By Margo Ragan
Severe back pain does not discriminate among its sufferers; it can afflict young and old, the rich and famous. The late President John F. Kennedy wore a back brace for most of his adult life and Tiger Woods, despite his legendary athleticism, has undergone spine surgeries to relieve his pain. For Dr. Victor Hsu, spine surgeon at the Rothman Institute, helping people by using his superior medical skills is the major reason why he changed his original career direction and entered the medical field.
A little background information about Dr. Hsu helps to understand his motivation. “I was graduated from the University of Pennsylvania with a degree in Finance,” he said, “and I went to work in reinsurance in New York for a year. It was the best decision that I could have made because I discovered that despite the considerable financial rewards, working in finance was not a calling. Helping my fellow man, was.”
Telling his parents that he had studied for the wrong career was not as difficult as one would have thought. According to Dr. Hsu, his parents are highly educated individuals who immigrated to this country because of all the opportunities presented. They agreed wholeheartedly with his decision to change his career path, and encouraged his enrollment in Temple's medical school.
“I completed my specialized spinal training at the San Diego Center for Spinal Disorders,” Dr. Hsu explained, “and that is where I met a pediatric doctor who has served as a mentor for me. I admired how he related to children who had pediatric spinal disorders, and how he made them feel less apprehensive about their condition. I have tried to follow his ways.”
The spine presents a major challenge to the medical practitioner. There are 33 individual bones stacked on top of one another, movement or injury to one of them has a domino effect on the rest. “I wanted to practice my specialty in a facility that offered full orthopedic services, and that brought me to the Rothman Institute,” he said.
The Rothman Institute is a success story in and of itself. Founded by Dr. Richard Rothman who still practices surgery well into his eighties, the Institute has 25 locations in the Mid-Atlantic region, and has a staff of more than 145 fellowship trained experts in their specialty. There are no general orthopedic physicians on staff. As Richard Cushman, Public Relations Director, explained, “If you have a knee problem, we have specialists for your knees, as with every musculoskeletal part of the body. Our facilities are located out into the communities we serve, eliminating the need to go into the city for medical help,” said Cushman.
Because the spine is so complex, Dr. Hsu recommends a preventive approach that all people can use in order to prevent future spine problems. “I am the team physician for Germantown Academy where my two children are students,” said Dr. Hsu. “I realize that today's sports are very competitive, and youngsters have to keep muscles and joints in shape. My task is to inform them on ways they can strengthen their backs while maintaining flexibility.”
Dr. Hsu is an advocate of yoga, starting at any age. “Yoga is very helping in building strength in your core,” he said. “A strong core not only helps with your posture, but it stabilizes your back.” He also emphasized that core muscles protect your abdomen and hips.
Water therapy is another positive step a person can take to protect their back. “Water is 600 times more resistant than air so that your exercises are very effective,” he said. “Water therapy decreases stress on your joints and gives you increased mobility. If you should fall, the worse thing that could happen is that your hair could get wet.”
There are other modalities that can be used to prevent spine injuries or lessen pain. “I talk to my patients about acupuncture, meditations, as an alternative,” Dr. Hsu said. “I want my patients to get better without resorting to surgery, or leaving surgery as a last option.”
Clearly, Dr. Hsu takes a very humanistic approach with his patients. “We have to work as a team, patient and physician, to have the right surgery for the right reasons. As with any surgical procedure, we have to consider the risk/benefits to the patient.”
The advances of technology offer several options to the patient, depending upon the severity of the patient's condition. Dr. Hsu likes to discuss the possibilities of using minimally invasive surgery or robotic spinal surgery, both practices in which he is especially skilled.
“Minimally invasive surgery uses a smaller incision, which means a smaller scar and decreased blood loss,” Dr. Hsu explained. “It is less damaging to the muscles and surrounding soft tissue to the spine. Those tissues are not cut, but dilated by my using especially designed equipment.”
Even though the procedure can be performed in one day, and the patient may be allowed to return home in the evening, Dr. Hsu takes the time to explain that however safe the minimally invasive procedures may be, there is also a degree of risk, as there is with all surgery.
“Depending on the specific surgery, we may use either general, spinal or local anesthesia,” he said, “and there is always the element of complications, including blood clots.” Considering the network of nerves surrounding the spine, there is also the risk of injury to those nerves.
Space age robotic surgery is another alternative that can be presented to the patient, if his or her condition would apply. It is a relatively new technique that increases the level of precision the surgeon has when placing screws in the bones for fusions. “A major benefit of robotic spinal surgery is that it reduces the number of x-rays, radiation, needed for surgery,” said Dr. Hsu. “It is cutting edge technology and requires a surgeon who has additional training for its use.”
What happens when all options are considered and surgery is the last and best option? Since spinal surgery is one of the most challenging and riskiest types of surgery, I would want to know what kind of training a spinal surgeon such as Dr. Hsu has had. Aside from medical school, licensing, and a five-year residency program, a spinal surgeon must also have undergone a fellowship training. Expertise is essential because there are 31 pairs of spinal nerves that exit the spinal cord. One misplaced movement on the part of the surgeon could be a disaster for the patient.
Many of the recommendations for post-surgery recovery seem to be common sense based, yet the medical team tries to spell out what a patient should do or not do. Dr. Hsu says patients often rush their recovery time in their desire to return to their normal activities, and that is a mistake. Rule #1 is to ask for help in doing ordinary tasks around the house. Listen to your surgeon's instructions, and ask for pain medication, as there definitely will be pain.
Another simple recommendation is one Dr. Hsu initially advocated to me. “It is as important to stretch your muscles after surgery as it was to stretch prior to surgery,” he said. “Of course, the patient may not think he or she is able to stretch, but starting with little movements will help to invigorate the muscles and help in the recovery process. Taking baby steps will get you to your goal.”
Moving slowly around your dwelling is one more step toward recovery. While sitting in a recliner may be comfortable, sitting for long periods of time may not be a good thing as blood clots are a complication.
“It is important for the patient and the patient's family to know that the medical team is with them with support and expertise,” said Dr. Hsu. “Helping people lead a better, healthier life is the reason why I changed my life by going to medical school. It was one of the best decisions that I have made.”
For more information about Dr. Victor Hsu, spinal surgeon at Rothman Institute, visit www.rothmaninstitute.com/physicians or call for an appointment at 800-321-9999.