay by 1.3 days and an 88 percent decrease in morphine equivalent, given in the first 24 hours post-surgery.

“Both doctors and patients are becoming increasingly aware of the potential for the misuse of highly addictive pain medications and it’s important that we be part of this national discussion,” said surgical oncologist Michele Boyce Ley, who uses regional anesthesia as well as nonsteroidal medications such as Celebrex and gabapentin to help control pain for her patients having breast surgery.

Ley said her patients are doing so well, many are managing post-surgical pain with little more than Tylenol or ibuprofen.

“We have been working on this in earnest and getting training on these techniques because of concerns about opioid usage,” Kloth said. “Opioids have been the go-to solution for many years, in part because patients had high expectations of pain relief and because a bottle of Percocet is really cheap. These techniques are more labor intensive, but we’ve demonstrated value to the patient – and it’s the right thing to do,” she said.

Many patients also feel less lucid and less awake when using narcotics, which could delay physical therapy and rehabilitation.

Physicians have several opportunities to manage the use of narcotics, particularly important as patients leave the hospital with a plan for pain management during recovery.

Marietta said the techniques are not right for every patient and every case, but patients who are concerned about the potential for opioid misuse should have a conversation with their physician about pain control – and see if a nerve block would be appropriate.

Meet with Drs. Marietta, Kloth and Lambert Wednesday, November 15 as they discuss how anesthesiologists and patients can address this in practical terms at TMC for Seniors. More details available here.

Tucson Orthopaedic Institute surgeons team up with Operation Walk USA to change lives

Carlos Lopez Operation Walk USA patient

Carlos Lopez
Operation Walk USA patient

Recovering from major surgery isn’t something anyone looks forward to – unless you’re 49-year-old Carlos Lopez.  Lopez is home after spending the past few days in TMC’s new Orthopaedic and Surgical Tower.  For him, the recovery process means he’s finally received something he’s dreamed of for years – a new hip.

Lopez had been in excruciating pain since August 2009 when the father of four suffered an on-the-job injury.  He was a food service truck driver and was headed to Texas on Interstate 10 when a car slammed into his truck causing it to roll.  “I felt like I was in a tornado,” he said.  Lopez’s legs were pinned beneath the steering wheel, and he was trapped for about half an hour until emergency medical services arrived and cut him out of the wreckage.

Lopez's truck after the accident

Lopez’s truck after the accident

Lopez underwent therapy, but when he returned to work a month later, the pain continued.  He endured it for years until it finally forced him to quit in January 2012. “The pain was unbearable.  I would fall off the ramp at work and injure myself.  I was physically not able to do my job anymore.  Since my case had been closed, I was not eligible to receive any more help under worker’s comp,” Lopez said before his surgery.  “My legs are uneven because of the problem with my right hip, and my left leg being forced to compensate.  I live with constant, excruciating pain between my knee and hip.  I’ve developed a hernia from my injuries, as well as a back problem.”

Before his surgery, he walked with double canes for support.

Lopez is one of 10 patients from around Southern Arizona who received the joint replacement surgery they so desperately needed, but were unable to afford.  It’s all made possible thorugh a partnership between Tucson Medical Center and Operation Walk, a private, not-for-profit, volunteer medical services organization that provides free surgical treatment for patients who do not have access to life-improving care for debilidating bone and joint conditions.

The program was brought to TMC by orthopaedic surgeon Dr. Russell Cohen.  He was inspired by a trip he took to Vietnam as part of Operation Walk International.  “I was very moved by the gratitude people showed.  It’s a true honor to take care of those with no means to otherwise be helped.  I wanted to help those in need who live in our community,” said Dr. Cohen.

Four Tucson Orthopaedic Institute surgeons, including Drs. Cohen, Andrew Mahoney, John Wild, and Larry Housman, performed the surgeries on these patients in one day.  “It’s so gratifying to be able to help these people get back to doing what they love, without being in pain.  Some of these patients – through no fault o their own – had their lives turned upside down, and I am happy to be able to help them in this way.  It’s the right thing to do,” said Dr. Housman.

The patients meet medical guidelines, as well as financial poverty guidelines.

Carlos Lopez before surgery

Carlos Lopez
before surgery

“I feel so overwhelmed and blessed to be part of this program,” said Lopez.  “I truly consider it a miracle that I was selected.  I know the recovery process will be challenging, but I’m ready for it.  I will do whatever it takes to get back on my feet without my double canes.”

The program was the result of a well-coordinated effort by entire teams of people who made it possible.  The surgeons donated their time, as did anesthesiologists from Old Pueblo Anesthesia.  Hospitalists volunteered their time to care for these patients after their surgery.  Tucson Medical Center donated the space and necessary prescription medications.  Stryker Orthopaedics provided the joints, and Gentiva is providing free home health services to assist these patients during their recovery.

These patients receive top-notch care all the way through their recovery process – at no cost to them.

For patients like Lopez, this is just the beginning of a drastically improved quality of life.


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