Photo By Jean Graves | 1st Lt. Jonathan Ekas, occupational therapist at Bayne-Jones Army Community Hospital...... read more read more
FORT JOHNSON, La. — Bayne-Jones Army Community Hospital continually strives to increase access to care for Soldiers and their Families at the Joint Readiness Training Center and Fort Johnson, Louisiana. This week wraps up the collaborative efforts of active and reserve assets from across the Military Health enterprise to bring enhanced hand and wrist surgical capabilities to BJACH. For Shelby Snyder, it may be the end of a long road to recovery.
Shelby Snyder, spouse of Capt. Richard Snyder, Task Force Live Fire, Operations Group, JRTC and Fort Johnson, is no stranger to the medical system. She has found herself in and out of doctor’s offices for various issues and illnesses in recent years. As a military spouse who moves around frequently, she encourages others to empower themselves to be their own advocates regarding their health. Her most recent health related journey began on Feb. 4 when she woke up with pain, along with loss of mobility and dexterity in her right hand and wrist. A local artist and potter by trade, Snyder said the use of her hands is important for normal day-to-day activities and for her livelihood.
Before beginning medical interventions for her hand, thumb, and wrist, she attempted therapeutic cupping and soft tissue rolling techniques.
“I’ve used these techniques in the past to soften tissue and alleviate muscle pain,” she said. “I was hoping I could manage my own pain and restore the mobility in my hand and wrist with applied pressure and increasing blood flow to the affected area.”
After several attempts to solve her issues on her own, she finally called and made an appointment with her primary care physician at Bayne-Jones Army Community Hospital where the process began to determine what was going on, remedy her pain and find permanent solutions.
“While in Germany I had a similar feeling in my left hand and they told me it was de quervain tenosynovitis, which is a painful condition affecting the tendons on the thumb side of my wrist,” she said. “After discussing what was going on with my doctor, I was referred to occupational therapy where I spent two months working to resolve the issues I was having.”
1st. Lt. Johnathan Ekas, certified strength and conditioning specialist, and the chief of occupational therapy for BJACH, said patients are referred to him from PCMH, the orthopedics department, 3rd Brigade Combat Team, 10th Mountain Division holistic health and fitness and from network hand and orthopedic surgeons.
“Most OT referrals are due to musculoskeletal pain that range anywhere from the neck to the fingertips impacting a patient’s functional use of their upper extremities,” he said. “Each referral and patient are different. In occupational therapy, we use exercises, tabletop activities, soft tissue mobilization and simulated work tasks to accomplish physiological adaptations needed to regain function and perform normal day-to-day tasks.”
Ekas said, as a specialty provider at BJACH, PCMH is his biggest referral source.
“One of my primary roles is to assist primary care with diagnosing hand and upper extremity conditions,” he said. “Patients are often sent to me before seeing a surgeon to determine whether the patient is a candidate for conservative non-operative treatment versus surgical interventions. There are a variety of tests and assessments in addition to conducting patient interviews that are used to determine whether the individual is a candidate for surgery.”
Ekas said listening to his patients and good cohesion between departments within the hospital is key to positive outcomes.
“One of my hand therapy instructors, Dr. Gregg Pitts, a subject matter expert in the field of hand therapy, taught us the most important part of an OT’s evaluation is the patient interview section of the evaluation,” he said. “Our patients will tell us what is wrong with them. As a provider, it is my responsibility to ask the right questions and get the information needed to assist that patient with treating their condition. In more cases than not, if I am thorough when interviewing a patient, I can usually figure out what is wrong before I even begin taking measurements and running tests.”
In Snyder’s case, after attempting several weeks of therapeutic interventions, she continued to experience more pain and loss of mobility.
Ekas referred her back to primary care for further evaluation and imaging.
Snyder’s primary physician was unavailable, so her next appointment at PCMH was with Maj. David Flick, an individual mobilized augmentee assigned to BJACH. Flick, a family medicine doctor, is a U.S. Army Reservist who conducts his annual training at BJACH.
Flick completed his residency at Tripler Army Medical Center and joined the IMA program after seven years of active-duty service. This year was his first rotation at BJACH.
“While my time at BJACH is brief by nature, I can provide additional access to care above and beyond BJACH's normal capabilities. I also bring a fresh perspective with me which can be of value,” he said. “My current role in my civilian practice is what's called a ‘crossover physician’ which means I don't have my own panel of patients, but I see everyone else’s. In this role, I am specifically looking at things from a fresh perspective and always thinking outside the box. In this regard, I am often able to catch things that can sometimes be difficult to see or hear. My mentor in medical school always told me to ‘be quiet and just listen to your patient, they will usually tell you everything you need to know,’ I take this to heart and try very hard to resist the urge to interrupt. I let the patient just tell me everything they are concerned about up front.”
Snyder said, Flick quickly confirmed de quervain tenosynovitis and initiated referrals to the radiology and orthopedic departments. On May 12, she had magnetic resonance imagining (MRI) done.
“My first appointment with Dr. Ed Southern was on June 12th in the orthopedics department following my MRI,” she said. “By the time I met him, I was unable to perform normal daily functions with my dominate hand without experiencing extreme pain, and he suggested injections to provide some immediate relief before looking into surgical solutions.”
Snyder said the shot didn’t provide any relief, so surgery was imminent.
“Fortunately, during my first appointment with Dr. Southern, he told me there was a hand specialist coming to BJACH in August from Brooke Army Medical Center who could perform the surgery if required,” she said.
Snyder said the most alarming part for her was that from the point of injury to the time she got the surgery, her pain and mobility progressively worsened.
“In April, while turning the key in my ignition I felt and heard what seemed like a tear,” she said. “1st Lt. Ekas and Dr. Flick got me on the right track to recovery. If BJACH didn’t have a hand surgeon from BAMC coming, I would probably have been referred to the network.”
Lt. Col. Grigory Charny, deputy commander for BJACH, said having a hand and elbow expert from BAMC come to BJACH is a big win for patients.
“We care for thousands of beneficiaries, just like Shelby, whose illness or injury follow the map that providers create to identify, treat, and resolve a host of conditions,” he said. “We do not possess the full array of specialists and subspecialized surgeons at our hospital that are available in large medical centers. When our map takes patients outside the care of our MTF, we have three choices: send them to a large military medical center, send them to a local specialist, or bring experts here to our facility.”
Snyder said patients should continue to advocate for themselves throughout the process.
“If I’m unable to work, I don’t get paid. Getting my range of motion back and getting this taken care of is important not only for my overall well-being but also for my livelihood,” she said.
Lt. Col David Wilson, orthopedic hand and elbow surgeon for BAMC, said he and the team at BJACH have a good working relationship. They coordinated his travel to limit inconvenience for patients and increase the spectrum of care at the JRTC and Fort Johnson MTF.
“I have a good working relationship with the surgeons, the ortho physician assistant and the occupational therapist at BJACH, we share patients frequently,” he said. “When the opportunity came up for me to travel to central Louisiana, I jumped at it.”
Wilson said this is not only a win for our patients but for our combined teams.
“It facilitates teaching and sharing of educational and technical resources between orthopedic surgical colleagues. I’ll be scrubbing in with BJACH surgeons on common hand and upper extremity cases during my time,” he said. “For the operating room team, the goal is to explore efficiency improvements in the throughput of common upper extremity cases. I’ve coordinated with the OR clinical nurse officer in charge in advance to get some equipment on hand that will further the efficiency of the BJACH OR in the future.”
Cindy Nelson, group practice manager of surgical services at BJACH, said this is a first in her 15 years at BJACH.
“Having Dr. Wilson come to us will save our patients the time traveling to San Antonio, Shreveport or Lake Charles,” she said. “This will prevent a delay in care and allow us to take care of our patients in a timely manner.”
Nelson said 15 patients, including Snyder, were preloaded for preoperative appointments Aug. 23 with right hand surgeries scheduled the 24th and left-hand surgeries on the 25th.
“We’re calling it our hand rodeo,” she said. “This is a win-win for our team and our beneficiaries. Following their surgery, each patient will get their medications, post-surgery orthopedic appointments and occupational therapy sessions right here in house. In fact, 1st Lt. Ekas will be observing the surgeries and helping these patients with their postop recovery efforts.”
Ekas said having the orthopedic, radiology, rehabilitative, primary care and surgical departments working together is important for a productive medical system.
“No one department has all the answers or is appropriate for all patients in all circumstances,” he said. “With this in mind, there is a mutual understanding between all of us that we are stronger together and benefit from helping each other with solving the patient's problems. We do this by working as a unit to diagnose and subsequently treat our patients.”
Ekas echoed Snyder’s sentiment on patient self-advocacy.
“One of the major reasons I push for patients to speak up for themselves is that they are ultimately the ones who have to live in their body,” he said. “They are the subject matter experts when it comes to their perceived experiences and know the effect the injury has on their body better than anyone else.”
Charny said providers work in tandem to take care of patients.
“This story illustrates a multi-disciplinary approach model. Patients receive care from their primary care physician, with the help of our radiology department, and appropriate consultation from our occupational therapist and orthopedics specialist,” he said. “Every provider adds their expertise for treatment and evaluation, building towards a success story.”
Charny, who attended medical school with Wilson, said it was a great reunion and he is proud of the team taking care of Snyder.
“Success like this cannot be done without professionals like our clinical and operating room nurses, medics, technicians, our credentialing department and group practice managers,” he said.
Every patient’s journey is unique. Every injury or illness will take the patient down a different road. Understanding their rights and resources to advocate for their own health care is imperative for the achievement of positive outcomes.
For Snyder, the road to recover has just begun, but by being an engaged patient and working through the process from point of injury to diagnosis to surgical intervention, she has the end of the road in her sights.
Editor’s Note: The BJACH Patient Advocate Office, located in room 2654 on the 2nd floor of BJACH serves as a link between patients and hospital staff at all levels and can offer education and information regarding policies, procedures, systems, and concerns about care and safety within the hospital. For more information call 337-531-3628/3880 or send an email to usarmy.johnson.medcom-bjach.list.patient-advocate@health.mil.
| Date Taken: | 08.24.2023 |
| Date Posted: | 08.24.2023 13:36 |
| Story ID: | 452074 |
| Location: | FORT JOHNSON, LOUISIANA, US |
| Web Views: | 272 |
| Downloads: | 0 |
This work, BJACH hand rodeo: One patient’s journey, by Jean Graves, identified by DVIDS, must comply with the restrictions shown on https://www.dvidshub.net/about/copyright.
Orthopedic Surgeon
