Celebrity trauma: Deniz Tek

Deniz with Iggy

In a bland era of X Factor music, you need someone like Deniz Tek. As the great man put it, talking about the onset of punk, following what he calls the 'post-hippie malaise period' of the early 70's (I remember it well):

At last, somebody getting back to basics. You compare it to maybe one or two years before, everybody’s listening to a triple album by Yes called Tales from Topographic Oceans, and if there’s anything more boring in the world, you’d have to tell me about it. That was just the epitome to us of the dreadfulness and horror of what music had become, and it was a breath of fresh air when these New York bands started blowing all that away.

There's a lot out there on this polymath, but put simply, if you like punk, metal, surf music, and the darker edges of those, like fellow Australians (sort of) The Saints playing Nights In Venice, then you'll love Tek and his awesome band, Radio Birdman. Or as this website said, he’s the “axe-wielding rock soldier commanding the legendary Radio Birdman blitzkrieg”, which is about right. Think also Stooges, MC5 (both bands were his buddies), Blue Oyster Cult, early Alice Cooper etc. Halcyon days.

But why am I writing this? Most orthopaedic surgeons these days seem to listen to Ed Sheeran or U2, who make the previously mentioned Yes seem like the Sex Pistols. The above named bands are the antidote.

Well Tek is different. When he was in his band in Australia (he's actually from Michigan) in the 70's he was studying medicine at the University of NSW. He got the textbooks out on tour.

In the 80’s he joined the US Navy, based in Hawaii and ended up as a flight surgeon organising medic evacuations, major trauma protocols and delivering emergency care all over the world, in all climates. His radio call sign actually was Ice Man.

He subsequently went on to run an Emergency Medicine service with a lot of trauma in Montana, and now combines music with painting, writing and doing EM work part time in both the US and Australia. You thought you had a complicated life?

Here he is on the professional medic/rock musician dichotomy:

"usually if it's a busy shift or there's heavy things going down I don't think of anything else until the shift's over. The other thing is you can compartmentalise and whilst I'm taking care of sick people music doesn't intrude. I think that in aviation there's a lot of value in that also. Guys that climb into the cockpit of a jet have to be able to leave their family problems behind. Y'know...the wife's goin' out with someone else or the kid's on drugs. They climb into that cockpit and if they don't do everything exactly right they're gonna die...and may be kill other people too.

One of the requisites for that is to totally compartmentalise your mind.  They screen pilots for that ability in psychological tests. If you're not that sorta person...you're just not right for the job."

Fair point - ever had the stress-inducing bleep about a family matter when you’re  in the middle of a long operation? Compartmentalise!

His website is excellent on many levels, but I particularly commend this tale of being called out to a military plane crash in Arizona. Even the Guardian likes him.

He gives career advice too:

"Any encouraging words to the young kiddies?


Work hard at whatever it is you like to do. Nothing worthwhile comes easy. And stop complaining."

Parachutes and the pelvis

*

That old saying, that an X ray is just a 2-dimensional snapshot of what actually happened, is true.

When the acetabulum fractures, the femoral head may have been halfway across the inside of the pelvis before it bounced back to where it sits on the X ray, to give one example. The injury is everything that got damaged then, not just what that 2D X ray shows. The average pilon fracture is equivalent to a small explosion in your ankle.

Most of this less obvious damage is soft tissue of course, hence the appeal of Oestern and Tscherne's slightly clunky classification of soft tissue injury, as a counterpart to Gustilo in open fractures. It seems fairly accurate, but does anyone actually use it?

A lot of pelvic ring fractures and related injuries are essentially internal dislocations of the pelvis through the symphysis and SI joints. They spring back usually, even the vertical shears to a large extent, but can you imagine what it's like at the moment of injury?

Well, imagine no more.

A big hit at the moment is Admiral William McRaven's very short and readable set of life lessons, expanded from his speech to graduates at his alma mater, the University of Austin, Texas. Rest assured, it's not a mindfulness manual. McRaven was the chief of the US Navy SEALs, and ran the operation that took out Bin Laden.

In fact it's not unlike Leo Gordon's matrix lessons, a staple of this blog.

The more general point that McRaven is illustrating with the following excerpt is that we all need help sometimes, and success in something is rarely down to ourselves alone. He describes his very tough rehab after what I think was a very bad 'open book pelvis', which happened in midair. Honestly. His description is pretty vivid...





....the book is genuinely worth reading. This particular episode confirms what we don't know from discharging people three months after injury, but one does rapidly learn doing medicolegal reports - all trauma has rehabilitation challenges, and many injuries leave you with lifetime symptoms, long after your injury has officially 'healed'.

Celebrity orthopaedics: Gabriel Batistuta, Marco van Basten and a disquisition on pain

Here's a scary description:

I left football and overnight I couldn’t walk. I wet the bed even though the bathroom was only three meters away. It was 4am and I knew if I stood my ankle would kill me.I went to see Doctor Avanzi (a world-renowned specialist in Orthopaedic trauma) and told him to cut off my legs. He looked at me and told me I was crazy.I couldn’t bear it any longer. I can’t put in to words just how bad the pain was.
I chose the right leg (to be operated on) as the doctor couldn’t do both.I didn’t care. My problem is that I have no cartilage or tendons. My 86 kilos are supported by bones alone. That’s what generated the pain.

And here's the author of that description, in action, wrecking his ankles, for our benefit...



Batistuta was probably the best striker of his day, and one of the best ever. If I can quote from the well known biting South American striker of today, Luis Suarez:

The ultimate? Gabriel Batistuta. He was a spectacular No 9 - great at finding space, shooting from outside the box, good in the air. He was always a reference for me and I used to watch the way he played. He took free-kicks as well. I don’t get to take them here! (laughs) but I’d copy him and watch videos of him all the time.

I agree with the sharp toothed Uruguayan. Not only was Batistuta an awesome player, he was a modest appealing person, who always looked super cool. He scored 300 club goals, and 56 for Argentina in 78 games, which is better than Messi.

However, he was wrecking his ankles. He had numerous steroid injections to get him through, and they probably didn't do him any favours in the longer term. 

The assessment of pain severity is one of the hardest things in orthopaedics - one man (or woman's) agony may be another's "well it hurts but I try to ignore it", and yet it's the basis on which we offer complex operations with significant complications. 

Most surgeons would recognise the claim "I have a very high pain threshold, doctor" as probably meaning that the opposite is true. For what it's worth, I never use the VAS 1-10 scale. A waste of time. However, Batigol's description is pretty good, as is (most of) his understanding: My problem is that I have no cartilage or tendons. My 86 kilos are supported by bones alone.

It sounds to me like he had an ankle fusion, not, note, an ankle arthroplasty. He had "two screws surgically placed into his ankle to help alleviate the pain and support his movement" and the outcome?  "Since I’ve had the screws put in, I’m much better now than I was three years ago.” 

"I left football and overnight I couldn’t walk", rings true. Batistuta actually had a long career, 1987-2005 at the top level. I've seen quite a few professionals with completely wrecked knees play into their mid-thirties by limiting training, watching their diet, NSAIDs and probably most importantly, great positional sense. They run about that bit less. When they stop playing though, it goes downhill quickly.


Everyone thinks of knees, with ACL's and menisci, when considering sporting injuries, but ankle problems prematurely wrecked the career of all time Dutch great Marco van Basten, although worringly, he blamed the surgeon. He also appears to have had a fusion, he certainly had bone fragments removed from the joint, back when the unnamed maligned surgeon was trying to salvage things. When the weight bearing surface area is as small as it is, then you know that's going to be associated with major problems. I've done hips and knees on relatively youthful ex-footballers, who still play in kickabouts with no problem. Ankle fusion is not that good, but it's not bad either.

In case you're wondering how good van Basten was...




Here is van Basten's description of his pain. Not dissimilar to Batistuta:

After three years of pain I wanted a normal life again. Just imagine feeling pain every minute of the day, somewhere in your body. And that for three years! It dominated my life. From my ankle the pain bounced back into my whole body. As long as there's still hope you can still recover, you're willing to accept the torture, but after so much treatment and so many medical experiments I finally realised I was running up a dead end street.

And the outcome?

Now I'm glad I made the decision, because I'm finally free of pain and I'm dealing better and better with my handicap

It all goes to show how lucky we are that knee and hip replacement are so good. These other procedures don't really come close, but it's all about the pain.

Remember kids, low impact activities are best when you're old

Why did you want to be an orthopaedic surgeon?

According to Wikipedia, a Venn diagram is a diagram that shows possible logical relations between a finite collection of different sets."  History buffs will further be fascinated to know that Venn diagrams were introduced in 1880 by John Venn in  a paper entitled On the Diagrammatic and Mechanical Representation of Propositions and Reasonings in the "Philosophical Magazine and Journal of Science", about the different ways to represent propositions by diagrams.

The author takes his role in applying such concepts in science and graphical representation to this blog very seriously.

So here, according to Facebook, I believe (not my scene), is the genesis of an orthopaedic surgeon...

Makes sense to me.

Celebrity orthopaedics: U2

....specifically their dreaded singer Bono/Bonio. This is when he fell off his bike in Central Park in late 2014.

The talented trauma surgeon whom you can blame for Bonio's ongoing career is Dean Lorich at HSS in Manhattan. To quote the sanctimonious caterwauler himself: "The recovery has been more difficult than I thought. As I write this it is not clear that I will ever play guitar again."

Well he made it. Nice X rays, Dean

The Bonio distal humerus

Celebrity orthopaedics: Paul Stanley

Post THR exercise routine

One of my occasional pleasures is seeing how once youthful rockers grow old, get ill etc. I remember a picture of Rod Stewart coming out of a New York pharmacy clutching a large box of anti-inflammatories. A few weeks ago we had Joe Perry with his walking stick.

Well, here's Paul Stanley (65 last month), the guitarist with the star on his face from Kiss. He's an orthopaedic case history:

"What I do has taken its toll. I've had both my rotator cuffs surgically repaired. They're all similar to sport injuries. I've torn my meniscus in both knees and had a hip replacement. This is all from onstage performances. It's like doing a triathlon with a guitar around my neck. You have to jump, sing, swing your arm and play the right chord. With that combination, anything can go wrong. I used to jump up in the air and land on my knees. It didn't hurt then, but it does now."

He was 52 when he had his hip done. Last year he had a torn biceps fixed, with all the vital technical details:

Not only that, he identified the difficulty deciding whether to undergo a hip replacement in a tweet after bandmate Gene Simmons was critical following Prince's OD on analgesics for his hip disease (keep up):

As he said about his own decision:

"I wound up postponing my hip surgery and, you know, it's like reading in the newspaper your own death, you know, when you keep reading about your hip surgery, and I haven't done it, but I'm just postponing it for awhile. I have, you know, every intention of continuing doing what I've been doing, but little by little I'm turning bionic."

Interestingly Paul did have a complication - recurrent dislocation. Money can't guarantee that you avoid it. When I did private medicine I always felt my complication rate was slightly higher in the private sector. . It would be interesting to know what the salvage procedure was, because he looks like he's functioning at a pretty high level. Although...

"You know things did not go as well as they could have or perhaps should have. Hip replacement is major surgery yet it's fairly routine. It's done so often. The actual procedure has changed so much that you basically have the surgery and are walking that day. But there's a saying, minor surgery is what somebody else is having. This clearly was not minor surgery and the first one did not go well and kept pulling out or dislocating almost immediately. So within two months I went back and had it done again, which seemed to fix one problem and start others. The recovery has taken way longer and been more painful than I expected. It will never be great."


And that fits with the evidence that although patient satisfaction after dislocation soon catches up - if the hip is stabilised - the functional scores are frequently less than in the uncomplicated hip arthroplasty. 

I'm not a huge fan of Kiss, though I kind of like the whole trashy metal showbiz thing. Here they are in 2014. That's a 10 year old revision hip in a 62 year old you're looking at. Not bad.