Scoliosis Town Hall: Scoliosis Patients Share Their Success Stories Post-Surgery

– All right, it looks like we have people (indistinct) I’m hoping you guys can hear me People nod if you can hear me Yes, okay We’re gonna wait for just a few more minutes We’ve got almost 50 people coming on and I’m going to share my screen Lindsay’s texting me, we can hear you, great I got my Zoom up there, my first one Here we go All right, can you guys see that too? Okay, I think we maybe just have a few more minutes Time is 5:02 We’ll get started at 5:05 (whispering) – For those of you who are joining just now, we’ll be starting promptly at 5:05 So, we’re just letting a couple more people come online All right, I think we can probably get started So I wanted to thank everyone for coming It looks like we have a really good turnout My name is Dheera Ananthakrishnan, I’m one of the Orthopedic Spine Surgeons here at the Emory Department of Orthopedic Surgery My practice focus is adult deformity surgery I focus on scoliosis and these are really complex surgeries and they’re not only complex in terms of the surgery that’s required for the patients, but they’re pretty complex in terms of the patient’s journey even to get to me, having the patients go through surgery and caring for them afterwards and getting them to recover from surgery All of these things are really complicated So, in interest of trying to educate patients, other providers, people caring for patients, we are going to hear some stories today Six of my patients, these are surgical patients

and although they all have scoliosis, they all have their own stories that are unique to each of them And it’s been my pleasure to get to know them and to help them through this journey So, we’re really happy to have all of you here, we have a really good group of family members, other patients, providers, we have some people from our Women’s Multidisciplinary Clinic and we’ll just go ahead and get started I’m gonna pass this off to the facilitator who is Nancy Vepraskas, this is really her baby, she’s brought out this, and I think I’m gonna hand it off to you Nancy I’m gonna stop sharing so people can see you – Thank you Dr. Ananthakrishnan I am so excited to be here Again, I wanna welcome everybody that’s here this evening My name is Nancy Vepraskas as you just heard, and I’m serving as the facilitator for this evening I’m very, very excited to be here with this group of people And it’s true, I’ve been (indistinct) this because we all want to share this story The purpose of this Town Hall is to talk to you, share the stories of those of us who are on tonight Six adult deformity and scoliosis patients who are all different in how we presented, in the surgery we had, and yet we’re all the same We’re gonna share with you this evening our journey, our recovery, our encouragement to others of you who are listening, who may see this surgery the same way that we did It was a hard decision, I have the surgery, is it a challenging recovery? Hell yes, it’s a challenging recovery but you end up with a life renewed and re energized, we would all say absolutely So what we wanna do tonight, our goal tonight, is to encourage other people to get informed We want them to weigh their options and then if you’re like us, good candidates for surgery, we hope you’re going to leave tonight thinking about saying a very loud, yes, to preparing, to pay attention, to being patient in your recovery process, doing what you’re told, but then reaping the rewards of waking up every day, grateful to have your back So for us, this is an evening of possibilities and celebrations Now, most of you who are on the call, thanks to COVID-19 are very experienced in Zoom use, so, I won’t bother to go into a lot of details with that We do plan to keep to our 90 minutes We wanna share our story, and we wanna have time for Dr. Ananthakrishnan to share her perspective as well along with Sarah and Maggie, two great Scoliosis Physical Therapists, who are here at Emory And we want to have time for questions So, if you will please provide your questions via the chat icon, that’s down at the bottom of your screen If we don’t get to everyone, then we’ll provide an email to which questions can be forwarded We know that as was just said, that we have patients on here tonight, we have potential patients, we have doctors, support teams and families And so each one of you brings a unique perspective to this surgery and recovery, and you probably have different questions So with that, let’s get started I’ll go first of the six Again, my name is Nancy Vepraskas, I am 70 years old, I am a wife, a mother, a grandmother and owner of a leadership performance company I was first diagnosed with scoliosis when I was 14 So that would have been 1964, a really long time ago My parents didn’t like the surgery option, which was a year in a body cast and so the decision was made that what I needed to do was just get on with life and live with it and so that’s what I did My life was certainly good, I’ve had a great and rich life, but every grown woman with scoliosis remembers the tears you shed as you were putting clothes on and they didn’t fit right, and well, meaning people kept telling you to stand up straight when frankly you couldn’t But life moved on and I suppose I lived with pain most of my adult years but that’s really not the part I remember Early on, I had a doctor tell me that one day, I simply wouldn’t be able to walk anymore It was told to me like it was a fact, not something that could be changed or something I could do anything about Now, I was vehement that I was going to live my life fully

He wasn’t gonna tell me I was gonna be a person who wouldn’t walk, but I have to say his word certainly stuck in my head I was at the beginning, once he talked to me of taking on the job of pushing the rock up the hill And although I periodically saw a nonsurgical orthopedist and certainly saw a lot of doctors in the course of my life, never was there a discussion of reconstructive surgery, I think you’ll find that different for several of the other people on the call I was just told how best I could manage it People reminded me how strong I was and that just edged up my pride in being a person who could overcome all of this, after all, I don’t think I thought I had much of a choice I had a team, I still have a team, thank goodness, I still have that team that kept me going And I just went on until I couldn’t go on anymore As a matter of fact, as Dr. Ananthakrishnan knows, I met her because I came to see her as a patient, because I was going to a physical therapist and she wanted to get a baseline And she sent me to an ortho over at Well Star, who I think took about 10 minutes looking at my x-ray and walked into the room and said, you need to go back to Emory, you need to get in their system There’s a doctor, Dr. A, that’s who you need to see, you need to have surgery, as a matter of fact, you need to have surgery like yesterday So, of course I thought she was wrong, but I got into the Emory system And I do think that if you haven’t been followed for a long time, and you’re entering into the Emory infrastructure, it’s really daunting That’s why I’m so glad that I’m hearing that there’s gonna be an interdisciplinary team because getting prepared for the surgery is an absolute process And I was a novice in terms of figuring out who I should see and how I would get in to see them and what kind of questions I should ask And I will say for me as well, one of the big issues that my age was, I ran into a lot of doctors who just basically told me had lived with my scoliosis this long, I ought to just keep living with it The problem was I wasn’t living much anymore I had started to be in situations where catching my breath was really hard if I did any sort of exercise, I taught a class at Georgia State where I sat down almost the entire school season My husband drove me in and picked me up and brought me home, I could barely walk a block and even short trips from the car to a restaurant required somebody taking my hand to make sure that I could keep my balance I love hospitality and entertaining and that just became absolutely grueling for me And it was sad for me to watch my family just kind of gather around me to kind of keep my reputation intact, but my life just kept getting smaller and smaller And honestly, I just hated it, but I was scared too and wondering with all these people telling me maybe I was not, maybe I was too old to do it, but then I clearly remember one day when I just thought I’m having this surgery, that’s just it And so in June of last year, about a year after I met Dr. A for the first time, I went in for surgery two days 16 hours, but who’s counting? And came at fused from my sacrum to T seven I still have a significant curve, I think Dr. A we’ll talk a little bit about that It turns out that much of my back was already fused But it is such a huge improvement It’s certainly a big deal that my breathing has improved, I have better digestion, I walk on my own, I don’t have to be accompanied And of course, having the hump on my back go away and dropping two shirt sizes was a really pleasant after effect, I wasn’t necessarily sure I would have The surgery is hard, the ICU experience is really hard ICU nurses are amazing I created a prayer and support team for whom I’ll be grateful for all my days getting through this My family was amazing I will tell this part of my story that I originally told my family not to come to the hospital It wasn’t that I was afraid of the surgery, honestly, the only thing that worried me

by the time we got to the actual surgery date was waking up with a breathing tube which didn’t happen by the time I woke up, it had been taken out, but I was afraid that on drugs, I wouldn’t be able to handle me well And I had lived a life of just taking control of my own circumstance and who wants their kids to see them when they’re totally out of control, right? But the lesson I had is I came out of this is when you’re in recovery from this kind of surgery, you’re actually not in charge of anything Recovery has a mind of its own, your body has a mind of its own And you just have to give in and do what it’s telling you, it wants you to do, you can’t overpower it The last thing I’ll share is I think one of the oddest experiences for me on the emotional side was the day Dr. A told me I could drive We left the doctor’s office, my husband was all set for us to go out and celebrate And I just said, I just wanna go home, and I just went home and cried because I think it was the first realization that my day of pushing the rock up the hill, the day of overcoming was coming to an end And Dr. A, I say this to you every time I see you, I am grateful every day, so thank you And now I’ll turn it over to you – All right Thanks Nancy So these are, I’m gonna show just some brief x-rays from each patient We’ll hear from Sarah Hite, who’s one of our Emory scoliosis therapists who’s helping Nancy now So these were Nancy’s x-rays when she came in, she had a, you can, this, the X- ray on the left is looking at her from the back And the one on the right is looking at her from the side And she had a really significant curve It’s almost an 80 degree scoliosis over here, and then a compensatory curve above this And I’ll tell you that these x-rays actually don’t look as bad as she did when she came into my office A lot of patients will, she mentioned the dress size, a lot of patients will wear really big flowy clothes, kind of hide the fact that they have this, what’s called the deformity And she was really doing that and I remember thinking, how is this woman walking around so capable, used to controlling everything I just felt terrible that you would suffer for so long The other thing that I think and I think probably the reason that you really came to see me was a lot of it was basically at the bottom of where your scoliosis was She had mentioned she was completely fused all the way from here and then everything below, it just kind of broken down the bottom of the leaning Tower of Pisa, just broken down And she had a lot of pressure on the nerves in that area, which I think was part of what her problem was, and you can kind of see this as her CAT scan over here on the right side This is that hump that’s totally fused through here This was her MRI and you can see these are her kidneys, her lungs are actually kind of getting squashed down, the area where her stenosis was really bad, it was right here And she had really the trifecta of problems, it was pretty complex, I actually talked to a couple of my partners about what to do and whether we should try to correct this big hump is a really really very, very dangerous surgery And my feeling was that she didn’t really need that, we did, I was a little concerned about her bone density So I think she mentioned a little bit that the interdisciplinary, multidisciplinary approach of trying to get other people in to help with bone density, with breathing exercises, pre-op therapy, what we call prehab, try to get people ready for the surgery These are things that we’re trying to take a little bit more of a global approach on to get these patients ready to have a big surgery So she did have two surgeries This was actually, I think, in between, or just before the second surgery where we actually put two spacers in at those broken down levels and then ended up flipping her over or going from the back the next day And this is what it looks like now So to her point, her curve, I elected not to try to do anything to that area that was already locked in We just did most of her correction below and above that And her curve now measures in the 60s which is, I went back through your records Nancy, it was what your curve was probably think of 15 years ago, it was in the 60s ’cause I measured some of your old films and yeah, I mean she looks, it’s really too bad we couldn’t do this in person because you could see how really amazing she looks And she’s got some residual weakness, I was in her leg and she’s working with Sarah

Sarah, I don’t know if you wanna chime in here and see, make any comments about Nancy’s progression – Yeah, absolutely So, hi, I’m Sarah Hite, I’m a Schroth certified scoliosis specialist I’m fortunate enough to work a few floors below Dr. A I work at Emory and about two years ago, I opened a scoliosis clinic So, I work with majority of patients with scoliosis, both pre and post op in all ages from like 11, 12, all the way up to 100 And about two months ago it was when I met Nancy for the first time And we’ve been seeing each other for about once a week for about eight weeks And when she came in, she looked great Luckily, Dr. A did all the hard work And so just like what Dr. A said, her main complaint was that residual weakness in her legs, not being able to walk as far as she wanted and some trouble going up downstairs So, during the initial evaluation, the things that I assess are center of gravity, and if you remember on the x-ray, you might not have noticed, but on the x-ray, Dr A did such a good job, getting her head right over top of her pelvis, which then really helps people be more balanced when they’re walking And that’s one of the first things that I assess for patients when they come in postoperatively ‘Cause depending on where they’re fused on the bottom, you can still have mobility in the pelvis And so if they’re not fused and the pelvis isn’t quite sitting under them, that’s one of the things that we work on But luckily with Nancy, that was not an issue, she was perfectly balanced We also look forward and back as she balanced And that was another thing that looked pretty good, she wasn’t leaning forward anymore And so then what we were left with was she had a little reduction in the ability to stand on one leg and a little bit of weakness both in the hips and then in one of her ankles And so over the past eight weeks that’s what we’ve really been focusing on, getting her core strong, her legs strong, helping with body mechanics And then another component that is Schroth based and you remember looking at her initial x-rays as well as her talking about just having reduced endurance, shortness of breath, things like that And that’s actually very common for patients with scoliosis at that degree And when it gets into the thoracic spine, it can make it difficult to breathe And so one of the main components that I work on, both pre and post operatively is helping patients learn how to breathe and helping to it’s what we call Schroth breathing, so helping to kind of promote a little bit of D rotation I mean, obviously her spine is fused so we’re not D rotating the spine, we’re just helping to expand some of those muscles within her ribcage that have been contracted for 60 years and helping to open them up so she can continue to breathe And so every one of her exercises have had a respiratory component, making sure she’s breathing and all that And so, I mean, at this point, our next steps are really just to continue to progress the body mechanics and gait training, really trying to maybe get on some uneven surfaces and going up over barriers and things like that But overall, she’s been a great patient It’s been a pleasure to work with her – All right, Connie, if you’ll come off mute, which you just did, it’s your turn – Hi, I’m Connie and good evening I’m a typical 12 year old that had scoliosis developed My PE teacher kept telling me to stand up straight, stand up straight, and I was so frustrated, I go home to my mom and say, she’d be won’t leave me alone, she won’t leave me alone, please help me So, we thought it was in my hips and I went swimming one day and my mom was there and saw my curve So, I had a pretty decent orthopedic doctor follow me And I wore a Milwaukee brace from, he waited from this summer to the fall So, I wouldn’t be so hot with all the leather all around me to put me in it And then I wore it till I was 16, off and on after I was 16, I would sneak and only wear it at home But at school I was some way or another probably was not a good thing but that’s when I had to live my life I went on nursing school, I got lucky that the hospital I went to put me into a pediatric unit initially, a lot of kids, but it just saved my back, I think more than anything, to be able to work a longer time without some injury (coughing) excuse me But in my 40s, I started having a lot vertebra pain and I went to see one of the Emory surgeons there And so he followed me and had me in a 20 year study, he retired, I quit going I just started doing, I had specific exercises to do, but in 2018, in the spring, we had been at the beach

and I noticed ankle pain, I couldn’t walk very well, it progressed for a few months I did PT I couldn’t walk stairs very well, had a lot of pain in my sacral area more So, it was time for me to see Dr. A again, I had seen her two years before, just to follow up, we decided I was stable, we just keep going And I told her I was broken ’cause I was broken And we went through the process of MRIs and stuff to see what was going on And I had a facet joint cyst in my L four or five and Dr. A started talking about surgery (mumbles), like you were very happy with me, ’cause I can’t say no for a few times but finally I knew I had to make that decision, I was very scared because it’s a big surgery and I was already scared ’cause I knew my life had already started changing And so I had the surgery in November of 2018 My curve shows on x-ray and the thoracic area was like 82 before surgery Dr. A went in and she’ll tell you, I got out of it back to like a 44, which I’m very pleased I had the support of my family, my husband, I’ll start crying, was unbelievable in helping me and someone asked just a little bit ago about bursitis in your hip, yes I had it for years, it’s gone I do not have bursitis in my hip anymore And my medication in the hospital was morphine and Tramadol I went home on Tramadol and Tylenol and weaned myself off because I did not want to be that person that could have an addiction We live our life now, we’ve traveled, we do things that weren’t, that I didn’t feel like I was able to do as well as now I can That’s all – Well, thanks Connie Let me, I’m gonna show your x-ray So, we’re starting off with two largest curves here So, these are Connie’s x-rays and I remember thinking when she came in, the first time you came in, you’d been following with Dr. Horton and the first time you came in, I just couldn’t believe that you could have this deformity and really not have much pain Connie’s one of the quiet ones in the group So I think she’s just stoic and bears it really well And pretty much all of the patients that are here today are essentially the same They put up with a lot of day to day pain and by the time they get to me, it was really incredible to me that actually the thing that really caused her to have a problem was I’m sorry, it was once again was once again at the bottom of the leaning tower of Pisa So, she ended up having this fossette which I think I have a picture of it Yeah, so basically this is at the very bottom of that deformity So, kind of to Sarah’s point, the body has to try to keep holding your head over your pelvis And so you can see her chest is kind of shifting over here towards the right And then these levels over here get really broken down and she ended up getting a really bad degeneration here and there as you can see, there’s like this little balloon of a cyst, similar to the cyst people get on their knees with arthritis and that was pushing on her nerves And actually by the time we went to surgery, I’m pretty sure your leg pain was kind of gone, the leg symptoms that you had The mistake would be to just go in and try to open this up without addressing the whole deformity Obviously, if somebody is in their 80s and can’t tolerate a really big surgery, then that seems reasonable But for somebody like Connie, who’s otherwise healthy, really on almost no medication wants to live her life, and what Miss. Vepraskas said earlier, your life is getting smaller and smaller We ended up doing a pretty big surgery on her This is her, like you had a T four to the ilium fusion and yeah, somebody leave the hospital with just Tramadol is pretty impressive after this type of operation But I think it just goes to show how much day to day pain these patients have She’s done remarkably well

and yeah really an inspiration and yeah, very smooth, I have to say – I think I probably spent more time preparing for your case then I’ve spent even talking to you post op up until now So, yeah, I think it’s a good testament to the stoic nature of a patient – Ken, its your turn Remember to come off mute – Yeah, I’m unmuted, yeah Hey, good evening I’m Ken Shaw, I’m 62 years old I’m an anesthesiologist And my story is a little bit different from everyone else’s because I had a normal spine until about 25 years ago when I had a pretty severe back injury from what I call a weekend of extreme yard work, which entailed pulling binds from trees for about three days So, about the 20 years after the injury, I had off and on, it was a right low back, right hip and right leg pain that would bother me here and there, occasionally would limit my activity where if I was doing a lot of walking, I stop and squat because my hips are hurting so bad where I just couldn’t keep going And I plugged along all those years with my back and about a year prior to my surgery, which was in 2016 So this was about 2015, the pain changed, it became, it worsened It was all of my right hip for the most part of right leg I start developing a right leg weakness and even going to foot drop The pain was so bad where my last nine months before I had surgery, I see stuff on Ikea mat on the floor in my home I’ve worked full time scale as anesthesiologist, so I wore to work, I caught a weight belt is like a compression belt, you could cinch, and that kind of helped me get through the day Finally in March of 2016, I had the good fortune of meeting Dr. A and I remember going in to see her the first time And it was a very emotional meeting for me because I’ve now realized I had met somebody that could actually take care of me We discussed all my back issues, the surgical plan I remember when Dr. A brought up the sheets of what she wanted to do and it was gonna be a two stage surgery I think she said it would take six hours for one part and 12 for the next We went over the postop, the recovery, the postdoc And I really, whenever we get Jennifer Hudson was her nurse at the time and I think she still is And Jennifer said, basically you can you’ll be married to us for the next year? So, and that’s pretty much how it is I was able to get worked in early, so my surgery was gonna be about seven weeks later from our meeting And by the time my surgery date came around, I was so ready I was excited actually And Dr. A gave me the name of two of her previous patients who were male, about my age and similar kind of surgery So, I called both of them and talked to them and they were most helpful, and they answered a lot of little things you just never think about So, I mean, I’ll have everything ready I remember walking in the door of the Ortho Spine Hospital It was April 29th And I had my first surgery which was (indistinct) which is a lumbar interbody fusion And that’s what I do the anterior approach And it took less than six hours and I remember waking up from that and I was totally pain-free The hip pain I’d been experiencing so badly for the last few years was totally gone and it’s never returned I also had regained two inches to my height, I’m 6’5, I think I’d dropped down to about six foot two, and I’m pretty much back to 6’5 The second part of the surgery which was four days later, it would be May 3rd, 2016 We did TA to the ellie infusion and I was told 12 hours you’ll be in ICU, you’ll be intubated, probably it was less than 12 hours and I remember waking up and I was not intubated, and I was in ICU just the one night I was glad ’cause I just, I don’t know, I wouldn’t be back in the regular room I was discharged with postop day number nine I have been basically pain-free and about the only thing I ever experienced what I call like a back tightness or just like, as am I getting my back It’s nothing, (indistinct) It’s not anything bad, it’s just part of it I stay very active, I do like a TRX, which Dr. A said i can do I do a lot called senior yoga, which is not the extremist, the basic yoga, what you hope poses for And I do meditate, I’ve gotten a lot more in tuned to who I am as a person And the biggest takeaway from this is what I thought was going to be a really crappy life four and a half years ago

It’s like I got my life all back, given to me on a silver platter And I thank Dr. A every single day And I’m so grateful for this person because she basically saved my life And I know she hates me when I say that, but it is so true And everybody that knows me, they know how much I love that person ’cause she’s just wonderful – Dr. A, can you top that? – You guys are turning this into like a, yeah, a Dr. A fast, which I didn’t really want, that’s not the purpose of this, but and yeah, it was not a silver platter and you’re supposed to be painting a realistic picture for people, (indistinct) Scoliosis surgeries out of silver platters So yeah, what’s really interesting to me and we talked about this in our prep for this is that all six of these patients and it’s been sometimes you guys can see that we’ve operated on them, I’ve operated on them And it’s an us, its a we, Ken mentioned Jennifer Hudson We have our therapist, Sarah and Maggie, my admin, my PAs, it’s a huge team It’s really not just me But the thing that struck me about Ken with Dr. Shaw was that he’s an anesthesiologist And once again, he was just so deformed You can see here on the right side, he is really leaning forward He’s got the C shaped curve He could not stand upright And a lot of the reason he could not stand upright, and again, I think the thing that really pushed him kind of over the edge was he had in this region, and this is what’s called the degenerative scoliosis So as he mentioned he didn’t have the scoliosis from adolescence Right in the region where the curve is very short, acute curve is the most severe He had a huge amount of compression on the nerves The deformity was also pretty rigid And so that’s why we went in from the front first, and we put these on, you could see this was a thoracoscopy shot from the first day where you put these spacers in to try to give him some of that, his natural curve back And then that, and just to your point, I know you’re an anesthesiologist and you plan exactly out how much anesthesia you need for each surgery but you don’t wanna land the plane with no gas, right? So usually overshoot on the amount of time that we’re gonna need So, yeah, so this is what he looks like now And obviously this is a pretty rigid area So to his point about you lose a significant amount of flexibility So, there’s always a trade off, obviously with anything in life and particularly with surgery where you’re always gonna be trading and in this case, you trade some flexibility and motion for decreased pain and improved function So, a lot of patients will ask me, can I touch my toes? The majority of the time, and the answer is yes, you’ll lose maybe some rotation inside of side bending, but overall people’s function for this type of problem is significantly better So, and yeah, he was a pleasure to take care of everyone, all these patients been a pleasure to take care of, but you’re painting a way to smooth to the picture We think we have some people that had some problems that are coming up so they, (mumbles) All right, who’s next Nancy? – Steve – Well, good evening everyone And I’m Steve Henley and I’m 68 year old retired, industrial maintenance professional At least I like to think I was And I’ve been set up for a while with back pain for probably 25, 30 years And it’s gradually and gradually got worse My primary care physician, he dealt with me for a few years and he finally said oh, I’m gonna send you to the Emory Clinic And he called, made an appointment for me I went and saw one of the doctors at the Emory Clinic who prescribed a epidural injection into my spine And as a result, it helped enough that he said he didn’t think surgery would be necessary And that as a result, he would turn me over to the Emory Pain Clinic So, I was at the pain clinic for years, as things progressed, I went from, when it had a spinal cord stimulator installed to simply mask the pain that I was having down my right leg

And after that, after having the spinal cord stimulator installed, it working and I had it adjusted three or four times before we finally ended up taking it out completely The meantime I had a laminectomy done, which cleared up a lot of problems that on the right side, but as a result of that, all the pain moved to the left side of my body, and from my hip all the way down to my toes and kind of like Ken, it just developed to the point that I was missing steps, I’d have to stop and get my bearings again, so to speak But then also on top of all that, back in 2003, I had gastric bypass surgery And as a result of the gastric bypass surgery, not being able to take in some of the nutrients that needed to be and how well they were handled by the body It created a lot of problems preparing for this surgery, but I never heard my wife had suffered with scoliosis when she was younger and had been in a body cast, but no one had ever mentioned scoliosis to me until about 10 years ago And it was after the laminectomy surgery And Dr. Gerald wrote said, Emory, he’d mentioned to me one day, has anybody ever said anything to you about scoliosis? And my answer was no, I’ve never, no one had ever mentioned that And, so was it long after well, probably in 2014, I was in, well, yeah No 2017, I was introduced to Dr. A, and first thing she said at that time I was down to 180 pounds And she said you need to gain 20 pounds before we do this surgery And I had all the required to do it by all my providers that were looking after me at that time So, it was kind of life changing and getting ready mentally for the surgery and through a lot of prayers and a lot of consulting with my wife and my son It was, I can’t mention how great they were to me while I was recovering from this surgery But the morning of the surgery, I was in such a peace that I don’t remember half the time, I don’t even remember going into the operating room So, and ever since then, it’s all been up hill, I’m no longer my course, I mentioned earlier to the group that I had paid him a left leg prior to surgery, and that I have a little bit of a nerve pain in my right leg and my physical therapist, Michael Dunn, is a dry Needler and dry needling had been introduced to me about 2013 And Michael kept me going for a long time, going to see him twice a week And he am performing the different dry needling techniques that he bought in those dry needling techniques kept me going for a couple of years And I retired in 2016, company that went bankrupt that I was working for And so the pain at that was to a point that I wanted to retire anyway, I just didn’t, I couldn’t hold up And if it hadn’t been for how long I been working at my previous job, they probably would have fired me long time ago but I was still able to function having been on some very serious pain medication from 2003, up until surgery And within the first three months of having the surgery,

I was off of all painkillers that I was on And it got to the point that the pain was debilitating but it was also not sleeping as much Not that I should, I would sleep for three or four hours and that would be it And it was basically all from the pain Now, I sleep too much now, but I’m trying to gain back what I lost during the last last years But Dr. A has been a godsend And to me, I just wished that I had the surgery done 10 years ago rather than having to wait till February of 2019 to have it So, that’s my story – All right, thanks Steve So these are your x rays, your original ones from when you came to see me, you’d have the spinal cord stimulator removed Your scoliosis also was a degenerative scoliosis too So to your point about you not really knowing you had scoliosis, I actually went back and looked at some of your old films too You didn’t have scoliosis when they first put in the spinal cord stimulator But what happened is, is that the multiple times that you’ve had bone taken away And I also think that some of your problem was a little bit related, as you mentioned to the gastric bypass So, when you have an operation like that, you lose nutrients as you mentioned, and your muscle strength decreases or bone quality decreases, and that allows everything to kind of collapse down So, your scoliosis and kind of like Ken’s was not really that large when compared with Nancy’s and Connie’s, but there’s a lot of, really a lot of degeneration and collapse here You can see your rib is just about here, right on top of your pelvis You’ve got this big hump here, you’re consuming a lot of energy This was to Sarah’s point before about your body’s trying to keep your head over your pelvis So, you got all of these compensatory mechanisms trying to that, which is very fatiguing for patients to live their lives like this The point about me having you gain weight, and sometimes it’s harder for me to get people to gain weight and lose weight was that really needed to have some extra muscle on, and pretty much everybody loses weight after the surgery So, you were in a position of being dangerously thin and really at a risk for having an infection The other issue that I was worried about with you is you mentioned where the chronic narcotics So, you were on narcotics for decades and it’s a real amazing win that you are off those narcotics now, which is just incredible So, let me show you and this was your CAT scan which is, you can see these big gaps This is where you have the laminectomy here And the spinal cord stimulator has to get put in, the spinal cord stimulator was in right next to the spinal cord over here And you basically collapsed down with these bone spurs And this is your x-rays Now, I remember we were a little worried that there were a couple areas in here that weren’t healing I had considered doing an anterior and a posterior surgery but I know you didn’t want the anterior So you really did some yeoman’s work about a, doing your physical therapy, keeping as strong as possible, and then wearing that brace and really trying to limit your activities and your fusion is healed up So, I would say it’s a win on all counts – Okay, Robin – Okay So hi, I’m Robin and I’m 57 I had my surgery on May 12th of 2018, and it feels miraculous The process of getting to where I am today was long I was diagnosed with scoliosis when I was 11 and I wore a Milwaukee brace and then a Boston brace I was a very slow grower, so I wore them till I was about 20 And I lived fully, I mean, I was very active I gave birth to children Scoliosis did not really pop up in my life in a significant way until I turned 50 And then at that point, my pain increased gradually until I finally had the surgery And I mean, I did so much, when I got the brace age 11 the whole notion was you don’t wanna have the surgery, did anything you could do to avoid the surgery And so, when I started having these problems

at age 50, chiropractics, I saw Sarah actually be different kinds of physical therapy I ended up having an injection, I mean, ibuprofen I mean, I had, I took so much ibuprofen for so many years I mean, just to keep going And I have this analogy, this frog analogy where if you throw a frog into boiling water, it’ll jump out But if you throw a frog into cold water and you slowly turn up the heat it’ll die because it doesn’t realize the gradual increase After the surgery when I look back, to what I was enduring, I mean if it had started off that way, I would have like gone to a surgeon, right off the bat But for me, it was just a matter of adjusting I’m a lawyer I mean, before my surgery, I had to lay down at meetings in movie theaters I have to sometimes go into that I ought to laid down, I couldn’t sit for long periods of time, I was in horrible pain And the orthopedist I was seeing at Emory basically said look, your curves less than 40 degrees It’s less than 40 degrees, we’re not gonna operate, so basically, you’re in limbo Like at this stage, you just kinda gotta deal with it And which, so I was in my 50s, what did that mean? And I was getting more debilitated And then my daughter came in to my room one day ’cause I was lying in my room when I was home like all the time And she said, mom, it’s really hard to see you getting things so debilitated and you just need to stop being afraid of the surgery And I was like, afraid? But, first of all, what are you talking about? And then I thought about it, it was like, yeah, I’m really afraid of this surgery, right? I mean, sort of where my orthopedist said, you can’t do it, it wasn’t like I fought with him or argued, it was just like, okay And then it was like, okay, this is gonna change And so I started looking around the country at different surgeries, I was wanting to do like less invasive surgery Then my chiropractor told me about Dr. A, and so checked her out And it was a really big thing about meeting with Dr. A was I wanted to do, I thought I wanted to do less invasive surgery Dr. A was very clear that she doesn’t do that, and she doesn’t work on patients after they’ve had that and explained to me the benefits of just sort of opening right up and kinda seeing it all there and being able to deal with it that way And really in hindsight, I’m very glad for that So, after the surgery, the first three months are really hard, they were for me But I just wanna say before the surgery, you couldn’t tell from looking at me, like I didn’t have a hump I kinda was centered pretty well So, people really couldn’t tell After the surgery, I remember when I had my staples out for the first time, I actually looked at my scar and I freaked out cause it’s this long scar And I was like, oh my God, like what my, this stuff is in my body And it was just so kind of overwhelming but did stuff to kind of keep my mood up, sitting out in the sun, you can’t do much the first few months, you gotta kind of stay pretty still But, a year later, like a year after my surgery, my son and I, I took him to Iceland He graduated from college and we took a full trip and did lots of walking And right now, I mean, I walk a few miles every day and I feel like I have my life back And that’s just, it’s a miracle I mean, it’s something I just feel so blessed about every single day I’m aware of it every day I had amazing support from my spouse My mom was incredibly supportive, I know she’s on this call And Maggie is my physical therapist and has been amazing in helping me just strengthen so that what I wanna do, I don’t wanna have limitations I can’t do somersaults, I’ve gotten over that, but otherwise I can do pretty much what I wanted and that’s it Oh wait, I wanna say one other say one other thing, sorry, so I was home and it was like what I wanna do with the rest of my career? After the surgery, you got a lot of downtime and I’m a lawyer and I just that given that I had the surgery which fit for it, that was a question to begin with ’cause it’s so big, I thought well, what am I going to do with the rest of my time? And I decided I left my job so that I could focus full time on criminal justice reform and other human rights work and which feels great So I mean that change wouldn’t have happened had it not been for the surgery And that’s a really positive thing in my life Okay, now I’m done – Thanks Robin, Dr. A,

– So, these are Robin’s films and I think we can bring in maybe both Sarah and Maggie to talk a little bit ’cause I think we have some time And I think she touched on a lot of really good points The first one is that, yeah, so your curve, I remeasured all your curves today and you actually have these, they’re relatively mild, right? You guys have already seen Connie and Nancy’s curves and this curve So you’re, I would say that I don’t know where your curves were when you were braced but the braces probably did a good job of holding your curve at a particular level And so the magic number 40, between 40 and 50 degrees if it’s over that, we think it’s gonna progress That’s kind of what we tell people when they’re younger But one of the things that you guys, patients have taught me is that, what’s in the book is not always what it is in person And so for Robin, you have this curve, I think the main curve measure, maybe 34 degrees, you have a little bit of a curve up here going up into the thoracic spine And you actually have sort of almost like a curve going right up into your cervical spine too And I know we’ve talked about that You didn’t really comment on any of that that bothering you necessarily But you can see the sort of diffused nature of this curve And I think I remember like we were trying to find like one level that was the problem So the point about like, I don’t do minimally invasive surgery Well, I mean, if it’s indicated I’ll do it, but in this type of thing, it’s a little bit like spitting in the ocean, right? So we couldn’t really see that there was one area that is really the primary pain generator You had degeneration all through this region This area is very flexible, so what that means is when you’re standing up or things are getting compressed down, there you had a lot of arthritis there And really for someone in your age group, the ideal thing is to really address the whole deformity, it becomes very difficult My point about go somewhere else and get one level done, then it becomes a little like locking in that bottom of the leaning tower Pisa And then I’m trying the rest of the time to move things over after things are already locked in down here So, that I think is a very, it’s a good lesson Like you guys are all for, and I’m sure everyone in the panel who’s listening can hear out how driven all of you are and how you’ve used to pushing through pain And you’re used to really controlling situations and it’s a good personal development journey to go through a big surgery like this And I think that it’s a good learning experience for me as well ’cause I I’ve learned a lot from all the patients I know that Jennifer, Amanda, my PA and my LPA, Dale Sigler, even my admins, Neesha, I think all of these guys are on the call and they’ll tell you they’ve they learn stuff, we all learn from each other So we elected to, and I think it was we, it was a joint decision to fuse you right up into this upper curve and leave this way, upper cervical thoracic one alone because it didn’t seem like it was giving you any problems so we’ve been following that And I know you worked with Sarah preop and you’re working with Maggie now And maybe both of them can speak a little bit to your case but I think overall, you’re doing great and we’ll keep following this curve and hopefully you won’t need anything else – Maggie, would you like to add some things? – Sure, I’m happy to So I worked with Robin postoperatively and her rehab after surgery was actually, it went really smoothly mostly because she had some really great PT by some really great therapists beforehand So we were able to build on that She already knew the concept of a lot of the breathing that I’m sure Sarah introduced to her She had great core stabilization from all of her work with a colleague of mine at another practice in Atlanta So we just capitalized on that She didn’t have a ton of mobility issues It was more about improving strength, core strength And really, I would say that part of her rehab went really really fast and has now really focused on trying to preventatively manage that cervical thoracic curve that Dr. A was mentioning now And I will say I know a lot of these patients have kind of sugarcoated over it, but it’s a lot of hard work, their rehab is not easy And I think they’re so grateful for feeling so much better that they don’t realize how hard they’re working in therapy And I know both Lorri and Robin, their compliance is tremendous and you really have to stick

with it to see those benefits and work really hard with it And they’ve both stuck with it and they have a comprehensive at home wellness program Robin’s up to walking I think three and a half, three and a quarter miles daily We use the pool for her quite a bit I don’t have access to a pool, but I kind of coached her through aquatics program postoperatively which was really, really helpful for her And then really just focusing for her now more on scapular shoulder blades, strengthening and postural stuff up above – Thanks Maggie Lorri – Yes Okay, hey, I’m Lorri and I’m 55 years old and I always, I guess I’d always had scoliosis I didn’t really realize I had it until I was in my 20s and I was at a doctor’s appointment for something else And I remember looking over, he mentioned scoliosis and I saw the curve and I was like, oh yeah, that doesn’t look right But, whatever, I didn’t care I didn’t have any pain I was extraordinarily active growing up in sports and everything, never really had a problem with it until as I got older into my late 20s, I started having back like tightness, general pain, nothing horrific until about four years ago And it started, so I was right around 50, 51, I guess And it really started hurting And then it progressively got worse, very quickly And I saw several doctors, I did shots, I did ablations, I did you name it, I did it Nothing was helping me And it was getting worse and worse and worse So finally, I started looking at, doing research and I saw several doctors in the country Everyone was saying the same thing Everyone was pointing towards the surgery I did not wanna do it I’m a big, big baby, did not wanna do it So I ended up in Dr Rodts his office at Emory, who’s kind of an acquaintance of mine And I remember I was sitting in his office in tears and I said, Rusty, you got to do something for me I can’t stay the sir, I cannot And he is, it’s the best thing anyone said to me He said, you have got to get your head around this You are gonna do it, you have to do it And you’re basically gonna give up a year of your life to get the rest of your life back And you’re still young enough, this is, you’ve got the rest of your life to live And this is a good thing And he pointed me in Dr. A’s direction And by the time I saw her, I could not stand on my feet for more than five minutes I was in such pain I had to sit down or I had to bend over to charter it to my, it was my lower back that really caused the most pain for me And we went on a trip right before I had the surgery and I had to be in a wheelchair in the airport, I couldn’t walk So, I thought my life was over, I really did I wasn’t sleeping, I slept in a chair for a year, a year and a half I couldn’t sleep in a bed, couldn’t lie flat, not sleeping is considered as a torture, method of torture, and I get it I would have told her anything at that point I mean, I was walking around on nothing It was the lowest point I’ve ever been in my life So had the surgery, I guess, eight hours, (mumbles) I don’t really remember And I think they I’m Elian to TA maybe, Teton I got them mixed up and I was in the hospital for eight days I was the freakish patient, you hear it all these people losing all this weight from the surgery? Yeah, I gained about 40 I was so inflamed I look like if you touch me with a pin, I would explode And of course, I mean, they thought I had clots, all kinds of weird things going on with me And I had a very difficult recovery, I’m not gonna lie, it was tough, it was painful, it was long, it’s more pain than I’ve ever experienced in my life And I looked like the Michelin man, the Michelin tire man, I was so, I mean, literally if you had touched me, I should have exploded No one really figured out why that happened But I ended up at six months, I ended up doing PT with Maggie and that’s when my life started changing I started getting so much better bit by bit those little bitty exercises

that you thought were so ridiculous, changed my life And all of a sudden, it was a year after the surgery, I started looking more like a normal human being and my life got so much better And all I can say is I’m out walking five miles a day now, all the weight’s gone, all that’s disappeared, I’m back to normal, I have a life And it’s just, like Rusty said, I gave up a year to get the rest of my life And I will tell you every single day of my life, I think about Maggie and I think about Dr. A and I got my life back and I can never and I know she doesn’t want this to be a Dr. A party, but when someone gives you your life back, it’s hard not to think about them all the time and be grateful So, that’s it – Thanks, Dr. A – Yeah So, yeah Lorri again, kind of like Robin the magnitude of her curve was not horrible, this is about a 45 degree curve but again, the degenerative changes here there’s a lot of rotation right in this area, it was pretty impressive And it looks like, I think maybe Dr. Rodts might’ve sent you for a discogram because the CAT scan you had before or they were trying to find one level that was the problem – I’m never, ever forgiven for that – Yeah, that was agony to have every one of your just shot up with fluid to try to find one and not surprisingly, it wasn’t just one disc So, yeah, I mean, I remember when I saw you that I could tell you were miserable, I was worried ’cause you were I think over 200 pounds when I met you, you were close to 200 – 138 now by the way – Yeah, I know it’s remarkable And the thing that was I really learned from you was that, I can’t explain everything because you did blow up, you look like that Stay Puft marshmallow man from the “Ghost busters” – Thank you – I remember Maggie calling me and telling me that she was happy to send you out the back door because she couldn’t let you see any of my other, like my preop patients, because they wouldn’t be, my practice was gonna die on the line So she had a separate entrance for you to go in and out for the first part of this So anyway, it’s all turned out good now, one year later, like miraculous, and you did have a T 10 to the pelvis, you should have almost no scoliosis when we say the curvature measures under 10 degrees, I think I measured you at maybe 12 and yeah And somehow all your weight dropped off I don’t want this to be a magic weight loss thing but I wish I could explain these things I knew you were miserable when you went to the Mayo Clinic at Rochester in January Desperate, desperate for help Maggie wants to, from Fit Core wants to jump in here – Yeah, I will say with Lorri the biggest thing is if I were to, like in one sentence, I feel like she felt trapped in her body Even six months after surgery, she felt like she had no mobility I know we’re joking around state puff marshmallow man, but she just couldn’t move She could barely walk I mean, she was just miserably trapped So for her, we did a ton of mobility work, stretching, manual work, trying to get some length and some mobility and the muscle tissue encouraging slow graduated movement I mean, she was having trouble with just basic activities of daily living, toileting, dressing, getting up and down a flight of stairs And it wasn’t that she couldn’t do it, but her body was just fighting her And so that was our biggest goal initially after surgery was just to get her moving and feeling like she could have some more mobility and things – Awesome But at this point, I want to say thank you to all of you for sharing your story We’re not done yet We wanna have a chance to offer some advice and an encouragement Before we do that, Dr. A, is there anything you would like to add? – I don’t think so I think maybe I’ll just summarize stuff with the number when we’re wrapping – At the end, okay So Connie, you were gonna offer some suggestions to people, either considering the surgery or to think about in recovery or encouragement you’d like to offer, what would you like to say?

– I would say give up your pride That’s the first thing you have to do is give up pride ’cause you’re gonna need assistance with a lot of things you weren’t planning on having assistance with Using a cane, use a walker Don’t be thinking you’re too young for it ’cause you don’t want to fall off The core, I had so many years on my core and I says that I just pretty much got out of bed in ICU without any problems, I mean with help but I didn’t have issues with walking So, get that core strong and keep on afterwards having great PT type people to work with you really helps – Thanks Connie Ken, how about you? – Hold on, you’re you’re muted Ken – I’ll probably one of the biggest thing for the two patients I got their names preop and called them both That was extremely, extremely helpful And the second thing is you do need to prepare to be check out of mainstream life for at least six months and listen to what Dr. A and Jennifer tell you to do, follow the rules, don’t try to do things you’re not supposed to do I know the big thing with me was I wanna get off the pain meds and Jennifer said, we don’t want you to go cold Turkey, we want you to graduate, get off the meds So, listen to what they tell you and do the exercise that you’re told to do and try to be the best place you can because in the end, it benefits you – Super advice Steve, how about you? – Well, I forgot to mention all the injections ablations that they have done on me over the years I mean, I believe every joint in my back had an injection and sometime that was a two or three injections, but at the same time, no, that helped And having the core strength and keeping your body strength up, take the arms and legs prior to surgery is probably the biggest recommendation I can give to any body And like Ken said, six months to a year, at least the first six months you’re completely out of circulation I mean, go to the store or something and walk around the grocery store or whatever was good but at the box, but for the first three months, you’re just completely limited to being at home And that was kind of hard to get used to And, but you can get core strength up and again, the leg strength has a lot to do with it to me So, encouraging words, I’d give anybody – Robbin – So to be not to look online for answers And in terms of before the surgery, what it’s gonna be like, or like a lot of horror stories on there, like Dr. A can give you names of patients that have gone through it And even after the surgery, when their times are low or like was I progressing the way I should be? Looking online, you’re not gonna get what you need So, there are plenty of us who have been through this, and I’m always really happy to talk to folks I’m also noticing, on hear a question about childbirth and I had no trouble giving child, having given birth to children with the scoliosis Others may have explained risk at it, but it was not an issue for me Okay, that’s it – Lorri – I would echo if you’re able to get in touch with someone who’s had the surgery ahead of time, do it I think that is, I would have loved to have had that option, and I didn’t I will also speak to this, and this may be just me, but I was not prepared for the depression that really set in on me during the recovery I did have the weird inflammation and the state puff marshmallow man or whatever I was but, that was part of it, but just being alone and being in pain and not being able to do anything, it’s some, I really struggled with that It can be very, very depressing and challenging So don’t, be aware of, just do be aware

of that and know that that’s normal But, if there is someone that you can get a phone number for and have it, do it because it would have been wonderful to have had someone who had gone through this to tell me it’s gonna be okay, you’re gonna be okay And someone who has actually gone through this, because if you haven’t had this type of surgery before, it’s a big deal, it’s tough And I did not expect that, I did not see that coming, so that was a little hard for me – Well, and Lorri, I wanna add to that when several of us got together for lunch for the first time, and we were at different stages in the recovery, we had someone with us who was a lot earlier in surgery and in recovery process And it was such a remembering for all of us Remember we were like – [Lorri] Oh, I forgot – How bad it was bad – And it made her feel so much better if I remember correctly because she saw us walking around and, it’s yeah, it’s tough It’s a tough recovery, but I will say one more thing I do remember thinking, I’m going to do every single thing they told me to do, Maggie and Dr. A told me to do, because if this, for some reason doesn’t work, it’s not going to be because of me, I am going to be the model patient, and I did, I did everything I was told to do – I would say the same thing on that because I told Dr. A, I’m not coming back because I think I wasn’t supposed to So we’re gonna follow instructions, and I would say that to people in terms of the support you need, when you get rails on your bed, or a hospital bed, or a rock ray seat in your bathroom or you using your walker, all those things that we always would have railed against because by God, we were gonna muscle through this You need to say to yourself, like Connie said, you don’t wanna fall So, do all that kind of stuff, will go a lot better And I would add again, what several of you said is when people tell you it’s a six month recovery, that first stage of recovery, it is a six month recovery Of course, I thought that meant two months but it doesn’t, it just six months recovery And then the second, six months are still part of the recovery, but it’s a much more nuance thing I remember thinking that the end of six months, this is great, and this is as good as it’s gonna be and I’m good And I could not believe the amount of increased improvement I had the second six months, all in a more nuanced stage, but still very, very real – I had significant improvement even after the first year I know everyone says, a year, I just finished my second year since the surgery and my life today is so much better than it was even at one year So I don’t know how to explain that but that’s my experience – Somebody asked about how long does the pain last? And one really piece of great piece of advice, I think Dr. A, your office gave me was you look at it week to week, right? Like any particular day, off day, you’re just not, you’re in bad shape But, if you look from week to week, you see a gradual improvement on the pain level, we’re obviously, it’s the worst scanning I think it’s three months, it’s significantly better, at six months, it’s much better And then after that, I agree it’s nuance, but it’s, we said how bad, it’s bad, bad, but week by week, it gets better and you get through it and you just do – Yeah, I think it’s just really important to know that part Robin, that you’re gonna get through it and it’s not what it’s always gonna be like I noticed down here somebody else asked about sleeping on their back or their side or whatever I had been sleeping on my stomach at the time before the surgery And Dr. A said to me, well, its good you’re trying to get a little lift, you’re able to breathe but I sleep both on my side and on my back now, I didn’t sleep on my back in the early, probably three months or whatever, right? Because you’re getting used to the road and you got scar tissue and all that kind of stuff, but kinda issues – The other thing I want to say about pain mostly is for folks who are thinking about this, before the surgery you have pain, but you know it’s not getting any better After the surgery, you’ve got all this pain

but you think, okay, but it’s improving And so there’s a way in which that pain is handled because there’s an end in sight – Other, Steve, I didn’t ask you (mumbles) – Say that again Nancy – Any recommendations or advice that you would give people, encouragement that would give them? – Oh yeah, you asked if that, but someone had a question about bariatric surgery If you haven’t had it, I don’t think you’ll have to get it, try some of the other programs out there that are nonsurgical Again, it’s created some, I mean, I’m on vitamin supplements every day, and will be the rest of my life just to keep my blood work in some semblance of normal But I’ve went from all my blood work being above the line to everything, a lot of the key factors being below the line now So, I wouldn’t recommend anyone that’s got a back problem I lost the weight hoping that the back problem would get better but instead the back problems continued to get worse I was able to do a lot more than what I had been doing prior to the surgery, just because of my weight But after the surgery, I was able to do more and consequently, I was using my back more And I think that probably made the back pain even that much worse And I was on so much pain medication, the narcotics, I did not realize how bad I was and, I was able to function on daily basis but other people saw it in me, but I wasn’t able to see it because I was living with it But after having the surgery and being off the pain meds, about two or three months after coming off of all the pain medication, I was on, I was so much better I mean, I was seeing things clearly where before I wasn’t complete processing everything, so – This is just a beautiful story Steve Sarah, Maggie, anything you would like to add in terms of advice or encouragement? Sarah, I’ll ask you to go first and then Maggie – So the one thing that always kind of stuck home and I see someone who even, and Miriam asks about kind of the spouse and what the roles, and so that was one of the biggest things that a lot of my patients have told me is that, especially if they’re used to being the homemaker and the one that kind of the house going and rolling, that they have to step back from that role, for a long time and so it’s hard for them to, you just, have to kind of manage that and set the right expectation And that’s why I think it’s great that Dr. A involves the spouse in some of the visits and make sure that everyone’s kind of knows that that’s gonna be the role going forward And then it was, hear Robin talk about how literally each week it gets better And we’re lucky as PTs is we see you before surgery but then I don’t see you again for six months to a year And so I see that big change And so we don’t really see so much the in between, but it’s just kind of keeping your spirits up and knowing that each week it’s gonna get better and better and better – Maggie – Yeah, I think Nancy you may have mentioned it, but one thing I hear from my patients and what I coach my patients on is having that team around them So, it can be family and friends, a team of clinicians and clinicians that you can kind of trust the process with and you no longer have to do all the work and carry the burden yourself and know that these people are going to do that for you, and to guide you down that path Scoliosis management, whether it’s surgery or not, I think requires a team and it can be anyone from nutritionists We’ve heard some of the nutrition aspects of this It can be your physical therapist, your massage therapist, your physicians, your spouse, but having that team around you, I think can be really helpful And then the other thing I would say is that I think Robin was speaking to it It’s just knowing that it will get better and trusting the process and just putting your faith in people and knowing that I’ve done this, I’ve done what I can do to get myself here And then now they’re gonna take it the rest of the way

for me, as long as I continue it as best that I can I would put a plug in for prehab for those of you who are considering surgery Please encourage a physician to recommend some prehab or some pre therapy prior to your surgery I think it does make a world of transplant patients, I see who have done therapy prior to their surgery are remarkably better and have vastly different outcomes, better outcomes than the patients who did not go to therapy prior to So, if you haven’t, please encourage your physician to recommend that for you – That’s great advice Maggie I will say the one other thing and then Dr. A, I’ll turn it over to you is I had expectations of how the whole thing was gonna go And of course a lot of the recovery was different than I thought I mean, in some ways, parts of it were easier than I thought it, and in some ways were hard And what I realized was my whole brain was like being rewired I was learning how to like (indistinct)band in space and how to sit down and out of move and how your legs worked And I remember swinging out of the car and like freezing in motion, like my foot didn’t exactly know where it was supposed to go And it’s just your body’s all this work to keep you upright And now you’re going into space It takes a little while for all that come back, normal kind of thing, and I think it’s exhausting And so that’s why you sleep all the time So, Dr. A, I’ll turn it back to you – Yeah, so we have a lot of, I think we’ve answered most of the questions I can specifically answer some more Lauren Rosen asked about constipation, constant coughing, those are things that we see We see quite a bit of improvement and afterwards, again, it depends on the individual patient A lot also depends on where you started out, I think every patient’s journey, I think that you guys can see everyone should be able to see every patient’s journey is very different I think the team approach is really important We had a couple of our texts on, one of the texts that helps me during all cases who never gets to see the actual patient, never gets to meet you guys So he’s excited I can’t do this by myself We have a few reps on we’re also helping out and we wanna be part of the team I have a team behind me, I’m like thankful to all my partners and we discuss all of your cases I think to Maggie’s point about having a team, about really, really prepping whoever your surgeon is to get you moving forward I would encourage people to see people early and now Christine War birds’ on here and she wishes she could walk much further than she could By the time a lot of you’ve gotten to me, you’re so debilitated that it’s very, very difficult to, you can’t unring a bell So, especially the people with stenosis and you’re noticing weakness and leg pain I don’t know, none of you guys really spoke to this, but a lot of times I do have people afterwards say I wish I had done this earlier I wish I had done it earlier I don’t really believe in hindsight and regrets in surgery, you can’t have regrets cause you gotta keep moving forward Otherwise you’ll gloat about something that just happened, but I do think that trying to seek out help early is really important And so that, and let me just kind of share the, we’re gonna send out an email with people’s contact information for more questions And if you wanna schedule an appointment with a spine doctor, we’ll send those numbers Sarah’s here at Emory, Maggie is at Fit Core I have a really good network of therapists, we all really are very avidly discussing cases Tanisha Crittle is my admin who’s been amazing, helping me schedule all this If you have any other questions, you can reach out to her and I’ll send you guys some emails But I think we’re probably good to go I’ll try to answer other people’s questions when I like pull the chat afterwards, so – So, Dr. A, as we wrap up, I do know that on behalf of all of us who are patients of yours, we too wanna thank the team that stands behind you, both in terms of visits into the office and also all those people that are part of the surgery team So many of them come in to say hello before surgery starts and they do amazing work And as much as we all strongly know what a miracle worker you are, we also know that you couldn’t be (indistinct) all these other folks And so it’s our honor and privilege to if had this time to spend with people tonight,

I know we all have more of these, so that more people can be aware of that this is an option and we look forward to seeing folks in the future So, thanks for having us Dr. A – Thanks very much – [Lorri] Thank you – [Dr. A] Thanks for coming – Thank you