McGee-Fest 08...oops...08...I mean...09

“Sickness impedes the body but not the ability to make choices, unless you choose so. Lameness impedes the leg, but not the ability to make choices, unless the mind chooses so. Remember this with regard to everything that happens: Happenings are impediments to something else, but not to you.”

-- Epictetus 135 C.E.

MCGEE-FEST LETTER

Dear All:

I hope you and yours are well.

Our friend Tim McGee is about to undergo one of those life challenging experiences that awaits us all in the grand scheme of things. On January 5 he will have a ten-hour surgery at the University of Wisconsin-Madison to remove his larynx and rebuild his voice box. This procedure has three components: 1) veins, arteries, and skin are taken from his left forearm; 2) cartilage is taken from his rib, which is then combined with the skin and blood vessels to rebuild his voice box; 3) skin is then taken from his thigh to patch the area from which the skin, veins, and arteries were removed.

Like many of us (including myself), his financial situation has been trying. Credit card debt, providing for family and meeting the unpredictable contingencies of everyday life are issues common to us all, but dealing with these problems while coping with a major illness presents a different set of obstacles. While he has some health benefits, expenses like gas, food, and lodging for long trips to Madison are draining.

As many of his friends are musicians, I think we have a duty to help Tim and his family. To that end I think a musical benefit would be in order. Having some experience with these events around Ann Arbor, I think we could provide sizable help if we maximized our resources.

My thoughts are this (and these are just general suggestions): we could have about 6 acts do a half hour set each (5-6 songs). Logistically, there would be a drum set and back line of amps. This would negate the burden of lengthy set ups, etc. I was thinking Punch, Tret Fure, Fast Eddie, Daryll Syria (Project or Congo Se Menne), Bongo Fury (Jerry Kippola), Laurie Hayes’ Flat Broke Blues Band, or whomever else might be interested.

Having the Walrus name attached, and doing a short set (equal to the rest of the performers) where we would do 5-6 Walleye hits would provide a huge draw and hence make more dough. I also thought this event might be coordinated with the class of 69 reunion weekend (July 24-25) as a way of increasing the attendance.

In short, our purpose would be to make money for McGee. It’s a chance for all of us to direct our energies toward a worthy endeavor, and to curry some good karma with our various deities.

Local Merchants could be involved to donate items to a blind auction, donated food could be served, the bar could donate a percentage of the drink money, and the door would go to the McGee family. If some money were needed to assist wayward musicians, that could also be managed.

It’ll take a bit of work and group coordination, but I think it’s our obligation to make this happen. Were any of us in Tim’s situation, he would do the same.

Best - Randy

ABOUT TIM’S SURGEON

So, there’s a sort of formal letter suggesting what we can do to help. Now, a bit about Tim’s surgeon, first off, he’s a Michigan man:

Gregory K. Hartig, MD, FACS
Professor, Division of Otolaryngology-Head and Neck Surgery
K4/720 Clinical Science Center600 Highland AvenueMadison, WI 53792-7375
Appointments: (608) 263-6190
Office: (608) 265-8207
FAX: (608) 265-9255
hartig@surgery.wisc.edu

Education

MD, University of Michigan, Ann Arbor, MI, 1988
Internship, St. Joseph Mercy Hospital, Ann Arbor, MI, 1988-1989
Residency, University of Michigan, Ann Arbor, MI, 1989-1993
Fellow, Head and Neck Reconstructive Surgery, University of Pennsylvania Medical Center, Philadelphia, PA, 1993-1994

Clinical Specialties

Dr. Hartig is certified by the American Board of Otolaryngology-Head and Neck Surgery. His practice combines traditional head and neck surgery with facial plastic and reconstructive surgery. He has extensive experience managing head and neck cancer, including tumors of the skull base, and performing microvascular free tissue transfer reconstruction. Dr. Hartig directs the head and neck oncology program at UW Hospital and Clinics, and is chief of the otolaryngology service at the William S. Middleton Memorial Veterans Hospital.

Research Interests

Dr. Hartig has research interests in the cytogenetics of head and neck carcinoma, free flap physiology, and airway reconstruction.

Recent Publications

Been MJ, Watkins J, Manz RM, Gentry LR, Leverson GE, Harari PM, Hartig GK. Tumor volume as a prognostic factor in oropharyngeal squamous cell carcinoma treated with primary radiotherapy., Laryngoscope. 2008 Aug;118(8):1377-82. [PubMed ID: 18418275]
Hodge CW, Bentzen SM, Wong G, Palazzi-Churas KL, Wiederholt PA, Gondi V, Richards GM, Hartig GK, Harari PM. Are we influencing outcome in oropharynx cancer with intensity-modulated radiotherapy? An inter-era comparison., Int. J. Radiat. Oncol. Biol. Phys. 2007 Nov 15;69(4):1032-41. [PubMed ID: 17967300]
Upton DC, McNamar JP, Connor NP, Harari PM, Hartig GK. Parotidectomy: ten-year review of 237 cases at a single institution., Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery. 2007 May;136(5):788-92. [PubMed ID: 17478217]
Wiederholt PA, Connor NP, Hartig GK, Harari PM. Bridging gaps in multidisciplinary head and neck cancer care: nursing coordination and case management., Int. J. Radiat. Oncol. Biol. Phys. 2007;69(2 Suppl):S88-91. [PubMed ID: 17848305]
Sippel RS, Ozgül O, Hartig GK, Mack EA, Chen H. Risks and consequences of incidental parathyroidectomy during thyroid resection., ANZ journal of surgery. 2007 Jan-Feb;77(1-2):33-6. [PubMed ID: 17295817

O.K. for some of you this might be a bit boring, but what’s kind of cool about this guy is his interest in leeches. That’s right, LEECHES! Maybe McGee can just swim around in Lake Independence and those motley little blood suckers will take care of the rest. So what’s the deal with leeches? Here’s some info:

Hirudotherapy, the use of medicinal leech for medical purposes, was introduced by Avicenna in The Canon of Medicine (1020s). He considered the application of leech to be more useful than cupping in "letting off the blood from deeper parts of the body." He also introduced the use of leech as treatment for skin disease. Leech therapy became a popular method in medieval Europe, namely the leeches from Portugal and France, due to the influence of his Canon. A more modern use for medicinal leech was introduced by Abd-el-latif al-Baghdadi in the 12th century, who wrote that leech could be used for cleaning the tissues after surgical operations. He did, however, understand that there is a risk over using leech, and advised patients that leech need to be cleaned before being used and that the dirt or dust "clinging to a leech should be wiped off" before application. He further writes that after the leech has sucked out the blood, salt should be "sprinkled on the affected part of the human body."[1]

In Modern Medicine:

Medicinal leeches are now making a comeback. They provide an effective means to reduce blood coagulation, relieve venous pressure from pooling blood, especially after plastic surgery, and stimulate circulation in reattachment operations for organs with critical blood flow, such as eye lids, fingers, and ears.

Because of the minuscule amounts of hirudin present in leeches, it is impractical to harvest the substance for widespread medical use. Hirudin (and related substances) are synthesised using recombinant techniques.

They are also being used in relation to the treatment of various Varicose conditions

Here’s what Tim’s doc has been up to:

Testing a Device to Replace the Leech for Treating Venous Congestion
Gregory K. Hartig, MD; Nadine P. Connor, PhD; Thomas F. Warner, MD; Dennis M. Heisey, PhD; Majid Sarmadi, PhD; Michael L. Conforti, DVM, MS
Arch Facial Plast Surg. 2003;5:70-77.

ABSTRACT

Objective: To test the effectiveness of a device designed to promote decongestion and tissue survival of a fasciocutaneous flap during 15 hours of complete venous obstruction.
Methods In a porcine (THAT’S A PIG!) model, a 9 x 7-cm fasciocutaneous flap was elevated and the associated veins were clamped, causing complete venous obstruction for 15 hours in 6 control and 6 treatment animals. Up to 3 devices were used to treat the flap in a predetermined pattern. Control flaps were not treated. Measures of treatment efficacy included blood volumes removed; changes in skin color, surface perfusion, and tissue oxygen tension; and end point histologic findings.

Results: Control flaps were characterized by progressive darkening of skin color, undetectable surface perfusion, and low levels of oxygen tension. Histologic assessment showed severe congestion and extravasation of blood and distinct signs of necrosis. In contrast, treated flaps had significant improvements in skin color, surface perfusion, and subcutaneous oxygen tension. Histologic analysis showed little, if any, congestion and no signs of necrosis. Mean blood volume removed was 29.5 mL/h.

Conclusion: The device was effective in decongesting a large area of tissue during 15 hours of complete outflow obstruction, based on quantitative measurements of tissue health and viability.
INTRODUCTION

Use of the medicinal leech (Hirudo medicinalis) for treatment of venous congestion in transferred or replanted tissues has become the standard of care in situations in which surgical correction of a venous obstruction is not feasible.1-5 Unfortunately, there are numerous drawbacks with the use of leeches, including negative perception by patients, family, and health care workers; the possibility of infection; increased nursing care; and the possibility of unwanted leech migration or feeding on healthy tissue.6-11 Furthermore, our personal experience suggests that leeches are of limited value in situations in which significant venous congestion is present.

During the past several decades, there have been many articles3-5,11-13 that describe the use of medicinal leeches in clinical situations. However, the efficacy of leech use for treating congested tissue has not been documented in either clinical trials or experimental studies. Our work14 initially focused on characterizing the performance of the medicinal leech by using a clinically relevant swine model. In evaluating leech performance, we found that the average blood meal of a leech when feeding on a congested porcine fasciocutaneous flap was only 2.45 mL. Subsequent passive bleeding from the leech wound after leech detachment on the same flaps averaged only 2.21 mL during the first 2 hours after detachment. The effects of active and passive bleeding resulted in a focal improvement in flap color and perfusion, which was limited to a site only 1.6 cm in diameter, centered on the middle of the leech wound.14 Clearly, leeches have limited ability to decongest a large or severely congested flap. An alternative method for blood removal from congested tissue flaps must be developed to promote tissue survival.
In developing a mechanical device to replace the medicinal leech, we first focused our efforts on a method to improve passive bleeding from the leech wound after leech detachment.15 We developed a mechanical device that provided heparinized irrigation and mechanical agitation of the leech wound. This device increased passive bleeding by 156% during the first 3 hours after leech detachment. However, the practical effect on the congested fasciocutaneous flap was minimal. In other words, the severe global venous congestion in this extreme model was largely unchanged even with an increased volume of blood removed.

Through evaluation of medicinal leech performance and development of a first-generation device to increase passive bleeding, a second-generation device to completely replace the medicinal leech was developed. This device removed more blood from a congested flap than a leech (under identical conditions) and provided more complete tissue decongestion of larger tissue flaps than a leech.16 The goal of this study was to test the mechanical device during prolonged complete venous obstruction (15 hours) using a clinically relevant fasciocutaneous flap. Measures of flap health, including flap color, surface perfusion, subcutaneous tissue oxygenation, and end point histologic findings were used to evaluate the ability of the mechanical device to treat the venous congestion vs untreated control flaps. Our long-term goal is to develop a commercially available mechanical device with the ability to salvage congested tissue.

Well, There hasn’t been a lot of my voice in here (some of you might find this a blessing) but I’ve tried to offer some info on the capable hands Tim’s assigned himself to, provide an opening for those of us who want to help in an active way (passive sympathetic understanding is also a help), and garner some props for the lowly leech.

Peace - Randy