Message from the AAHS President: Nash Naam, MD
Nash Naam, MD
AAHS President
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2020 is a year that, borrowing from President FDR, will live in infamy. COVID-19 has touched almost every human being on our planet either personally, professionally, or in both ways. AAHS has not been immune to the sweeping changes and impacts of the pandemic. The American Association for Hand Surgery, like many professional organizations, has faced issues amidst the uncertainty and anxiety COVID-19 has caused.
One of AAHS's most difficult decisions this year was related to the Annual Meeting. After a careful and thoughtful discussion centered on maintaining the health and well-being of our members, attendees, faculty, staff and families, the Board reached the painful-yet-necessary decision to cancel the 2021 meeting. It was especially difficult because this year AAHS had received a record number of abstract submission, 584 total abstracts, and we know that authors, faculty, members and attendees were all looking forward to meeting in beautiful Hawaii. The program committee under the leadership of the capable Julie Adams, MD, Mark Rekant, MD, Cynthia Ivy, CHT and Vanessa Smith, PA are working diligently to organize virtual educational opportunities for the AAHS community in January in place of our traditional conference. Details and registration will be available shortly.
The Board also carefully and methodically examined and discussed the different options for leadership progression given there would be no Annual Meeting or business meeting in January. After careful evaluation of the various options, a vote by the Board decided that the current leadership would freeze for one year, meaning the current leadership will continue in the same capacity until the Annual Meeting in January 2022. This will allow members of the leadership to have the full experience of serving on the Board and give each member of the leadership the opportunity to contribute in a meaningful way.
These decisions were not easy, and no decision seemed to be a perfect one. But working together as an Association and as a group of dedicated hand care professionals will ensure that the mission and the vision of AAHS remain intact with more renowned enthusiasm and vigor to serve our members and our profession to the best of our abilities. With this dedication and enthusiasm, we will be able to navigate these treacherous waters and come out of the fog as a stronger and more relevant organization.
In lieu of its traditional program with our industry partners during the Annual Meeting, the AAHS will work with industry in new ways in 2021. We will be offering virtual sponsorship opportunities as well as opportunities for industry to share with our members’ information on their products and services. The Hand Association is always thoughtful and balanced with its relationships with industry, and please be aware that it is AAHS policy to keep our members’ contact information secure and confidential. Support from our industry partners always helps with annual operational expenses and this will be true in 2021 as well as we anticipate it may be another unusual year.
I am pleased to share that the Technology Committee under the leadership of Dr. Kyle Eberlin, has announced the launch of the new website for AAHS. The refreshed website provides a better layout to access resources including the new Patient Reported Outcome Guide created by Drs. David Bozentka, Brian Adams, Nik Kazmers and Jennifer Waljee. There are also over a dozen recordings of previous webinars and opportunities to be more involved with AAHS. Please take a few moments to look through the site at your leisure.
Aside from its virtual sessions being planned for January 2021, the Hand Association's annual webinar series continues with programs scheduled for November and December. Please plan to participate and share these opportunities with your colleagues and trainees. The November 19th webinar will be on The Mangled Upper Extremity, Simplifying Reconstruction and feature Drs. Suhail Mithani, Kyle Eberlin, and Steven Koehler. The December 3rd webinar will be on TMR and feature Drs. Glenn Gaston and Jaimie Shores, Kerstin Baun, MPH, TOR/L, and Norah Malkinski, OTR/L, CHT. Registration will be available for these programs soon.
2020 has been very different, and 2021 will likely be different as well. The challenges we have encountered personally, professionally, and as an organization will make us stronger and more adaptable.
I would welcome any feedback from our members and please reach out to me at any time by phone or email. I certainly appreciate your input.
Stay healthy and stay strong.
Thank you again so much for this honor.
Nash Naam, MD
President, American Association for Hand Surgery
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Mark Your Calendar and Register for the 2021 Sunday Webinar Series and On-Demand Virtual Sessions!
- Sunday, January 10, 2021, 6:30pm ET: Miss the Masters? Distal Radius Fracture Management by the Very Best
- Sunday, January 17, 2021, 6:30pm ET: You Have Some Nerve! Are Nerve Transfers Better than Tendon Transfers?
- Sunday, January 24, 2021, 6:30pm ET: Ulnar Wrist Pain-Solutions from the Experts
- Sunday, January 31, 2021, 6:30pm ET: What You Need To Know About Practice Management and Telemedicine in 2021
- Sunday, February 7, 2021, 6:30pm ET: Ouch! Another Flexor Tendon Problem
- Sunday, February 14, 2021, 6:30pm ET: Missed or Mismanaged Conditions
CME credit will be available for each webinar. Unable to attend the webinars live? No problem! AAHS will be recording all webinars, and recordings will be available for replay in the on-Demand Library. Beginning in January 2021, participants will also have access to the On-Demand library of pre-recorded abstract presentations and recorded webinars. CME credits will be available for each topic session.
REGISTER TODAY
Registration includes access to the entire Webinar Series and all sessions within the on-Demand Library.
Best Holmes Case by Andrew Zhang, MD
A 49 year old man suffered a high voltage electric injury to his L shoulder and R Leg. His entire scapula along with all of the muscles around it were necrotic and serially debrided. Only pec, lat, brachialis plexus, axillary vessels and some axillary soft tissue still remained attaching his arm to his body. Surprisingly he had normal elbow and hand function! He also underwent a right above the knee amputation due to the electric injury. To save his arm we employed 3 different static and dynamic suspension techniques to stabilize his shoulder. To provide static support, we hung his arm to his second rib using an Achilles’ tendon with bone allograft. We anchored the bony end into his humerus and tied the tendon end around his his second rib, we elevated the latissimus muscle and moved it to the posterior superior shoulder to cover the wound and also provide the poster superior dynamic pull. Lastly, we transferred a functional TFL/ALT composite flap to the anterior shoulder securing the muscle end to the the remaining clavicle and the tendon end to the humerus to provide additional dynamic support. We used the transverse cervical vessels for anastamosis and superscapular nerve for the neuronization. At over one year follow up, he retained full function, had no pain, was able to elevate his shoulder and did push-ups.
This case was first presented at the AAHS 2020 Annual Meeting in Ft. Lauderdale, Florida as part of the Best Hercules vs. Best Holmes Cases session.
Therapist Corner: Role of Nutrition in Hand and Upper Extremity Rehab
Saba Kamal, OTR, CHT
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Today’s patient is a well-researched person who prefers a holistic approach and is very conscious of what goes in their body. In the past there were very few patients who would ask me about their diet and what they should consume or avoid to help expedite the healing process. My usual response was to avoid caffeine and excessive alcohol.
But today I have to keep a list based on their injury or disease of the upper quadrant. Here is an overview of what I offer to them. Hailing from India I feel like they expect me to know it all when it comes to herbs and diet. So, I dug up my heritage found the foods that assist with healing when treating patients with upper quadrant injury / disease process.
Caffeine – Avoid excessive intake as it works as a vasoconstrictor. It can restrict healing by limiting blood flow to the healing parts and thus should be avoided.
Excessive alcohol - works as a vasodilator and can cause swelling in the distal extremities causing stiffness in the digits, thus increased pain and increase in scar tissue formation.
I had a patient a while back struggling to get his fist, but one day it was extremely swollen and obviously making a fist was out of question. On questioning he couldn’t come up with why his hand was swollen. During the course of the treatment that day the patient happened to mention that he had a little too much to drink and this was seen over a few visits that every time the patient had a little too much alcohol it resulted in increase in swelling in the hand the next day where he had more pain and stiffness which he couldn’t attribute to anything else.
Now, it seems almost every patient asks you if they should take Turmeric or Gingko and so I had to research it out.
Looking back at my roots, remembering my past, every time I was sick, I remember the glass of milk with turmeric that was presented to me. Yes, not the most pleasant memories of turmeric but it has been used for centuries, and it is known for medicinal benefits. Herbs are the basis for Ayurveda. We are what we eat.
Having said that, I decided to dig through my culture to find out what foods are beneficial and what could be harmful to us when trying to recoup from injuries. Also, figuring out if certain foods may assist our medical condition to help us get better and stay healthy.
Salt – Properties – Beneficial or harmful?
It’s a known fact that excessive salt is harmful for blood pressure, but does salt play a role in ligament laxity, stiffness/ flexibility. Yes, too much salt makes cells attract water like a sponge. Increase in swelling will cause stiffness in the extremity resulting in pain and increased scar tissue formation. Eating less salt may also reduce calcium loss from bones, reducing osteoporosis and risk of fracture. People with rheumatoid arthritis (RA) may feel salt's effects even more. Corticosteroids, commonly used to treat RA, cause the body to hold more sodium. Sugar - blood sugar levels if not maintained may manifest in multiple trigger fingers and diabetic shoulder which mimics adhesive capsulitis – Bitter gourd a known vegetable helps with reduction in sugar levels.
A 45 years young active patient presents with bilateral adhesive capsulitis. On questioning he has diabetes that he had been struggling to get a handle on. He had been walking 5 miles every day, eating right and is insulin dependent. I happen to mention the benefits of bitter gourd but didn’t think he will take up on the suggestion. When he returned a week later, he was very excited about his new discovery. He had started juicing the vegetable and taking a tablespoon on empty stomach every day and to his surprise and mine, what the medications couldn’t do this vegetable did it. Over the weeks he was thrilled to report that he may not be needing to take the medications for high blood sugar since he has been able to maintain normal blood sugar levels with this vegetable and his diet and exercise.
Turmeric: Curcumin is the main active ingredient in turmeric. It has powerful anti-inflammatory effects and is a very strong antioxidant. Unfortunately, curcumin is poorly absorbed into the bloodstream. It helps to consume black pepper with it, which contains piperine, a natural substance that enhances the absorption of curcumin by 2,000%
Growing up in India, turmeric is a common ingredient in daily food consumption. Almost every meal has both the turmeric and black pepper in some form. As mentioned earlier, if you were sick you got an extra dose mixed in milk, or fresh turmeric is pickled in vinegar and then consumed only to make your mouth and teeth very yellow.
What does this mean, why is an anti-inflammatory herb needed in our diet? Acute, short-term inflammation is beneficial, as the blood brings in the appropriate ingredients to help our body fight the problem and help heal itself. It can become a major problem when inflammation becomes chronic and inappropriately attacks our body's own tissues. Scientists now believe that chronic, low-level inflammation plays a major role in almost every chronic disease.
Therefore, anything that can help fight chronic inflammation is of potential importance in preventing and even treating these diseases. Curcumin is a bioactive substance that fights inflammation at the molecular level. Arthritis patients have reported good outcomes to curcumin supplements. Given that curcumin is a potent anti-inflammatory compound, it makes sense that it may help with arthritis.
Fish oil - DHA in fish oil, has been shown to have anti-inflammatory effects that reduces cytokine levels and promotes gut health. It may also decrease the inflammation and muscle damage that occur after exercise, however potential side effect is, that fish oil may thin the blood at higher doses, which can increase bleeding.
Ginger - Two components of ginger, gingerol and zingerone, may reduce the inflammation linked to diabetes. 1,600 mg of ginger daily may help decrease insulin and HbA1c levels significantly. Recommended dosage: 1 gram daily, but up to 2 grams is considered safe. When nursing an injury, increase the use of ginger in your daily habits. Add fresh ginger to your cooking and prepare a tea with 2 inches of fresh ginger, 1 tsp Lose Green Tea (or 1 teabag of organic green tea), 1 liter hot water, a squeeze of fresh lemon and raw honey to taste, in the morning which you can keep warm and sip throughout the day.
Pineapple and Pomegranate Juice - Both juices contain an enzyme that acts as an anti- inflammatory and anti-irritant, which speeds up healing. When you feel you’ve overdone your exercises and have a new pain or ache that doesn’t feel right, power up on antioxidants and said enzymes to support the healing process. Make yourself a juice or smoothie with lots of fresh pineapple and/or pomegranate, then add a little ginger and turmeric while you are at it. Castor oil - Castor oil packs are great in alleviating pain and help heal injuries as well as lessen the appearance of old scars. Warm a teaspoon of castor oil in your hands and massage it into the area you want help with. Cover with a glove to prevent staining. Then put a warm pack and leave on for 10 minutes so the oil can be absorbed into your skin. If you have sensitive skin do a small “patch test” first to make sure you don’t react to the castor oil. Get rid of inflammation by including these in your diet...
- FRESH FRUITS & VEGETABLES HELP REDUCE INFLAMMATION.
- INCLUDE DAILY CUPS OF GREEN TEA.
- OMEGA 3 ANTIOXIDANTS.
- ADD CERTAIN SPICES TO YOUR DIET TO REDUCE INFLAMMATION.
- DRINK ENOUGH WATER DAILY.
- WHOLE GRAINS HELP REDUCE THE INFLAMMATORY HORMONE HOMOCYSTINE IN THE BODY.
A balanced diet and a balanced lifestyle help recoup faster from any injury. Increase in stress increases the perception of pain. So, learn the skills to manage stress. Practice mindfulness download the apps that can assist you with mindfulness training and get well and stay well.
Specializing in Shoulder Elbow Wrist and Hand Therapy
www.HandsOnCareTherapy.com
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A Letter from the Editor
John Fowler, MD
Editor, Hand Association News
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In my last “Letter from the Editor”, COVID-19 was just becoming more widespread in the United States. I noted how uncertain everything was at that point. Six months later, little seems to have changed. Many of us have returned to more regular workloads. However, many institutions are still running outpatient clinics at half capacity and restricting certain “elective” surgeries. Prior to COVID-19, many of us were scolded if we didn’t remove our masks immediately upon leaving the operating room. Now masks are worn continuously in public spaces. There remains much uncertainty about the wisdom of returning to school, sports, and resuming “normal” life. Unfortunately, so much of the reaction to the pandemic seems to be based on one’s political beliefs rather than data and science.
I certainly look forward to the day when we as a society have effective medications and a vaccine(s) to control this virus. I look forward to scientific meetings that don’t take place on video conference and the chance to gather with friends and colleagues. I wish you all health and safety.
Sincerely,
John Fowler, MD
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AAHS Upcoming Webinars with AAOS and Affiliates:
AAHS/AAOS Webinar: The Mangled Upper Extremity: Simplifying Reconstruction
Faculty: Suhail Mithani, MD, Kyle Eberlin, MD, Steven Koehler, MD
Date/Time: November 19, 2020 at 8:15 PM Eastern Time
FREE for AAHS members, registration will be available soon.
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AAHS/ASHT/AAOS Webinar: Targeted Muscle Reinnervation
Faculty: Glenn Gaston, MD, Jaimie Shores, MD, Kerstin Baun, MPH, OTR/L, Norah Malkinski, OTR/L, CHT
Date/Time: December 3, 2020 at 8:15 PM Eastern Time
FREE for AAHS and ASHT members, registration will be available soon.
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