>> THE POSTOPERATIVE COURSE AFTER SPINAL DEFORMITY SURGERY
FOR EARLY ONSET SCOLIOSIS, THOSE CHILDREN ARE USUALLY GETTING
A GROWING ROD PROCEDURE AND THEIR REHAB IS VERY SIMPLE.
THEY'RE UP WALKING THE DAY AFTER SURGERY.
THEY'RE OFTEN GOING HOME ON THE THIRD OR FOURTH POSTOPERATIVE DAY.
THEY'RE OFTEN BACK TO SCHOOL WITHIN A WEEK OR TWO.
AND THEN BACK TO GYM AND SPORTS, IF THEY WERE PARTICIPATING BEFORE,
WITHIN THREE TO SIX MONTHS.
>> THE ABILITY TO INSERT GROWING RODS HAS PROVIDED A LOT,
IN TERMS OF STABILITY AND PREVENTING DISEASE PROGRESSION,
TO THE POINT WHERE MANY OF THESE CHILDREN, IF TREATED EARLY
AND AGGRESSIVELY, DON'T END UP SEEING ME OR SEEING MY COLLEAGUES
IN PULMONOLOGY BECAUSE THEY'RE STABLE.
THEIR CHEST AND SPINE IS STABILIZED, AND THEY'RE ABLE TO GROW
IN A RELATIVELY NORMAL MANNER.
>> AFTER SURGERY THEY NOTICE THAT THEY'RE TALLER OR STRAIGHTER.
AND OFTEN THE RIB OR CHEST WALL ASYMMETRY,
THE SO-CALLED RIB HUMP, IMPROVES OR GETS MUCH BETTER,
IN SOME CASES GOES AWAY.
>> WITH THE VEPTR APPROACH-- AFTER THE INITIAL VEPTR IMPLANTATION
THEY'LL SPEND SEVERAL DAYS IN THE INTENSIVE CARE UNIT
AND THEN ABOUT FIVE TO SEVEN DAYS CONVALESCING ON THE FLOOR.
>> WE'RE EXPANDING THEIR CHEST WALLS.
THIS IS THEIR DRIVE TO BREATHE.
THIS IS THEIR INTERCOSTAL MUSCLES, THEIR LUNGS, THEIR DIAPHRAGM,
EVERYTHING IS BEING CHANGED.
>> IT DOES GIVE THEM A BIT MORE VOLUME.
YOU USUALLY HAVE STRAIGHTENED THE SPINE IN MANY OF THESE CHILDREN,
SO YOU'RE IMPROVING THE DYNAMICS OF RESPIRATION,
THE FUNCTION OF THE DIAPHRAGM.
>> AND BEFORE THIS IMPLANT, YOU FIGURE YOU'VE GOT A LUNG HERE,
AND THIS WAS HER.
THAT'S HOW HER LUNGS WERE, AND NOW THEY'RE LIKE THIS.
>> WHEN I WAS A BABY, I HAD A HARD TIME BREATHING.
WHEN I WAS GETTING OLDER, I HAD TO USE A INHALER.
NOW I'M BREATHING FINE.
I DON'T HAVE TO USE AN INHALER.
>> WHEN YOU'RE WATCHING YOUR CHILD SLEEPING AND YOU CAN SEE
THEY'RE HAVING A TOUGH TIME BREATHING AND ALL THAT--
AND JUST TO GET TO THIS POINT TODAY, WHERE SHE'S OUT COLD
AND ENJOYING HERSELF.
>> ONE OF THE ADVANTAGES OF USING RESPIRATORY THERAPY
IS THAT WE CAN HELP PATIENTS RE-RECRUIT AND BETTER UTILIZE
THE LUNG THAT THEY HAVE AVAILABLE.
>> A LOT OF THESE KIDS HAVE COMPLEX OTHER PROBLEMS.
>> MULTIPLE DEFORMITIES, SEVERE PROBLEMS.
>> AND THE NURSING STAFF DOES A GREAT JOB OF KNOWING
THE INTRICACIES OF WHAT THESE OTHER DIAGNOSES AND CONDITIONS ARE.
THAT'S ONE OF THE ADVANTAGES OF BEING AT A PLACE LIKE CHOP.
>> I THINK THAT THE ONLY WAY TO TRULY CARE FOR THESE PATIENTS
IS TO HAVE AN ORGANIZATION THAT HAS TOP RATE NICU OR PICU,
TOP RATE PULMONOLOGISTS, TOP-RATED DOCTORS,
TOP-RATED ORTHOPEDIC SURGEONS.
>> SO OUR TEAM, FROM NURSING TO ANESTHESIA TO THE REHAB PEOPLE,
BRACE PEOPLE, THEY'RE FAMILIAR -- THEY'RE COMFORTABLE
WITH THESE RARE CONDITIONS.
>> BETWEEN THE ANESTHESIOLOGIST AND THE PULMONARY
AND THE ORTHOPEDICS, THEY'RE ALL TOGETHER.
THEY DO THIS EVERY DAY.
>> I HAND OVER MY DAUGHTER TO THEM, AND I KNOW SHE'S IN GOOD HANDS.
>> IT MAY BE SCARY IN THE HOSPITAL, BUT PEOPLE ARE TAKING CARE OF YOU,
AND THEY'RE TRYING TO HELP YOU.
SO MOSTLY YOU DON'T HAVE TO BE SCARED OF REALLY ANYTHING.
>> IT'S VERY IMPORTANT TO MAINTAIN A CLOSE WORKING
RELATIONSHIP WITH THE REFERRING PHYSICIAN AND HAVE A BIDIRECTIONAL
FLOW OF INFORMATION.
>> WE CAN SEND E-MAIL COMMUNICATIONS BACK AND FORTH
WITH IMAGES.
I GET PULMONARY FUNCTION TESTS SENT BY E-MAIL AND THEN IT GETS
VERY EASY WITH A LITTLE BIT OF DATA TO PICK UP THE PHONE
AND TALK WITH THE REFERRING PHYSICIAN AND KEEP THEM TOGETHER
AS A PARTNER.
>> KEEPING THE PRIMARY CARE TEAM IN THE LOOP, UP TO DATE,
COMMUNICATING WELL WITH THEM IS NOT ONLY IMPORTANT FOR US,
BUT IT'S VERY IMPORTANT FOR THE PATIENT AND FAMILY.
WE PUT A LOT OF EMPHASIS AND EFFORT INTO THAT.
>> SO THIS IS ALL PART OF THE TREATMENT APPROACH.
NOT JUST TAKING CARE OF A CHILD, BUT TAKING CARE OF THE WHOLE FAMILY.