Big Radius Surgery Group

Healthcare organizations think strategically about their catchment area - the population they draw their patients from. Along these lines, I came up with a “name” for our small, two-person surgery group here - Big Radius Surgery Group. 

Dr. Nattier is the kind of guy you just want to bust through walls with. It is good to be here to work with a close friend. I hope he doesn’t get tired of me because, as the surgery roster shows, we are slotted to spend a lot of time together over the next 1/2 year.

We have seen our fair share of challenging cases lately, many in pediatric patients from as far away as Nigeria and with advanced stages of disease. We alternate call every other night and often end up with our “own” patients which is efficient and much like my practice back home. However, we tackle the more challenging cases together.

A lady presented to our clinic recently with Grave’s Disease - an autoimmune disorder that results in the thyroid gland enlarging and overproducing thyroid hormone. This can be treated with radioactive iodine but that isn’t available here. 

This patients had the characteristic bug eyed appearance of the disease and all the signs of thyrotoxicosis - pulse in 130s, profuse sweating, an enormous thyroid taking up the entire width of her neck and with so much vascularity that you could feel the bruit hum of blood flow when you touched it. We started with medications to slow thyroid hormone production and slow her heart rate. When she didn’t show for the next appointment, I fretted that she had died and regretted not admitting her at that first appointment. Thankfully she resurfaced with many of the symptoms under control and desiring the risky operation of thyroidectomy in attempt for cure of her hyperthyroidism and to relieve the pressure that her enormous thyroid placed on the other structures in her neck. 

There is a lot of give and take conversations in these two person operations - 

“Do you think that’s the nerve?” as we search diligently for the recurrent laryngeal nerve that moves the vocal cords…. “Oh - there is the parathyroid gland!” as we try to preserve the body’s calcium regulating gland that sits right next to the thyroid…. “I think you got it” when the bleeding stops after a delicately placed suture.

She is recovering well after her subtotal thyroidectomy. We tried to leave enough thyroid gland behind to minimize her need for thyroid hormone replacement and we continue to monitor her for that. When she removes her head covering her neck looks a lot different now. Her bug eyed appearance (proptosis that is due to Grave’s disease) is waning. She has a strong voice and can breath and swallow normally. These are little things that we sweat over before surgery and rejoice to see afterward.

Another challenge was this million dollar smile boy from Benin with a huge mass (sarcoma) in his right thigh. It had been growing for many months and was starting cause pain and affect his gait. We weren’t certain from examining him that it what relation this mass had to his femoral artery or if we would be able to salvage his leg. Thankfully - we were able to get what appeared grossly to be a complete resection, sacrificing a significant part his quadriceps in the process. 

The pathology results aren’t available yet but we do have some chemotherapy options here for these types of tumors so we are prayerfully optimistic about this little boy’s life! He is walking and smiling with his adoring mom. 

The big radius encompasses many wonderful people. It is a joy to be here among them.