sutures newsletter

PRODUCED BY AND FOR MEMBERS OF THE DEPARTMENT OF SURGERY August 2012 Issue | Archived Issues

Physician honors

- George Berci, MD, FACS

- Philip K. Frykman, MD, PhD, FACS, FAAP

- Hyung L. Kim, MD

» Read more


Congenital heart disease expert joins Cedars-Sinai Heart Institute

Evan Zahn, MD, an expert in treating children born with life-threatening structural heart problems, has joined the Cedars-Sinai Heart Institute to advance the study of congenital heart disease and develop more minimally invasive treatments.

» Read more


Upcoming CME conferences


Grand rounds

Click here to view upcoming grand rounds.

Advancements in the treatment of pancreatic cancer

By Andrew Klein, MD, MBA, FACS

Pancreatic adenocarcinoma is the fourth leading cause of cancer death in the U.S. and presents as advanced disease in greater than 80 percent of cases. Numerous advancements have led to significant improvement in survival of patients at all stages of disease.

» Read more

Plastic surgery team collaborates across disciplines

By Randy Sherman, MD, FACS

Since the establishment of the full-time plastic surgical service in 2008, we have had the privilege of working with most of the primary surgical specialties within the department at Cedars-Sinai in order to meet the reconstructive needs of each discipline's particular wound-related issues.

» Read more

Changes to Medicare reimbursement for outpatient therapy services start Oct. 1

There has been a recent change in policy regarding the reimbursement of outpatient therapy services by Medicare. These changes, established by the Middle Class Tax Relief and Job Creation Act of 2012 extended the annual outpatient therapy caps to services provided by hospital-based therapy clinics.

» Read more

Department welcomes 2012 surgical fellows

Thirteen surgical fellows have joined Cedars-Sinai’s Department of Surgery for 2012.

» Click here to learn more about them

FDA updates regarding Zofran, Ampyra

Pharmacy focus

The U.S. Food and Drug Administration recently released information that Zofran® (ondansetron) may affect electrical activity of the heart and the risk of seizures in patients with multiple sclerosis who are starting Ampyra® (dalfampridine).

» Read more

Arm yourself against the flu

Flu vaccine clinics begin right after Labor Day

Cedars-Sinai will begin offering free flu vaccinations to all employees, including medical staff, beginning Tuesday, Sept. 4, immediately following the Labor Day holiday.

» See the dates and locations

Circle of Friends honorees for July

The Circle of Friends program honored 74 people in July. Circle of Friends allows grateful patients to make a donation in honor of the physicians, nurses, caregivers and others who have made a difference during their time at Cedars-Sinai.

» See the names of those honored

Cedars-Sinai studies galaxy-exploring camera in the operating room

Neurosurgeons and researchers at Cedars-Sinai Medical Center and the Maxine Dunitz Neurosurgical Institute are adapting an ultraviolet camera to possibly bring planet-exploring technology into the operating room.


» Read more

Medical mission team in Guatemala sees increased need for care

The goals are the same, but the situations always change when the team based at Cedars-Sinai travels to Guatemala on its annual medical mission. This year 96 doctors, nurses and support staff found the city of Joyabaj to be in extreme need.

» Read more and see photos from the mission

Advancements in the treatment of pancreatic cancer

Klein 480px

By Andrew Klein, MD, MBA, FACS

Pancreatic adenocarcinoma is the fourth leading cause of cancer death in the U.S. and presents as advanced disease in greater than 80 percent of cases. Numerous advancements have led to significant improvement in survival of patients at all stages of disease.

Led by Nicholas Nissen, MD, director of Hepatobiliary and Pancreatic Surgery at Cedars-Sinai, surgeons at medical center have contributed directly to improving the surgical management of pancreatic cancer. First, the utilization of vascular reconstructive techniques common to liver transplantation such as portal vein grafting have allowed for resection of locally advanced tumors previously felt to be unresectable. Second, patients with disease that is initially felt to be unresectable can often be treated with neoadjuvant chemoradiation to allow successful surgery at a later date.

These protocols take advantage of more active chemotherapeutic regimens, such as the use of the nanoparticle Abraxane©, as well as improvements in the delivery of highly focused radiation therapy (Stereotactic Body Radiation Therapy, or SBRT).In addition, surgeons at Cedars-Sinai have developed an intraoperative surgical microscopy system to assist in the complex components of these procedures. Combining these advancements with improvements in anesthesia, ICU and ancillary care, the success rate for pancreatic surgery at Cedars-Sinai is now more than 98 percent.

The adjuvant treatment of pancreatic cancer in the past was limited both in number and efficacy of chemotherapeutic agents. New agents and creative chemotherapeutic regimens have resulted in improved survival of pancreatic cancer patients, and these regimens can be further tailored to the individual patient by direct analysis of individual tumor characteristics. An additional novel adjuvant approach, spear-headed by Cedars-Sinai surgeons, utilizes vaccines to boost the body’s innate immune response to pancreatic cancer antigens.

Unfortunately, most patients undergoing surgical resection of pancreatic adenocarcinoma will see recurrence, and as such, new treatments are desperately needed. Many of the therapies previously reserved for other tumors such as metastatic colorectal cancer are now being applied to pancreatic cancer, including resection or ablation of metastases, SBRT treatment of local recurrence, or hepatic arterial therapy for liver metastases.

But perhaps the greatest overall advancement in the treatment of pancreatic cancer has in fact been the development of the true multidisciplinary team approach to patient care, exemplified in part by the establishment of a weekly Pancreatic Cancer Conference which provides a forum for physicians to discuss complex patient issues.

For further details regarding advancements in the treatment of pancreatic cancer at Cedars-Sinai, please contact nicholas.nissen@cshs.org.

Klein, pictured above with a patient, is director of Cedars-Sinai’s Comprehensive Transplant Center, the Esther and Mark Schulman Chair of Surgery and Transplant Medicine, and professor and vice chair, Department of Surgery.

Plastic surgery team collaborates across disciplines

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By Randy Sherman, MD, FACS

Since the establishment of the full-time plastic surgical service in 2008, we have had the privilege of working with most of the primary surgical specialties within the department at Cedars-Sinai in order to meet the reconstructive needs of each discipline's particular wound-related issues. Wound care, in the broadest sense, is what we're all about. Whether they be life threatening, limb compromising, functionally debilitating or personally devastating to the self image of the afflicted patient, restoration of normal form and features remains essential to comprehensive healing and rehabilitation, whatever the presenting malady.

Highlighting our integration into a remarkable multidisciplinary service, the Saul and Joyce Brandman Breast Center – A Project of Women's Guild at the Samuel Oschin Comprehensive Cancer Institute – allows us to offer simultaneous consultation with patients followed by comprehensive surgical options for breast reconstruction using the most tried and true as well as the most innovative methods available. Free tissue transfer employing microsurgical techniques has expanded this field substantially. Women may now choose from a variety of procedures to suit their particular circumstances. Equally as important, during weekly multispecialty conferences, our medical, surgical and radiation oncologists have the opportunity to help shape reconstructive decisions allowing our center to provide the best in exquisitely planned, highly coordinated care.

Similarly, working in tandem with the orthopedic trauma, spine, total joint, foot and ankle, and oncologic services has resulted in a dramatic improvement in functional limb salvage after vehicular trauma, alleviation of recalcitrant osteomyelitis, and preservation of extremities that would otherwise be amputated in the course of cancer ablation. Digital and hand replantation, when indicated, are now an essential emergency service. Prompt response and early wound closure in the massively traumatized patient has been a hallmark of our interaction with our world-renowned acute care surgical services.

In line with our rapid expansion in cardiac transplantation services at Cedars-Sinai, we have had the privilege of contributing to the care of a select group of patients by providing effective and reliable wound closure. Thoracic surgery's aggressive, innovative and highly effective approaches to attacking the most intractable problems has created opportunities for plastic surgery to assist in offering bold, one-of-a-kind reconstructive solutions involving tumors, TE fistulas and neurovascular diseases of the trunk.

Thoughtful collaborations with neurosurgery, otolaryngology, urology, gynecology, colorectal and vascular surgery have opened the possibilities of specialty reconstruction given the most seemingly hopeless circumstances.

While our service is still young, having laid the foundation for thoughtful and effective collaboration with our surgical colleagues across the spectrum of the department, it seems the opportunities for plastic surgical growth at Cedars-Sinai are unlimited.

Sherman, pictured above, is vice chair of the Department of Surgery at the Cedars Sinai.

Changes to Medicare reimbursement for outpatient therapy services start Oct. 1

There has been a recent change in policy regarding the reimbursement of outpatient therapy services by Medicare. These changes, established by the Middle Class Tax Relief and Job Creation Act of 2012 extended the annual outpatient therapy caps to services provided by hospital-based therapy clinics.

This policy becomes effective on Oct. 1, 2012.

How this impacts your patients:

  • An annual reimbursement cap of $1,880 for occupational therapy
  • A total of $1,880 to be shared by physical AND speech therapy
  • The annual reimbursement caps are retroactive to Jan. 1, 2012, and any services received during the entire calendar year will be counted toward this cap.

What Cedars-Sinai Outpatient Rehabilitation Services plans to do to address this change:

  • Provide patient education to advise them of the change in their benefits
  • Monitor the caps and advise them of when they are nearing their limits
  • Re-examine the delivery of care to improve the efficiency of care provided with greater emphasis on patient involvement and participation in their rehab program

What Outpatient Rehabilitation Services asks of our referring physicians:

  • Reinforce the recommendations of the treating therapists with the patients
  • Emphasize the importance of patient compliance with home programs and recommendations to maximize the benefits of therapy
  • Discourage patient requests for referrals to address chronic conditions that are unchanged and don’t require skill-therapy intervention
  • Emphasize the utilization of therapy at times when there are changes in status (e.g.: physical or medical), a decline or change in function (falling, increased difficulty with activities of daily living and other functional activities, cognition, increased pain, etc.) or for preventative reasons – when education or early training can prevent or reduce the likelihood of a physical, medical and/or functional decline

Cedars-Sinai Outpatient Rehabilitation Services includes: Adult Orthopedic Physical Therapy Clinic, Occupational Therapy Hand Clinic, Voice and Speech Therapy Services, Neurological Rehabilitation Program and Fibromyalgia and Chronic Pain Program.

Department welcomes 2012 surgical fellows

Thirteen surgical fellows have joined Cedars-Sinai’s Department of Surgery for 2012.

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Ankur Gupta, MD
Advanced Laparoscopic & Bariatric Surgery Fellowship

General Surgery Residency
Cedars-Sinai Medical Center

University of California, Los Angeles
David Geffen School  of Medicine

Sandhu, Kulmeet MD 70px

Kulmeet Sandhu, MD
Advanced Laparoscopic & Bariatric Surgery Fellowship

General Surgery Residency
Montefiore Medical Center

Boston University School of Medicine

Teng, Brian MD 70px

Brian Teng, MD
Colo-Rectal Fellowship

General Surgery Residency
Univeristy of Buffalo

University of Minnesota School of Medicine

Collier, Ronald Derek MD 70px

Ronald Derek Collier, MD
Critical Care Surgery Fellowship

General Surgery Residency
University of Toledo Medical Center

Howard University School of Medicine

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Matthew Bloom, MD
Critical Care Surgery Fellowship

General Surgery Residency
Stanford University Medical Center

Duke University School of Medicine

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Melanie Edwards, MD
Minimally Invasive Thoracic Fellowship

General Surgery Residency
Beth Israel Deaconess Medical Center

Loma Linda University School of Medicine

Movassaghi, Mehran MD 70px

Mehran Movassaghi, MD
Minimally Invasive Urology Fellowship

Urology Residency
University of California, Los Angeles

University of California, Los Angeles
David Geffen School  of Medicine

Koopman, Steven MD 70px

Steven Koopman, MD
Minimally Invasive Urology Fellowship

Urology Residency
University of Mississippi Medical Center

University of Alabama School of Medicine

 No Photo 70px

James Lubawski, MD
Minimally Invasive Urology Fellowship

Urology Residency
University of Mississippi Medical Center

University of Alabama School of Medicine

Chung, Joshua MD 70px

Joshua Chung, MD
Cardio-Thoracic Fellowship

General Surgery Residency
Riverside Methodist Hospital

Loma Linda University School of Medicine

Puri, Vichin 70px

Vichin Puri, MD
Comprehensive Transplant Fellowship

General Surgery Residency
New York Hospital of Queens

Maharashtra Institute of Medical Education & Research

Kandeel, Ahmed MD 70px

Ahmed Kandeel, MD
Comprehensive Transplant Fellowship

General Surgery Residency
State University of New York – Buffalo

Wake Forest University School of Medicine

  

FDA updates regarding Zofran, Ampyra

Pharmacy focus

Ondansetron (Zofran®) and QT prolongation

According to the U.S. Food and Drug Administration, preliminary results from a recent clinical study suggest that a 32 mg single intravenous dose of ondansetron (Zofran®, ondansetron hydrochloride and generics) may affect the electrical activity of the heart (QT interval prolongation), which could predispose patients to develop an abnormal and potentially fatal heart rhythm known as torsades de pointes.

Ondansetron is in a class of medications called 5-HT3 receptor antagonists. It is used to prevent nausea and vomiting caused by cancer chemotherapy, radiation therapy and surgery.

GlaxoSmithKline has announced changes to the Zofran drug label to remove the 32 mg single intravenous dose. The updated label will state that ondansetron can continue to be used in adults and children with chemotherapy-induced nausea and vomiting at the lower intravenous dose recommended in the drug label, a dose of 0.15 mg/kg administered every four hours for three doses; however, no single intravenous dose should exceed 16 mg. Information from the new clinical study will be included in the updated drug label.

Click here to read the MedWatch safety alert.

Dalfampridine (Ampyra®) and seizure risk for multiple sclerosis patients

Using information received from post-market adverse event reports, the FDA recently evaluated seizure risk in multiple sclerosis patients taking dalfampridine (Ampyra®). The majority of seizures happened within days to weeks after starting the recommended dose and occurred in patients having no history of seizures, according to the agency. The FDA is updating the drug label to clarify recommendations.

Ampyra was approved to improve walking in patients with MS. Seizures are a known side effect of Ampyra, and seizure risk increases with higher blood levels of the drug. Ampyra is eliminated from the body through the kidneys, and patients with kidney impairment may develop higher blood levels of the drug, thereby increasing their seizure risk.

The FDA reminds healthcare professionals that Ampyra should not be used in patients with a history of seizures or who have moderate to severe renal (kidney) impairment (measured as creatinine clearance [CrC] less than or equal to 50 mL/min).

Click here to read the MedWatch safety alert.

Arm yourself against the flu

Flu IQ 180pxFlu vaccine clinics begin right after Labor Day

Cedars-Sinai will begin offering free flu vaccinations to physicians and employees beginning Tuesday, Sept. 4, immediately following the Labor Day holiday.

Flu vaccine clinics will be held on the following dates and locations:

Sept. 4-7

  • Harvey Morse Auditorium lobby from 7:30 a.m. to 3 p.m.
  • South Plaza Room 2806 (next to Medical Library) from 4 p.m. to 10 p.m.

Sept. 10-14

  • Harvey Morse Auditorium lobby from 7:30 a.m. to 3 p.m.
  • South Plaza Room 2806 (next to Medical Library) from 4 p.m. to 10 p.m.

Everyone is encouraged to get vaccinated to help protect against the flu, as well as to prevent the spread of infection to patients and family members.

"Many healthcare workers believe they 'never get the flu,' but even during a mild flu season, nearly one in four show serologic evidence of exposure to the flu," said Rekha Murthy, MD, hospital epidemiologist. "Because we care for patients who are at high risk of flu complications, it's important that all of us get vaccinated to help prevent the transmission of the flu virus throughout the medical center."

Those who decline to get vaccinated must complete a signed declination form. Declination forms must be hand delivered to Employee Health Service (EHS) or to a Vaccination Team Member during one of the scheduled clinics.

For more information, or to schedule an appointment for a flu vaccination, please call Employee Health Service at ext. 3-3322.

Test your flu IQ by clicking on the red start button above.

Circle of Friends honorees for July

The Circle of Friends program honored 74 people in July.

Circle of Friends allows grateful patients to make a donation in honor of the physicians, nurses, caregivers and others who have made a difference during their time at Cedars-Sinai. When a gift is made, the person being honored receives a custom lapel pin and a letter of acknowledgement.

Click here for more information about the program and for a list of past honorees.

  • Felicitas M. Acosta
  •  Ellen B. Klapper, MD
  • Kapil K. Anand, MD
  •  Brenda E. Laabs, RN
  • M. William Audeh, MD
  •  Tricia Len, MD
  • Irene K. Barnett, MD
  •  Andrew J. Li, MD
  • Daniel S. Berman, MD
  •  Michael C. Lill, MD
  • Satinder J. Bhatia, MD
  •  Josephine T. Maleon
  • Kelly Birk, RN
  •  Ted Marbury
  • Philip G. Brooks, MD
  •  Kimberly McGroarty, RN
  • Neil A. Buchbinder, MD
  •  Robert J. McKenna, Jr., MD
  • Christiane Michele J. Burnison, MD
  •  Stephanie McLagan, RN
  • Neyra Cannon, CNA
  •  Leslie Memsic, MD
  • Grace Carangal, MD
  •  Allan L. Metzger, MD
  • Christopher Chang, MD, PhD
  •  Monica M. Mita, MD, MDSc
  • William W. Chow, MD
  •  Kelly J. Moore, RN
  • Alice P. Chung, MD
  •  Kimberly Nash, BS
  • Stephen R. Corday, MD
  •  Surasak Phuphanich, MD
  • Donald C. Dafoe, MD
  •  Sheldon Reiss, MD
  • Catherine M. Dang, MD
  •  Elissa K. Rosenberg
  • David Defren, MD
  •  Barry E. Rosenbloom, MD
  • Premal J. Desai, MD
  •  Paul A. Rudnick, MD
  • Ricardo Duarte
  •  Vivian L. Salle, CN
  • Marla C. Dubinsky, MD
  •  Jescelyn A. Santos, RN, BSN
  • Margaret R. Farrell, RN, BSN
  •  Michael M. Shehata, MD
  • Charles A. Forscher, MD
  •  Jasminka Stegic, MS, ANP-BC, CCRN
  • Alex Foxman, MD
  •  Jerrold H. Steiner, MD
  • Genise N. Fraiman, MD
  •  Alfredo Trento, MD
  • Rodney A. Gabriel, MD
  •  Diane M. Tryciecky, RN
  • Richard E. Gould, MD
  •  David M. Ulick, MD
  • Yeren B. Habana, RN
  •  Kambiz Vahabzadeh, MD
  • Antoine Hage, MD
  •  Robert A. Vescio, MD
  • Seth Hoffman, RN
  •  Ronald G. Victor, MD
  • Nhung Hong Huynh, RN
  •  Michael H. Weisman, MD
  • David Jeon
  •  Janet White, MD
  • Stanley C. Jordan, MD
  •  Paula J. Whiteman, MD
  • Beth Y. Karlan, MD
  •  Edward M. Wolin, MD
  • Ilan Kedan, MD, MPH
  •  Paige Woodward, NP
  • Bahareh Kermani, RN
  •  John S. Yu, MD

Cedars-Sinai studies galaxy-exploring camera in the operating room

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Neurosurgeons and researchers at Cedars-Sinai Medical Center and the Maxine Dunitz Neurosurgical Institute are adapting an ultraviolet camera to possibly bring planet-exploring technology into the operating room.

If the system works when focused on brain tissue, it could give surgeons a real-time view of changes invisible to the naked eye and unapparent even with magnification of current medical imaging technologies. The pilot study seeks to determine if the camera provides visual detail that might help surgeons distinguish areas of healthy brain from deadly tumors called gliomas, which have irregular borders as they spread into normal tissue.

"Our goal is to revolutionize the way neurological disorders are treated. Ultraviolet imaging is one of several intraoperative technologies we are pursuing," said Keith L. Black, MD, chair of the Department of Neurosurgery.

The tumors' far-reaching tentacles pose big challenges for neurosurgeons: Taking out too much normal brain tissue can have catastrophic consequences, but stopping short of total removal gives remaining cancer cells a head start on growing back. Delineating the margin where tumor cells end and healthy cells begin never has been easy, even with recent advances in medical imaging systems, said Black, director of the Maxine Dunitz Neurosurgical Institute and the Johnnie L. Cochran, Jr. Brain Tumor Center and the Ruth and Lawrence Harvey Chair in Neuroscience.

But the ultraviolet camera might be able to see below the surface, he said. Because tumor cells are more active and require more energy than normal cells, a specific chemical (nicotinamide adenine dinucleotide hydrogenase or NADH) accumulates in tumor cells but not in healthy cells. NADH emits ultraviolet light that may be captured by the camera and displayed in a high-resolution image. The camera, on loan from NASA's Jet Propulsion Laboratory, employs the ultraviolet technology used in space to study planets and distant galaxies.

"The ultraviolet imaging technique may provide a ‘metabolic map' of tumors that could help us differentiate them from normal surrounding brain tissue, providing useful, real-time, intraoperative information," said Ray Chu, MD, a neurosurgeon leading the study with co-principal investigator Babak Kateb, MD, research scientist at Cedars-Sinai's Maxine Dunitz Neurosurgical Institute and chair of the board of the Society for Brain Mapping and Therapeutics.

Kateb observed: "This study and equipment-sharing arrangement represents the leading edge of an effort by Cedars-Sinai to develop the next generation of solutions for brain tumors, injuries and other neurological disorders right here at Cedars-Sinai's Maxine Dunitz Neurosurgical Institute by introducing paradigm-shifting technologies into the field."

In the clinical trial, the highly sensitive camera is placed near the surgical field, recording images as the neurosurgeon exposes and removes the tumor. Images are not used in decision-making or surgical technique but later are correlated with tumor appearance, laboratory findings, and MRI and CT scans to assess the ultraviolet technology's value in the operating room.

John S. Yu, MD, vice chair of the Department of Neurosurgery, and Adam N. Mamelak, MD, neurosurgeon and co-director of Cedars-Sinai's Pituitary Center, also are participating in the study.

The ultraviolet imaging study, which will include 20 patients, is open to adults undergoing open-skull surgery for any brain tumor that is within range of the camera lens. Enrollment information is available by contacting Suzane Brian, study research assistant, in the Department of Neurosurgery at (310) 423-7900.

Pictured above: Cedars-Sinai neurosurgeons and researchers use an ultraviolet camera on loan from NASA's Jet Propulsion Laboratory.

Medical mission team in Guatemala sees increased need for care

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The goals are the same, but the situations always change when the team based at Cedars-Sinai travels to Guatemala on its annual medical mission. This year 96 doctors, nurses and support staff found the city of Joyabaj to be in extreme need.

"The people we see on these missions are always really poor," said Cindy Renick, MSN, CCRN, who served as section leader for the recovery room. "But this time, it seemed as though there was even greater need than we've seen before."

Guatemala 2 220pxThe Cedars-Sinai team recently completed its 12th mission – all volunteers who used vacation time and paid their own way to spend 10 days providing medical care to isolated and impoverished parts of Guatemala. It costs each person about $2,000 to make the trip, which is arranged by HELPS International. A nonprofit group that organizes and supports a broad range of volunteer activities in Guatemala, HELPS brings medical services to far-flung villages where people have limited access to doctors and no way to pay for the care they need.

Joyabaj is a town of about 9,500 people in the Sierra de Chuacús mountains, the central highlands of Guatemala. The team set up shop in a local hospital.

Other than a small clinic and a couple of functional rooms, the hospital was empty, said Babak Larian, MD, an ear, nose and throat specialist who has participated in the missions since 2003.

"The hospital had been built for the area, but only 10 percent of it was being used," said Larian, who has served as director of the Cedars-Sinai HELPS mission for the past four years. "They didn't have the equipment to fill it, or the money or the staff to run it."

Using equipment provided by HELPS, the team turned a portion of the facility into a functioning hospital with four operating rooms and a recovery room, besides clinic and treatment areas. Of the four ORs, one or two would typically run until midnight. The recovery room was staffed 24-7, with nurses working eight-hour shifts.

In between performing surgeries and seeing patients, the Cedars-Sinai team pitched in to help the local doctors.

Guatemala 3 220px"The doctors running the ER there were so poorly trained, and I felt so bad for them," Larian said. "We helped them with the ER patients the whole time we were there."

One of the cases the local doctors couldn't handle was a middle-aged man whose leg was so badly infected, it had to be amputated.

"It was an un-healing wound that he had for four years," Renick said. "That's big. In all my time with the team, we have never done something like that."

But there was no choice – without the surgery, the man would have died.

"And he did so well – two days later he was sitting up and smiling, so happy to feel better," Renick said.

After four days in the recovery room, one of the nurses taught the man how to use crutches. A few days later, he was given a wheelchair made from bicycle tires and a plastic lawn chair.

"I asked his son how the father had managed to get around without crutches, and his son said, ‘I carry him,'" Renick said. "Everything about that case really touched me."

In all, the Cedars-Sinai team saw 1,500 patients, performed 134 surgeries, and did 200 dental consults and procedures. Part of the team traveled to the tiny village of Laguna Seca and operated a small clinic for several days.

"We like to arrange for outreach to smaller villages in the vicinity where we take a pediatrician, pharmacists and a couple of internists and set up a mini clinic," said James Laur, vice president for Legal Affairs at Cedars-Sinai. Laur has taken part in HELPS missions for the past 12 years.

"I got to be a helper with the outreach action squad this time," Laur said. "We showed up at the village health center and the entire village was lined up at the back door and the front door, waiting to see a doctor for the first time in years or in many cases ever."

The gratitude of the people they help is overwhelming – and humbling, Laur said.

"These are people who have very little, and yet they will always give you a gift, a hand-woven scarf or a tortilla they brought from home," he said. "And as they're leaving the recovery area, if they see you have (a HELPS ID badge), they'll stop you and give you a hug."

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