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Day 27: FINAL DAY

With a rueful look on our faces, we met at our final destinations.

Dr. Gross worked with Dr. Jason Bariteau.

Chris and Dr. Bariteau

Here they exchanged ideas about how to promote young foot and ankle surgeons with research and at a national organizational level. We then decided to make an Academy video about how to fix the failure of a 1st MTP synthetic cartilage implant.

A failed implant that will now need to be revised.

Dr. Kang spent the morning in the OR at EUOSH with Dr. John Rhee observing anterior cervical and lumbar fusion surgeries.  After an insightful morning with Dr. Rhee discussing surgical decision making and tips/tricks, the afternoon was then spent observing Dr. Tim Yoon at the Emory Orthopaedics and Spine Center.  The day ended with a review of cases at the weekly preop conference with Dr. Yoon and his team.

Rachel hanging out with Dr. John “X” Xerogeanes

Others had a different type of learning– at the Georgia Aquarium.  It is widely regarded as one of the best aquariums in America. It is the world’s largest aquarium, holding 10,000,000 gallons of water. It is widely busy and popular. The Aquarium has the greatest variety of marine life compared to any other aquarium in the world.


Once we collected ourselves and packed, we headed out to a final celebratory dinner at a beautiful French restaurant. We were toasted warmly by our hosts and had a fabulous last dinner together. This was truly an unforgettable experience that we will cherish for the rest of our lives. We have made lifelong confidants and colleagues. While the benefits of this fellowship are not immediate, we look forward to reconnecting with whom our paths have crossed.

One last picture!!! Of course my eyes are closed.

Day 26– Emory

We were distraught to wake and not wait for each of our colleagues to gather and be whisked away by the morning’s transport. But we survived. Today, we each had the opportunity to follow our hosts and other members in their division on their clinical day.

Dr. Gross spent the beginning of the AM with Dr. Jason Bariteau. https://providers.emoryhealthcare.org/provider/Jason+Bariteau/777577 Dr. Bariteau is a rising star in the Foot and Ankle world. Following this, Dr. Gross was able to hang out with Dr. Sameh Labib, arthroscopist and Foot and Ankle surgeon. It was also a pleasant surprise to see a former MUSC resident at Emory for a Sports Fellowship working with Dr. Labib today. https://providers.emoryhealthcare.org/provider/Sameh+A+Labib/777660

Dr. Gross and Dr. Ashford gearing up for the day.
Dr. Labib providing excellent care from a world class institution

Dr. Gross spent the day watching ankle arthroscopy, a posterior tibial tendon transfer for foot drop, an Achilles primary repair and Achilles reconstruction.

Dr. Kang spent the day with Dr. Tim Yoon and Dr. John Heller observing spine cases at the Emory University Orthopaedics and Spine Hospital (EUOSH). There was a variety of interesting cases, including a cervical disc replacement, cervical corpectomy, and posterior lumbar fusion surgeries.  The day was filled with thoughtful conversations and stimulating discussions on surgical decision making and surgical techniques/approaches.

Dr. Kang with Dr. TIm Yoon, Dr. Alex Arzeno (Emory Spine Fellow), and Dr. Ryan Patton (Emory Ortho PGY-2 Resident)

Dr. Khan and Dr. Samora started the day off early heading to the upper extremity research meeting at the VA. An insightful discussion was had regarding ongoing research at Emory related to biomechanics , basic science as well as database studies. We discussed the need for large multi- center randomized controlled trials to answer critical questions facing our speciality. Later in the day we had a tour of the VA and the labs with a fascinating overview of the current research related to stem cells and cartilage. We toured the sports facilities and received an overview as to the biomechanics and gate assessments performed in rehabilitating the elite athlete.

Dr. Frank spent the day with Dr. Kyle Hammond, Head team doctor for the Atlanta Falcons. They toured the sports medicine clinic and Falcons facilities.


Emory sports medicine complex

After we all met up again, the Emory team put together an awesome academic symposium at night. This was our last chance for this Fellowship to talk about what we are passionate about.

We really can give each others’ talks

We are extremely grateful to Dr. Boden and Roberson for the opportunity to interact with the staff and give us the opportunity to learn from them. As an extra bonus, Dr. Boden discussed the art of making the department a valuable asset for the hospital organization in a small group setting.

A penultimate group photo.

Day 25– Wake Forest and Emory

Dr. Frank was happy to get that free hour of sleep!
A gorgeous view from Dr. Frank’s walk in the AM

So… there are greenhouses and there are greenhouses. Dr. Gary Poehling, former Chairman at Wake Forest and Professor Emeritus, invited the faculty and the fellows to his beautiful home on Sunday morning for an early sendoff.

In the early 90s, Dr. Poehling had this brought from a few miles away, piece by piece until you see the splendid masterpiece it is today. This was originally constructed in the 1930s.
Drs. Teasdall, Emory, Poehling, Koman, Martin, Waterman, and fellows enjoying breakfast. Moin is keen to be updating his medical social media followers on his adventures.
Dr. Poehling telling us about his tremendous career.
“Just” a fountain on Dr. Poehling’s property.
Drs. Teasdall, Emory, Poehling, Koman, Martin, Waterman, Tuohy, Pilson, and fellows in front of the greenhouse.
5 fellows and their carry ons > 1 minivan. Thankfully, we played Tetris when we were younger.

After we beat Atlanta’s traffic, we made it up to Dr. James Roberson’s beautiful home. We were able to nap, do laundry, stroll or chit chat. Some people decided to do work.

Moin, Rachel, and Chris happened to stumble upon Atlanta’s best wings while taking a stroll from Dr. Roberson’s house. This made us incredibly happy.

In the early evening, our hosts came to the Roberson household for an informal meet and greet. We traded gossip and enjoyed great appetizers. The pairings were as follows:

Moin Khan – Hosted by Dr. Eric Wagner

Rachel Frank – Hosted by Dr. Kyle Hammond

Christopher Gross – Hosted by Dr. John Louis-Ugbo

Daniel Kang – Hosted by Dr. Tim Yoon

Julie Samora – Hosted by Dr. Charles Daly

A beautiful night in the Big Peach (or as it was called in the 1880-1900s– the Chicago of the South)

We parted and went our separate ways for dinner.

Dr. Ugbo and Gross enjoying Ethiopian cuisine. But not without some case discussion (see below!)

Dr. Ugbo doing some insanely difficult Charcot reconstructions in the ATL. Foot and ankle surgeons have plenty to learn from his vast experience.

We all hit the hay early as we know that in the marathon that is a travelling fellowship, the end of the race is as important as its beginning. Off to Emory’s clinics and ORs tomorrow!

Day 24 – Wake Forest Baptist Health

After retreating back to our hosts’ houses Friday night, we awoke with a renewed strength to cheer on the Wake Forest Demon Deacons. We were treated to a tailgate that was hosted by Wake Forest Orthopaedics and the Tailgate Guys. Apparently, people have been preparing themselves for the game since 830am!

Fellow and Host, Dr. Robert Teasdall– foot and ankle surgeons enjoying their tailgate coffee.

While the tailgate unfolded, Dr. Brian Waterman took us on a tour of the Wake Forest baseball team’s facilities. These rivaled many professional sports teams that we have been honored to take care of!

Now, we may be biased, but after the chocolate milk machine our favorite portion was the pitching biomechanics facilities. Wake Forest employes a full-time PhD to help study, analyze and improve a pitcher’s mechanics. I wish there were the same funding for surgeons. Imagine having someone watch how you operate and help improve your technique!

Baseball’s chocolate machine. Apparently, the first week they had it, they spent thousands of dollars on that delicious drink.
Inside the locker room.
Moin, enjoying America’s favorite past time. And yes, he did get it over home plate. Sort of.
Imperfect biomechanics

After some shenanigans of running the imaginary bases, we headed into the game. By the time we ordered our first hotdog, Wake was up 14-0!

Awesome seats for an awesome game

Half time!

https://godeacs.com/sports/2018/8/2/what-is-a-deamon-deacon.aspx

After the game, we needed to recharge. Dr. Gross and Dr. Kang met up with Dr. Christopher Tuohy to throw some axes. Here surgical precision is required to ensure that we do not hurt any appendage.

Entering what!!!???
No surgeons were hurt in the making of this photograph.

After resting up we met up the faculty for another awesome dinner. Dr. Waterman did an awesome job organizing everything in the city despite it being parents weekend at Wake and homecoming at Winston-Salem State.

Dr. Waterman, Dr. Emory, Dr. Koman, Dr. Martin, Dr. Butler, and fellows

Day 23– Charlotte Medical Center and Wake Forest

This morning Rachel and I started our normal routine of working out on the bikes and treadmills around 4am. It is important to keep our minds and bodies fit as we are well hosted.

The residents and fellows were kind enough to pick us up and we were brought to our speciality-specific conferences. At my foot and ankle conference, the fellows, residents, and I went through insanely complicated reconstructive cases that only the best of the best can take care of. Thankfully, the surgeons at OrthoCarolina are up for the challenge!!!

Discussing a difficult exchange tibial nail.
Posing with the Foot and Ankle residents, fellows (including MUSC’s own Dr. Anthony Barcel) and Dr. Carroll Jones.
Dr. Gaston and Dr. Samora leading the residents through anatomy dissection of the arm.

Afterwards, we met with the surgeons of Atrium Health and OrthoCarolina to discuss the future of the enterprise with Dr. T. Moorman. It is interesting to see what synergy happens when the hospital system and surgeons align. Each of us then gave talks ranging from Diversity to OrthoBiologics to Shoulder Instability and then Resilience. Dr. Gross gave a revamped talk regarding the surgical management of Charcot learned from a myriad of successes and failures.

Then the insanity began. We headed to the U.S. National Whitewater Center. It is an outdoor recreation and athletic training facility for whitewater rafting, kayaking, canoeing, rock climbing, mountain biking, and hiking which opened to the public in 2006. The Center is located on approximately 1,300 acres (530 ha) of land adjacent to the Catawba River, with more than 35 miles of developed trail. This facility is an official Olympic Training Center for whitewater slalom racing.

The Fellows and residents along with Dr. Joseph Hsu and Dr. Colin Anderson right after we geared up for ziplining.
Following ziplining and roping, we were able to enjoy lunch.
One final pose before jumping on the bus

Needless to say after all of that fun, we were tired. We then jumped on the transportation and made our ways to our individual sponsor’s houses in Winston-Salem.

Here are some images from around town. If you want to know more about its rich history, please follow this link: https://www.winston-salemdentists.com/rich-history-of-winston-salem-north-carolina/

Finally, the night culminated in a event at the RJ Reynold’s old power plant. A fantastic space to exchange ideas and make new friends. This event was MC’d by our main host, Dr. Brian Waterman. https://www.wakehealth.edu/Providers/W/Brian-Robert-Waterman

There was a tremendous amount of support by the faculty and residents from Wake Forest Baptist Health, despite it being a Friday night!

The hand surgeons, Dr. L. Andrew Koman and Dr. Julie Samora, trading tips and tricks.

We want to thank the Wake Forest Orthopaedics Department for its tremendous support.

Day 22 – Johns Hopkins University and OrthoCarolina/Atrium Health

We attended morning conference at the Johns Hopkins University Medical Center hosted by Dr. Jim Ficke, Director of the Johns Hopkins Department of Orthopaedic Surgery.  We had poignant talk by Dr. Ficke on the history of the JHU Department of Orthopaedic Surgery and the future of the program.  The NATF fellows were each given time to introduce themselves and discuss the highlights of the tour thus far.  We then had an open session for discussion and exchange of ideas with the JHU Department of Orthopaedic Surgery faculty and residents.

2019 AOA NATF fellows with Dr. Ficke at JHU Orthopaedic Surgery morning conference.
Dr. Kang with Dr. Paul Sponseller (Scoliosis Research Society President, Chief Division of Pediatric Orthopaedics), Dr. Khaled Kebaish (Chief Division of Spine Surgery), and Dr. Floreana Kebaish (Orthopaedic Surgery Chief Resident, future WashU Spine Fellow)

After a thought provoking conversation and time to network with the JHU Orthopaedic Surgery faculty, we headed to the Baltimore International Airport (BWI) to catch a flight for Charlotte, N.C.

Charlotte Airport

Hi there. Chris here.

It was quite a wonderful journey to the North for the past few weeks.  We revisited places we have learned and trained. We experienced the exhilaration of familiar haunts as we relived some fundamentally life- changing locales.  But as we land in the Carolinas, I feel renewed as the group’s only adopted Southerner. The air is warm, the smells inviting. No  puffy jackets required.

Now a little about North Carolina. It was established as a royal colony in 1729 and is one of the original Thirteen Colonies. North Carolina is named in honor of King Charles I of England who first formed the English colony, with Carolus being Latin for “Charles”. On November 21, 1789, North Carolina became the 12th state to ratify the United States Constitution.

When we settled, we walked from our hotel to meet our local hosts, Dr. Joseph Hsu and T. Moorman, at Wolfgang Puck.  We had a rousing conversation ranging from life in the Carolinas and to the opiois crisis.

We spent the afternoon going our separate ways to find the Charlotte that best fits us.  I am only going to assume that some  people chose to get their biscuit on at Bojangles, while I searched high and low for the best modern art that Charlotte has to offer.

Bechtler Museum of Modern Art

Nomadic Murals Exhibition

NASCAR Hall of Fame: TripAdvisor’s #1 Destination
Bojangles’ Famous Chicken ‘n Biscuits: founded 1977 in Charlotte

After we reconvened, we met the residents and attendings at the Carmel Country Club. We figured out who among the residents were sports medicine or foot/ankle very quickly.

It was inspiring to see such an awesome representation of women in orthopaedics!’

Making the Women in Ortho proud at CMC!

We were able to have stimulating conversation at each of our tables.

Day 21 – White House Tour and Johns Hopkins University

We were excited to start our day exploring Washington, D.C. with LTC Mel Helgeson serving as our guide.  We took a ride on the Red Line metro from Friendship Heights to Metro Center and started our journey with a short walk to the White House East Wing.

Dr. Mel Helgson leading the charge to the metro train..on our way to the WHITE HOUSE!
2019 NATF Fellows visiting the White House East Wing
2019 NATF Fellows and Dr. Helgeson visiting the White House East Wing
2019 AOA NATF fellows at the East Wing Ceremonial entrance.
Exiting the White House East Wing, following an insightful conversation with a U.S. Secret Service agent, we are extremely grateful for the service and dedication of our U.S. Secret Service.

After an engaging and interactive visit to the White House East Wing and with the U.S. Secret Service, we strolled by the National Christmas Tree on our way to the Eisenhower Executive Office Building (EEOB) and White House West Wing.

Walking to the Eisenhower Executive Office Building (EEOB), beautiful views of the National Mall and a view of the National Christmas Tree.
View of the White House on our walk to the EEOB and White House West Wing.
2019 NATF Fellows standing in front of the White House.
Remembering our friendship with our neighbors to the north, through the Webster-Ashburton Treaty. We are grateful for having Dr. Khan as a member of our tour, and hope to maintain strong bonds with our Canadian orthopaedic surgeons colleagues for many more years to come.
Approaching the White House West Wing.
Outside of the White House West Wing entrance.
2019 NATF Fellows and Dr. Mel Helgson standing outside of the White House West Wing.
Walking into the White House West Wing area.
Inside the White House Press Room.
Inside the White House Press Room.

We enjoyed an insightful and captivating tour, and our tour of the EEOB was capped off with a visit the White House Medical Unit, where we learned about the operational tempo and many man hours that are required to prepare for medical emergency response, in addition to the daily, routine White House clinic operations.

Walking to the Eisenhower Executive Office Building, view of the press getting ready for a briefing.
Outside the EEOB.
The Vice President’s Ceremonial Office and a picture of his desk in the EEOB.
The Vice President’s Desk Drawer.
EEOB West Rotunda which was designed by the Department of the Army.
EEOB East Rotunda which was designed by the Department of the Navy. Go Army! Beat Navy!
Visit to the White House Medical Unit.
Custom examination chair in the White House Medical Unit.

After an amazing visit to the White House, we hopped back on the metro, enjoyed a lunch near our hotel with Dr. Helgeson and then commuted up to Baltimore for our visit to Johns Hopkins University (JHU).

We were greeted by Dr. Dawn LaPorte, Program Director for the JHU Orthopaedic Surgery Residency, and a few moments later by Dr. Jim Ficke, Director, Department of Orthopaedic Surgery. We got our adrenaline fix with a climb up to the top of the JHU Domed Billings Administration Building, where we were enthralled by the views of the harbor and downtown Baltimore.

Visiting the JHU Domed Billings Administration Building
2019 AOA NATF Fellows and Dr. Mel Helgeson in front of the JHU Domed Billings Administration Building
2019 NATF Fellows with Dr. Jim Ficke, Dr. Dawn LaPorte and Dr. Mel Helgeson at the top floor of the JHU Dome.
Looking down from the top floor of the dome…only half way up.
2019 NATF Fellows and Dr. Dawn LaPorte Going up, up and up to the top of the dome.
Dr. Frank makes it to the top!
NATF fellows and Dr. Dawn LaPorte take in a breathtaking view from the top of the dome.

Following the JHU Dome tour we headed straight to dinner at Bo Brooks along the waterfront in Canton, where we enjoyed steamed crabs and excellent conversation.

Day 20 – Walter Reed National Military Medical Center

We took an early flight out of Charlottesville and land at Dulles International Airport, where we were greeted by LTC Mel Helgeson, Chief Department of Orthopaedic Surgery at Walter Reed National Military Medical Center (WRNMMC).

The group in front of the OR with Dr. Helgeson

We then arrived at WRNMMC in Bethesda, Maryland where we changed in to scrubs and headed up to the operating room to observe an osseointegration case with COL Kyle Potter and CAPT Jonathan Forsberg. Walter Reed is at the forefront of amputee care, and one of a few centers across the world performing osseointegration surgery/implantation for amputee patients, and the premier military treatment facility for amputee care of our wounded service members.

Dr. Forsberg explaining osseointegration technology and the implantation process.
The group in the OR with Dr. Mel Helgeson and Dr. Scott Tintle (2017 AOA NATF Fellow)
Dr. Khan holding an osseointegration implant.

Following our visit to the OR we were able to tour the MATC and had the honor of meeting a wounded service member currently undergoing osseointegration implantation surgery. We greatly appreciate the time he took to share his experience and the rehabilitation process since his traumatic injuries.

Spending time with SGT Josh Elliott (USMC, Ret.), injured Apr 2011 in Afghanistan. Thank you to Josh for sharing his story and inspiring us with his resilience.

Dr. Helgeson then provided a tour of the Walter Reed campus before we enjoyed a nice lunch in Chevy Chase.

Outside the original Bethesda Naval Hospital Tower, which is now part of the WRNMMC campus.

After lunch we met up with CDR Scott Tintle (2017 AOA NATF Fellow) and had a tour of the Computer Assisted Rehabilitation Environment (CAREN) Simulator and Gait Lab. Dr. Khan was harnessed in, and tested out his agility and balance on the CAREN.  Following this we linked back up with Dr. Potter, who provided an insightful presentation describing the amputee care program, and the early results of their numerous ongoing clinical trials

Dr. Tintle (2017 AOA NATF Fellow) with the 2019 NATF fellows at the CARAN simulator.
Dr. Khan getting harnessed in to the CARAN.
Dr. Khan ready to demonstrate his agility and balance.
Ready, set…go!
Dr. Potter giving a talk to the NATF fellows on osseointegration and an overview of the Walter Reed Amputee Care Program.

We finished the day enjoying dinner at Clyde’s in Friendship Heights with several Walter Reed orthopaedic faculty, and in particular enjoyed thoughtful conversations with Dr. Helgeson and Dr. Tintle (2017 AOA NATF Fellow) regarding leadership and managing difficult/challenging situations within a department. Leadership books were also discussed, including “Good to Great”, as well as “Radical Candor”. An absolutely fabulous day learning about military medicine and leadership.

Day 19 – University of Virginia

Our morning started early, as we were met by Dr. Chhabra and Dr. Miller in the lobby of the hotel. We had a quick walk over to the UVA Medical Center to participate in Fracture Conference. The orthopaedic trauma service had an extremely busy weekend, and many interesting cases were presented and discussed.

We then split up with our respective subspecialty host surgeons, and spent the day observing in the OR, and doing some outdoor activities. The fellows then enjoyed a nice lunch at Aroma with Dr. Chhabra and Dr. Miller.

Dr. Gross in the OR with his hosts, Dr. Joseph Park and Dr. Truitt Cooper.
Dr. Samora with Dr. Mark Abel on a morning hike.

A special afternoon academic program started with an overview of the past, present and future (in particular the impressive Ivy Mountain Musculoskeletal Complex to be completed in 2022) of the UVA Department of Orthopaedics by Department Chair Dr. Chhabra. This was followed by Dr. Miller (1994 AOA NATF Fellow) who introduced the 2019 NATF Fellows and provided an overview and explanation of the various AOA traveling fellowships.

Dr. Chhabra introducing the UVA Department of Orthopaedic Surgery.
Dr. Mark Miller introducing the NATF Fellows. Dr. Miller reminisces on his experience as an NATF Fellow in 1994.

Dr. Frank spoke on articular cartilage restoration and transplanation, Dr. Gross on Total Ankle Arthroplasty, Dr. Samora on Diversity in Orthoapedics, Dr. Kang on Resilience, and the evening was finished strong by Dr. Khan’s talk on PRP. We also reviewed two interesting cases, one case by Dr. Courtney Quinn (Sports Medicine Fellow) and Dr. David Diduch from the Sports Medicine Division, and by Dr. Joseph Park from the Foot and Ankle Division

2019 NATF Fellows at UVA Orthopaedic Academic Program with Dr. Chhabra and Dr. Miller.
Dr. Frank giving a talk on cartilage restoration and transplanation
Dr. Gross giving a talk on Total Ankle Replacement
Dr. Samora giving a talk on Diversity in Orthopaedics
Dr. Kang giving a talk on Resilience
Dr. Khan giving a talk on use of PRP for knee arthritis.

We then enjoyed a catered dinner of delectable Indian food. The academic program was nothing short of outstanding, and we were also fortunate to learn about and celebrate the Festival of Lights with Dr. Chhabra. Happy Diwali!

Following the academic program, Dr. Samora spent time with faculty from the Division of Pediatric Orthopaedics, as well as visiting professor Dr. Stephen Albanese. The other traveling fellows enjoyed spending additional time and discussing early career challenges with the UVA Orthopaedic residents at The Whiskey Bar.

Dr. Samora at dinner with the Pediatric Orthopaedic faculty and visiting professor.
NATF Fellows out with the UVA Orthopaedic Surgery Resident.
A pivotal moment of the tour, Dr. Frank rendering medical care with suture removal from a prior injury sustained during a downhill mountain biking event.

Day 18 – University of Virginia

We said goodbye to NYC, catching a morning flight from La Guardia Airport to Charlottesville VA.  Our group was graciously greeted by our hosts from the University of Virginia, Dr. Bobby Chhabra and Dr. Mark Miller.

We made a quick pitstop by our hotel, The Draftsman, where we changed and dropped off our bags.  We then headed out for lunch at Bodo’s Bagels where we enjoyed delicious bagel sandwiches and even better conversation with our hosts.

Following lunch, we linked up with Dr. Winston Gwathmey and then headed to the historic University of Virginia founded in 1819. We enjoyed a guided tour of the iconic Rotunda, Academical Village, and The Lawn, as well as learning about the early history of the university and its founder, Thomas Jefferson.

On the steps of the Rotunda with Dr. Miller
Tour inside the Rotunda.
Picture on The Lawn and view of the Rotunda with Dr. Gwathmey.

After an insightful tour of the UVA campus, we then took a short drive to Monticello, and toured the home of Thomas Jefferson, a national landmark and UNESCO world heritage site.  We were inspired and reminded that we are all endowed with “certain unalienable rights; that among these are life, liberty, and the pursuit of happiness.”

Monticello Visitor Center
View of Monticello from the pond, we learned this is the building imprinted on the back of a U.S. Nickel.
Picture outside of Monticello.
Picture with Dr. Miller, Dr. Gwathmey, and Thomas Jefferson.
Dr. Samora with Dr. Chhabra at the Ivy Inn for dinner.

We finished the day with a fabulous dinner at Ivy Inn (chef Angelo Vangelopoulos is a James Beard semi-finalist), which was attended by UVA Orthopaedic faculty members, and many thoughtful and entertaining conversations were had.