Louisville Magazine

AUG 2014

Louisville Magazine is Louisville's city magazine, covering Louisville people, lifestyles, politics, sports, restaurants, entertainment and homes. Includes a monthly calendar of events.

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60 LOUISVILLE MAGAZINE 8.14 Ali Azadi, 39, is a urogynecologist at Norton Women's Specialists. He completed a residency in OB/GYN at the University of Tennessee in Memphis and a fellowship in female pelvic medicine and reconstructive surgery at the University of Louisville School of Medicine. He told me this story about a sacral neuromodulation surgery, which had him implant a small battery into a patient's back, just above the hip. Te battery sends electrical signals, via a wire, to the nerve that controls the bladder. Te signals regulate symptoms of urinary incontinence and an overactive bladder. "We don't have any emergencies or life-threatening situations. Most of what we do is about quality of life. If women come with urinary incontinence, usually their lives are afected by that. Tey have to avoid social events because they always have to go to the bathroom. Tey can't travel because they need to fnd a restroom. It afects their sexual life. It makes them nervous and depressed. "Te actual implant is like a bladder pacemaker. A lot of these problems are because of dysfunctional nerves of the pelvic foor that don't send the right message to the bladder. Same thing as a cardiac pacemaker — if the heart rate doesn't work properly, you use the pacemaker to regulate the nerve. "For years and years my patient, a woman in her 60s, sufered from urinary incon- tinence and going to the bathroom constantly. It afected her at work. She was very disappointed from all the other treatments she'd previously had. She'd tried so many medications. "To see if the device will work, the patients come to the ofce and we evaluate them with a test. We put a very small, temporary wire next to the nerve and let them carry an external battery for a few days. Tey just attach it to their clothes. Before the test, we ask patients to write down how often they go to the bathroom and how many incidents of leakage they have each day. We compare that to the three days of wearing the device. If we show that there's greater than 50 percent in symptom reduction, we consider that a positive. My patient experienced three days of tests; then she came back and said it really worked for her those three days. "Implanting the device is not a big surgery, but you want to do it right. Te patient comes into the room, they put her to sleep, then put her in a prone position where they can operate. We're very careful about having a sterile feld because it's a foreign-body im- plant. Te treatment has been out there for more than 10 years, but not everybody does it and not everybody's familiar with it. It was sort of out of routine for the OR staf. "In the operating room, we do X-rays and make sure the lead, which will connect the device to the nerve, is exactly next to the pelvic nerve that controls the bladder. Tere are some patient refexes that we look for — for example, moving her toe for a second. If we see the right response, we know that we're at the correct nerve. Ten we make a three- to four-centimeter incision on the back, just above the hip, and implant the little battery. Af- ter we implant the device, we close the incision, usually with stitches that are reabsorbed, sometimes glue. It may take a few days for the nerve to get the maximum response, but usually it works immediately. Te patient has a remote control, like a TV remote, and they can change the stimulation based on what they experience. Some patients need more stimulation to control their bladders, some need less. "Tis patient's job requires that she walk between diferent areas at the hospital. She said that urinary frequency afected her daily job activities. After the implant, she seemed to be very happy about the fact that she did not have to take any medications and the fact that she doesn't have to stop work constantly to go to the bathroom." The Going Rate Kittie George, 49, is an orthopedic surgeon at Louis- ville Bone and Joint Specialists. She graduated from the University of Louisville School of Medicine, which is where she completed her surgery residency. Originally she trained in physical therapy, but she decided to go back to medical school after her mom had surgery for a broken ankle. "Te surgeon let me watch him fx it and I was hooked," she says. Here, she remembers a patient who was in a motorcycle accident. "When I was a resident, a guy in his 20s presented in the emergency room with a bilateral open patella fracture — so he broke both kneecaps. He was on a motorcycle and he landed in a creek. He had wounds on his knee: open frac- tures, mud, dirt, creek water, grass. You're looking at this guy thinking, 'Tis is not going to be good.' "I was looking down in those knee joints, looking at the fractures and thinking, 'Oh my gosh, am I ever going to be able to get this cleaned out, fxed and healed?' Normally when you see dirt and mud and creek water in a joint, they can wind up with chronic infection. I knew he could end up with amputations if the infections were uncontrolled. "You fx a fractured patella with a tension-band wiring, which compresses the fracture fragments. But the biggest priority with him, it wasn't fxing the patella; it was just continuing to wash him out. "To wash a joint you go to the OR. You open the joints up and wash them out with antibiotic fuid. We essentially have a giant Waterpik, a giant shower head that you put antibiotic fuid in, and you put antibiotic fuid all around the joint — a very forceful stream of fuid. You bring him back in two more days and do it again. Ten in two more days you do it again. It took a couple weeks. I bet we did it fve or six times. "Another one similar to that was a girl who was swinging on a rope into a lake and let go too early, so she landed in very shallow water. She had an open fracture of her tibia. She comes in and her bone's sticking out of the skin, and you've got, again, mud and nasty water. I bet I operated on her 20 times. Ultimately, she healed. "But I thought for sure this guy was going to be a bad outcome. "Probably three years ago, this guy found me in private practice and remembered everything. He remembered meeting me in the ER, all the surgeries. He's fne. He's mar- ried, has two kids. He was seeing me for another problem. "He still rides a motorcycle. Tat was the frst question I asked him. Motorcyclists are pretty dedicated enthusiasts." Non-Easy Rider W W

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