Author Archives: James Hundley, MD

About James Hundley, MD

Dr. Hundley is a retired orthopaedic surgeon and the originator and co-founder of OrthopaedicLIST.com, a resource website for orthopaedic surgeons and related professionals.

Hensler Bone Press Launched in December 2012

May 1st, 2013 

by Sean Hensler, PA-C (Neurosurgery) and Thomas Melin, MD (Neurosurgeon)

Wilmington, NC, USA: The Hensler Bone Press launched in the United States and in select countries internationally on December 18, 2012. It is a Class 2, 510K exempt device, FDA-approved for use. European launch is expected in March of 2012 following CE certification. Contact information for a trial is available on OrthopaedicLIST.com.  Then do a Quick Search for Hensler Bone Press to go to that listing.

During the course of many operative procedures, bone is removed with the use of high speed drills. The bone removed with this technique is usually discarded. Unfortunately, this discarded bone is an excellent source of autologous bone graft for fusion procedures — if separated from blood and other tissues. The Hensler Bone Press (HBP) is a new, innovative device proven to maximize the collection and separation of this previously discarded material to yield high quality autologous bone graft. This device produces compressed, viable autologous bone which is immediately available for use. Many orthopedic, neurosurgical, maxillofacial and podiatry cases involve bone fusion where bone grafting is mandatory. Though many options for bone graft exist, autologous bone graft is universally accepted as the “gold standard”. All other options (synthetic and biologic) attempt to duplicate the characteristics of autologous bone but none has achieved all of these characteristics. This fact, coupled with the high cost of synthetic and biologic grafting options, renders them inferior to autologous bone graft. Though this device may not completely eliminate the need for synthetics or biologics, it will significantly diminish the use of these products. In summary, the HBP is an easy to learn, cost effective device proven to yield high quality autologous bone graft, which will decrease, if not eliminate, the need for synthetic and biologic options.

Founded in May 2011, Hensler Surgical Products, LLC is a Wilmington, NC-based medical device company dedicated to finding and developing innovative products that help to cut costs within health care. Friends and colleagues, Sean Hensler, a Neurosurgical Physician Assistant, and Dr. Thomas Melin, Neurosurgeon, formed Hensler Surgical Products, as a way to conceive, develop and introduce leading surgical innovations into the medical field. Hensler Surgical’s first product to market is the Hensler Bone Press, an innovative 2 stage device, designed to both collect and separate blood from valuable autologous bone generated by the high speed drill during surgical bone fusion grafting procedures while not interrupting the flow of the case.

Regaining Shoulder Range of Motion

July 11th, 2012 

 by James D. Hundley, MD

During my first year of residency, Dr. Charles Neer, a famous shoulder surgeon, was our visiting professor.  We learned a lot from Dr. Neer but the idea that stuck with me forever was his simple technique for regaining shoulder range of motion following surgery.

Dr. Frank Wilson, our training chief, was very influential with his description of the shoulder capsule as being analogous to the leaves of an accordion.  You had to tease them apart bit by bit.  Except in rare cases, he frowned on manipulation under anesthesia.

Keep in mind that this is about regaining functional use of the shoulder in average people after a fracture or other injury and surgery.  It is not about regaining strength other than in daily use of the limb and it’s certainly not about the definitive rehabilitation of athletes.

Naturally I must insert a disclaimer:  I am not your treating physician.  I am simply telling you what has worked for my patients for many years.  Your treating physician is the one you should listen to primarily.  Consider these ideas as supplementary or complimentary to what you’ve been told.

Here are some ideas to keep in mind:

  1. Neer
    1. Most use of the shoulder is to put the hands in front of the body so if you can reach up in front enough to get to a cabinet above eye level and reach down to your lap, you can do most of what you want to do.
    2. A simple way to accomplish this is to grasp your palms together and interlock your fingers.  Straighten the elbows.  Then use the normal arm to lift the hurt one.  It works better if you lie supine since once you get to 90 deg. of forward flexion, gravity will assist you rather than fight you.
  2. Wilson
    1. Steady, almost constant, gentle stretching is needed, is generally safe, and can be very effective.
    2. You need to move your shoulder often, not just once a day or so when a therapist is there to help you.
    3. Manipulation under anesthesia seems fast but carries the risk of muscle and tendon ruptures as well as fracture.  Furthermore, after a manipulation there is a tendency to quickly return to the pre-manipulation contractures
  1. Hundley
    1. Passive range of motion precedes active range of motion.  “Passive range of motion” means that something moves the affected limb other than the muscles of that limb.  In these techniques you are using your good arm to move your bad one.  “Active range of motion” may be contraindicated following some operations (rotator cuff repair for example) and fractures.  Listen to your surgeon about when you can start active motion.  Unless you regain passive range of motion, there is no chance of regaining active range of motion.
    2. Flexion to get the arm overhead also helps with external rotation.  Concentrate on flexion and don’t worry much about external rotation.  It will follow.
    3. It absolutely helps to lie supine to use gravity when using the Neer technique.  Otherwise, “gravity uses you”.
    4. If you will prop your arm away from your body (pillows or arm rest or arm over the back of a sofa when sitting, elbow on a table or desk), you can change your starting point from down by the side to a better place.  That gives you a head start and helps tease those sticky layers of capsule apart.
    5. Be innovative.  Figure out ways yourself to stretch your arm forward and upward.  Reach up to a tree limb, bar, door jamb, whatever it takes, and hold on to it for as long as possible.
    6. Internal rotation is another matter.  You have to make that happen.  The best way is to reach the bad arm as far behind your back as you can and grasp the wrist of the bad arm with the hand of your good arm.  Initially it will be just pulling to get it behind your body.  Ultimately you need to start lifting the hand up the back until you get it as high as the hand of the good one will go.
    7. Physical Therapists are very important in the rehabilitation process.  If you depend on them to do all of the work, however, you are missing many opportunities to help yourself do better.  They can treat you once every day or two.  You need to be moving your shoulder almost all of the time.
    8. Finally, here’s something to keep in mind about healing and my concept of “cumulative pain”.  The body is a remarkable organism and starts trying to heal things almost the instant it is injured.  That includes surgery.  Healing starts with bleeding followed by formation of scar tissue and so on.  If you wait until the pain of injury/surgery has subsided before you do any serious movement of a joint, I think that there is a 100% chance of it scarring down and never moving well.  Early motion is critical.  Cumulative Pain:  I’ve always told my patients that the pain of regaining motion in injured joints can be equated to the pain of walking barefooted across a bed of hot coals.  If you go slowly, I believe that you will hurt longer than if you push through the pain and go faster.  Thus, your ultimate pain burden will be less if you move on and get it over with.  That’s not to say that you can regain your motion in a day, but you probably do need to regain it in two or three weeks.  Once four to six weeks have passed, you have a big mountain to climb.

Summary

  1. You can and need to help yourself regain motion in your shoulder after injury or surgery.  Your therapist is important but cannot do it all for you.
  2. If you are doing your own pulling, you may cause pain but you are unlikely to harm yourself.
  3. Time is critical.  You cannot wait weeks and weeks to regain substantial range of motion.
  4. Forward flexion is the most important movement.  Do this by grasping the hands together and lifting the good arm with the bad.  This is easier when lying supine than when vertical.
  5. Prop your arm away from your body as often, as far, and for as long as you can.
  6. External rotation tends to improve along with forward flexion, so concentrate on forward flexion.
  7. Internal rotation needs special attention.  Regain that by pulling the wrist of the bad arm behind and then up the back with the good hand.
  8. Check with your physician/surgeon before doing these exercises and do not begin lifting the bad arm with its own muscles without your surgeon’s approval.

 Dr. Hundley is a retired orthopaedic surgeon and is the president of OrthopaedicLIST.com.

HINARI: Journals and Books to Physicians in the Poorest Countries

June 19th, 2012 

by Donna Flake, MSLS, MSAS, Director, SEAHEC Medical Sciences Library

The World Health Organization (WHO) has created a tremendously innovative and benevolent program to help physicians, researchers, clinicians, students and health administrators in resource-poor countries.

In a partnership with numerous Scientific, Medical and Technical publishers, WHO provides access to thousands of full-text medical journals and medical books to these constituencies worldwide.  This is done through an internet based program called HINARI (www.who.int/hinari).

The program began in 2002, when WHO contacted key publishers, and requested access to e-journals and other resources.  Today over 150 publishers make their electronic publications available through HINARI.  The program includes access to over 8,500 full text journals, and over 7,000 full text medical books.  This greatly changed the playing field for the health practitioners trying to keep abreast of the medical literature.

Here is how a user from a resource-poor country can obtain access to the HINARI collection of full-text books and journals:

A physician at a medical institution contacts the HINARI program at the World Health Organization and registers for a login and password.

Accesses full-text articles, books and other electronic resources from the HINARI website.

Searches PubMed from the United States National Library of Medicine using the HINARI access code.

Pulls up full text journals and books through PubMed.

Of course there are still some obstacles to using HINARI including irregular supply of electricity, lack of hardware and insufficient bandwidth.

WHO is reaching out to teach members how to access the HINARI collection.  There are many trainers all over the world.  I received HINARI training at a conference of the Medical Library Association in 2009.  The purpose of the training was to instruct individuals from industrialized countries so that they could train partners from low-income ones.  In June 2009, I traveled to Moldova in Eastern Europe, and trained 23 health professionals at the Medical University of Moldova, and 20 health practitioners from the Free International University of Moldova. The class participants were very grateful for the HINARI program, and my training.  My SEAHEC Medical Library in Wilmington, NC has an international partnership with the Medical University of Moldova.  Silvia Ciubrei, Deputy Director of this library, is now a HINARI super trainer for the World Health Organization and travels to Eastern Europe and Russia for the purpose of providing training to health practitioners.  She speaks Romanian, English, and Russian, so her language skills are highly valued.  Silvia is also an excellent teacher.

The WHO divides the countries of the world into 3 categories:

In low-income countries, health practitioners have free access to HINARI.  (One example is Haiti).  More than 5,000 institutions in these countries have HINARI access.

In emerging countries, each institution must pay $1,000.00 per calendar year.  One example of a country in this category is Ukraine.  More than 1,388 institutions in these countries have access.

Richer countries – no access to HINARI.

Orthopedic materials in HINARI include:

Acta Ortopedica Brasileira

Advances in Orthopedics

BMC Musculoskeletal Disorders

Case Reports in Orthopedics

Chiropractic & Osteopathy

Chiropractic and Osteopathy

Clinical Medicine:  Arthritis and Musculoskeletal Disorders

Indian Journal of Orthopaedics

Internet Journal of Orthopedic Surgery

Internet Journal of Rheumatology

ISRN Orthopedics

Journal of Indian Rheumatology Association

Journal of Orthopaedics

Open Access Rheumatology:  Research and Reviews

Open Rheumatology Journal

Revista Brasileira de Reumatologia

Revista Colombiana de Reumatologia

Revista Cubana de Ortopedia y Traumatologia

Romanian Journal of Rheumatology

For more information on HINARI – www.who.int/hinari

 

Mrs. Flake is the Director of the SEAHEC Medical Library in Wilmington, NC, USA.  She has received numerous awards for her accomplishments including being named a Distinguished Member of the Academy of Health Information Professionals.

Why Use A Medical Library

March 15th, 2012 

by Donna Flake, MSLS, MSAS, Director, SEAHEC Medical Science Library

Physicians can save time and obtain current, evidence-based medical information from their medical librarians.  Many physicians feel compelled to seek medical information on their own, even though they are always pushed for time.  Many physicians simply “google” the topic.  However, Google contains fewer than 30% of the medical literature much of which is out of date and incorrect.  Some physicians use PubMed from the National Library of Medicine.  PubMed is a great database but contains very few full text journal articles.

I encourage physicians to contact the medical library nearest to them, and check out what is available.  I am Library Director at a SEAHEC Medical Library in Wilmington, N. C.  Our library has integrated its digital library inside the Electronic Health Record (HER) of New Hanover Regional Medical Center in Wilmington, N. C.  Physicians can go into the EHR, click on my library’s digital library and use:  over 2000 full-text journals, 60 full-text books, the evidence-based product DynaMed, the Cochrane Database of Systematic Reviews, and much more.  My local orthopedists can use this method to access these journals FREE OF CHARGE:

  • Clinical Orthopedics and Related Research
  • Clinical Journal of Sport Medicine
  • Journal of Bone and Joint Surgery (both American and British)
  • Journal of Orthopaedic Trauma
  • Spine
  • and more

A few other U. S. medical libraries that also have integrated their digital libraries inside the EHR of the hospitals they serve include:

  • Vanderbilt University Medical Center in Nashville
  • University of Pittsburgh Medical Center
  • Oregon Health and Science University Hospital in Portland
  • University of Washington Medical Center in Seattle

If your local medical library has not integrated its digital library into its hospital’s EHR, there are other methods of accessing your library’s digital content.  Many hospital libraries and university medical libraries put their digital content on the hospital’s or university’s intranet, and physicians can access it this way.

Your medical library can save you time, money and effort.  A 2011 survey of U. S. health practitioners revealed

  • 75% of survey respondents said “I handled an aspect of a clinical situation differently as a result of having information provided by a librarian, or the library”.
  • 1 hour to 2 hours 30 minutes of time was saved by health professionals using the librarian or the medical library rather than seeking the information on their own.

I also conducted a medical library-user survey at my hospital.  Doctors and other health care providers responded.

  • 59% of survey respondents indicated that information from library services influences decisions in patient care.
  • 73% of survey respondents indicated that information from the library would have been difficult to obtain on their own.

In summary, I encourage you to contact your medical library to see how you can use its services!  A medical librarian could be your best friend!

Mrs. Flake is the Director of the SEAHEC Medical Library in Wilmington, NC, USA.  She has received numerous awards for her accomplishments including being named a Distinguished Member of the Academy of Health Information Professionals.

Why Every OR Needs a SpeedBump™ Knee Positioner

by Allison Ellis

What is a SpeedBump™, you ask?  Simply put, a SpeedBump™ is an automated, hands-free knee positioning device that can be used during almost any knee surgery. It can be placed on any standard operating room table and goes under the sterile drapes. It is invisible to the eye during the surgery but definitely does not go unnoticed. The SpeedBump™ allows the surgeon to effortlessly and quickly move the knee to any position needed with just the step of a foot pedal. It can allow the leg of the patient to fully flex and fully extend, unlike with a sandbag or similar product. The foot isn’t locked into place like on stationary positioning devices, which allows for even more freedom to manipulate the leg as needed. And for the patients that need even more stabilization with the device, there is a stationary hip pad that rests up against the hip and thigh of the patient for added support. There is no need for an assistant to hold the leg during the entire operation, which causes less fatigue and allows the assistant to be more productive with their time in the OR. All of this makes for a better overall operating room experience.

The SpeedBump™ is not only great for the surgeon, but is also cost effective for the hospital or surgical center. Since the device is underneath the sterile field during the entire operation, there is no need to autoclave it, which reduces turnover time between cases. Simply wiping the device and foot pedal with a sanitizing wipe is all that’’s really needed. Disposables for the foot pedal and rotating foot bump are also available which would reduce the turnover time even more. The

SpeedBump™ takes less than 60 seconds to attach to the table and remove from the table and takes less than 60 seconds to move from full flexion to full extension.

The device can be purchased or rented, depending on the needs and demand of the hospital. And there is a free trial period for every hospital or doctor that wants to try it out. Simply put, the SpeedBump™ will change the OR experience in a positive manner, for everyone who uses it. Let us help improve your OR time today.

You can see more about the SpeedBump™ by clicking here.

Using a Stationary Bicycle to Regain Knee Flexion

by James D. Hundley, MD

I have often recommended stationary bicycling as a conditioning exercise for people who had difficulty walking, had poor balance, etc.  It can be boring but watching a sporting event or exciting TV show makes it less so.

On the positive side, it’s convenient, effective, and safe.  You can do it in your own home whenever time permits, day or night, and you don’t have to worry about being run over by a careless driver.

When I had total knee replacement I was determined to practice what I’d been preaching.  The sooner you regain your range of motion, the better it will be and, on a cumulative basis, you’ll experience less pain.  My own surgery was complicated by a femoral DVT that required clot removal and aggressive anticoagulation, the latter resulting in my knee filling with blood making it harder to flex.  I had to get my knee going, so I started using my stationary bike.

At first I couldn’t make a complete revolution, even with the seat fully elevated.  I rocked the pedals back and forth to flex the knee as much as I could tolerate and held it at the forward and backward endpoints for a few seconds, back and forth, back and forth.  Ultimately I was able to make a full revolution, an exciting event for me.

Once I was able to make a complete revolution with the seat elevated, I would ride slowly for five minutes or so until I felt that the knee was “warmed up”.  Then I would lower the seat and push some more.  Over a week or so I was able to progressively lower the seat to its lowest position giving me as much flexion as the bicycle would allow.

This is not to say that I didn’t also have physical therapy and do other exercises, but I truly believe that the bicycle helped me regain my knee range of motion.  I now have 135 degrees of flexion and extension to neutral, and credit much of that to using the bike.

My wife recently had knee surgery and has been using a similar technique.  In her case, however, she is also using the Ortho Pedal, an “add-on” that effectively shortens the crank arm attached to the sprocket.  With this she has made some full revolutions and we’ll gradually adjust the Ortho Pedal to lengthen the crank arm to increase her knee flexion.

Click here to see the Ortho Pedal.  It was initially designed for those with fixed limitation of knee flexion that took them away from bicycling.  With the Ortho Pedal they could resume something that they loved.  I can see how it would work well for that but have also seen it useful in regaining knee range of motion in the acute postoperative stage.

Dr. Hundley is a retired orthopaedic surgeon and the president of OrthopaedicLIST.com.

Laying Crepe

by James D. Hundley, MD

In days of yore, undertaker assistants were tasked with hanging crepe (black cloth) over the windows of homes of the deceased and were called “crepe hangers”.  Similarly, they laid crepe over the casket of the deceased.  “Hanging crepe” and “laying crepe” have become euphemistic terms for extreme pessimism.

Surgeons are castigated for “laying crepe” with patients and their families before surgery when the formal operative consent is obtained.  Critics claim this creates unnecessary fear in patients so that when the operation is successful the surgeon appears a hero or without fault if it’s not.

I disagree.  It’s neither about heroes nor about lawsuits.  It’s about “informed consent”.  Patients deserve to know the bad as well as the good before they have an operation.  Otherwise, how can they make informed decisions?

A good friend of mine was recently discussing upcoming surgery on his infant grandson.  The child has a congenital heart condition and has already undergone an open-heart operation.  The heart surgeon has apparently told the family that the second procedure is serious and will be more difficult than the first.  I told my friend, ”The surgeon was ‘laying crepe’.”

The surgeon is an esteemed, pediatric, cardiac surgeon.  He knows what he is doing in the operating room, and he knows that the family has a right and a need to be fully informed before consenting for their son to have surgery.  This is a serious situation and they deserve to know the good, the limits of good, and the bad.  They also need to know if additional surgery will be required in the near or distant future.  Thanks to a thoughtful surgeon, they are informed.

Taking this a step further, I’ve sometimes had patients tell me after the informed consent discussion, “Go ahead and do it, Doc.  It can’t be worse than it is now.”  My consistent response to that was, “Yes, it can always be worse.  I’m not sure you were listening.”

Finally, there is no way anyone can be fully informed.  Complications can occur that have never been reported or happen so infrequently that the surgeon feels these unnecessary to discuss for fear of losing the patient’s attention with such a long litany of potential problems that even careful listeners become overwhelmed and stop listening.

Perhaps the most important part of this discussion is what the surgeon may have left unspoken.  No ethical surgeon, except in dire, emergency circumstances when there is no other way to save life or limb, will perform a procedure that he is not confident can be successful.  He cannot promise a good outcome or that unexpected complications may not occur.  He can only promise that he is confident that he can perform the procedure properly and that he will do his best.

So, when your surgeon “lays crepe”, I think you should consider these things:

  1. Your surgeon would not be performing the procedure if he did not expect a successful outcome.
  2. The fact that he is telling you about potential complications tells you that he knows these things, will take measures to avoid them, and wants you to be as informed as possible before the surgery.
  3. By telling you what a good outcome will likely be, he is helping you set rational expectations.
  4. By telling you if additional surgery will be required, he is doing his best to avoid unpleasant future surprises.

What else does it tell you?  It says that he is not trying to “sell” (or talk you into having) the surgery by downplaying potential complications.  He sincerely wants you to be as informed as possible before making your decision.  You always have the right to say, “No.”, even as they are wheeling you into the operating room.

Dr. Hundley is a retired orthopaedic surgeon and the founder and president of OrthopaedicLIST.com.

Patient Warming: The Inside Story

by Scott D. Augustine MD, Augustine Temperature Management

October 15, 2015

 Almost 30 years ago, I invented a forced-air warming system for surgical patients and introduced it to the medical world.  Now, I am proclaiming that forced-air warming, in certain circumstances, is a danger to patients.  Given the irony, I thought some people might be interested in the full story.

 I was a new anesthesia resident at the Naval Hospital in San Diego when I first encountered perioperative hypothermia. Nearly all patients were clinically hypothermic on admission to the recovery room in 1981, and no one thought twice about it.  Despite using all available patient warming equipment (i.e. water mattresses, airway heaters, and fluid warmers) hypothermia was ubiquitous and considered an accepted part of surgery.

I started asking postoperative patients and found that “freezing to death” was the most memorable aspect of surgery.  My interest was piqued.

What was clear from the literature is that under anesthesia, general or conduction anesthesia, we all become poikilothermic.  Just like the reptiles, we gain or lose heat depending on the environmental temperature.  The challenge was obvious: how to produce a warm environment around a patient without requiring the whole room to be warm, as was the common practice in pediatric surgery.

During my spare time as a resident, I started working on an inflatable air blanket that would wrap around the patient and circulate warm air. The first prototypes were very crude and made of plastic sheets that were heat-sealed together using a clothes iron. The first blower was a hairdryer. It took a lot of prototyping and refining, but by 1988 forced-air warming (FAW) was launched in recovery rooms across America.

It was a good product that solved a need.  The “need” morphed from simply providing thermal comfort to avoiding the many recently documented negative physiological effects of hypothermia.  Hundreds of published studies demonstrated that mild hypothermia had an adverse effect on nearly everything that we studied: increased soft tissue wound infections, increased bleeding, increased adverse cardiac events, increased mortality, and increased hospital stays among other things.

FAW changed surgical practice and measurably improved the outcomes of hundreds of millions of surgical patients over the past 25 years.

I left Augustine Medical (renamed Arizant) at the end of 2002. Arizant was subsequently sold to a private equity firm and later to 3M.  After sitting out my two-year non-compete, I formed a product development company with no intention of getting back into patient warming. We were working on reliably producing a bubble of HEPA-clean air over a pillow for allergy and asthma reduction when we stumbled on the FAW waste heat rising phenomena.

Forced-air systems produce 1000 watts of heat at 40 ft/m3. Convective heat transfer is not particularly efficient, so only about 50 watts of the heated air gets transferred to the patient. We learned that there is a significant unintended consequence of that waste heat. The remaining 950 watts of waste hot air vents near the floor, heats the contaminated air resident near the floor, and then rises alongside the table into the sterile surgical field carrying contaminants with it.

For 18 months we studied the rising waste heat from every angle.  Bottom line–the waste heat rises 100% of the time, which is not surprising since it is a basic principle of physics.

Even though I had been gone from the Company for six years, I was feeling terribly responsible for the unintended consequences of my invention.  Digging into the research, we found that while soft tissue infections require contamination of over 1 million bacteria, the biofilm that can form on implanted material allows a single airborne bacterium to cause a devastating periprosthetic joint infection.  Clearly implant patients, especially orthopedic implant patients, were the “at-risk” group.

The fact that a problem turned up with forced air warming after 20 years on the market is certainly not unheard of in the medical device or pharmaceutical industries.  For example, Cox-2 NSAIDs—after many years on the market–now carry a “black box” warning to not use if you have coronary artery disease.  They are still very good drugs, just don’t use them if you’ve got heart problems.  Similarly, I believe that forced-air warming should have a “black box” warning: “do not use in implant surgery, especially orthopedic implant surgery.”

I became a doctor to help patients, not hurt them. I have the same motivation as an inventor, so I invented a safe alternative to FAW:  air-free HotDog® patient warming. It’s the only warming system that can warm from above and below the patient simultaneously, which is far more effective than either above or below individually. HotDog® uses conductive fabric to deliver safe, even warmth—no blowing air or water—resulting is a uniquely versatile, more effective warming solution.

Over the next short while, six independent studies were published corroborating our research showing that the rising waste forced air heat contaminates the sterile surgical field with contaminants from the floor.  One study by Legg et al showed 2000 times more contaminating particles in the air above the surgical site with FAW than with HotDog® warming.  McGovern et al published their study showing that their deep joint infection rates dropped 74% (1437 patients, 2.5 years, p=0.028) when they discontinued FAW in orthopedics. They switched to HotDog® for safely maintaining normothermia.

I let the manufacturer know about the problem with FAW, urging them to take action, offering business collaborations.   Their response was massively negative. The more research that was published showing contamination and infection risk, the more adamant their denials.  They have no credible research to refute the published waste heat studies—zero studies. With no research to promote, they instead decided to start a personal smear campaign against me and the HotDog® product, as if that could possibly solve their problem.

A company can obfuscate, confuse and mislead for awhile, but eventually their customers and plaintiffs lawyers catch on.  About two years ago, a law firm out of Houston filed two product liability lawsuits against that FAW manufacturer alleging that their clients’ devastating knee infections were caused by the waste heat from FAW. By August 2015, a Google search of “FAW infections” revealed over 100 law firms advertising for injured joint implant patients.  Many of these firms are also advertising on TV.  These mass tort lawyers are well funded and seem to be very well organized.  They have already filed for Multidistrict Litigation (MDL) certification in Federal Court. It is reasonable to assume that there could be tens of thousands of plaintiffs.

We at ATM are just 3rd party bystanders watching the litigation show.  While I feel terrible that my invention is causing catastrophic infections, I also feel that I’ve done everything that I could reasonably do to warn both the FAW manufacturer and the medical community.  FAW remains a useful tool, just not in ultra-clean surgeries like orthopedics. That is where air-free warming is the safer alternative.

Dr. Augustine is a retired Anesthesiologist and inventor of the HotDog® Warming System.

Conservative Management of Carpal Tunnel Syndrome and Shoulder Stiffness

These innovative Rehab Products are designed to help individuals experiencing musculoskeletal disorders like shoulder impingement, hand pain or carpal tunnel syndrome.  The products are all based on sound biomechanical principles and can be seen by clicking on the following links:

The Arch Assist provides soothing, massage-like support to the arch of the hand without restricting normal movement.  This is a great product for anyone who uses a computer for long periods or experiences symptoms related to carpal tunnel syndrome.

The Carpal Correct program is the answer to the question:  “What can I do to help carpal tunnel syndrome at home.”  This low cost e manual provides stretches and massage techniques that are based on recent research

Shoulder “Pros” are physical and occupational therapists who work directly with shoulder problems. “  The Shoulder Pro enables you to move your shoulder in an arc, the way therapists mobilize the shoulder. If you are serious about improving your shoulder range of motion on your own, please consider the “Shoulder Pro”.

Want to Learn How to Live? Attend a Funeral.

by James D. Hundley, MD

As we age, we trend toward different functions special to others and ourselves.  Think graduations and weddings when younger.  When you get older, however, memorial services become common.  Sometimes they’re for younger people, and those are really, really sad.  Of particular importance to this message, young people attend the funerals of young people in droves and the conversations and testimonials focus on early accomplishments and potential.  What I suggest, however, is that younger people should also attend some memorial services for old people even if you don’t know them well if at all.  There you can learn what was accomplished in a long life and perhaps discover what is important to those left behind.

While attending a memorial service recently it occurred to me that some great lessons in life could be learned by attending one.  Maybe it should be required of all students.

The fellow who died was an elderly gentleman with whom I had served on our hospital board.  We became friendly then but only rarely saw each other afterwards.  All I really knew was that he was a quiet, intelligent man who cared deeply about others and did his best to make the world a better place.

Upon reading his obituary and then when at his memorial service I learned what was really important to him.  Yes, he excelled at his profession (professional engineering and then management of a large plant of an multinational company) and he was a great public servant (active in his church, chair of our hospital board of directors, and so on) and those were discussed.  What really struck me was that his work, although important, was not the most important thing to him.  His family, other people and his religion came before his work.

He took his work seriously and worked at it very hard.  To rise to the level that he did in such a large company, he had to.  He had balance in his life, however, and never forgot his family.  That was made abundantly obvious by the testimonials made at the service.

Having been in the medical profession for over half a century, I have observed many physicians who act as if the only really important function in their lives is the practice of medicine.  Yes, one must take what we do in medicine seriously, but we must also realize that other aspects of our lives are important, too.  We cannot allow ourselves to be totally consumed b our profession.  If we’re fortunate enough to have a family, we must attend to them, too.  Not only will it be good for our spouses and children, it will be good for us, too.

So, if you want your life to be remembered in a great way by the ones you love and who love you, please take this advice.  Attend a memorial service or two and figure out how to make it happen.  It’s common to speak of planning for “End of Life” these days.  Well, if we look forward long before the end, we’ll be happier at the end of our lives if we like what we did during them.

Dr. Hundley is a retired orthopaedic surgeon and the founder and president of OrthopaedicLIST.com.