Recently Bucks County based orthopaedic surgeon David Hardeski, MD was asked what is craziest thing he's seen come into one of the trauma centers he has worked at?
"That's a tough question to answer," Dr. Hardeski said in a phone interview for Footballstories. "I've seen some very interesting cases come through. I had a young lady who got shot on the top of her foot with a crossbow. I had a gentleman who hurt both his ankles...he was using a leaf blower. He was blowing leaves...the problem was he was doing it at two o'clock in the morning on the roof of his house while it was raining. He was completely intoxicated trying to get the leaves out of his gutter.
"I had another gentleman that was on a motorcycle," Hardeski continued. "They found the motorcycle next to the road, and then three days later found the rider of the motorcycle still in the woods because he had injured himself so bad, he had gotten so much distance since he dumped his motorcycle, that no one could hear him or see him from where the motorcycle was."
Who would want to deal with these kinds of cases as a doctor? Apparently it is a perfect line of work for some, and we all benefit from that unusual dedication.
It is this kind of random, unpredictable, even chaotic environment that drew Dr. Hardeski to the visceral world of the trauma side of orthopaedic surgery.
If you go to Dr. Hardeski's bio page on the Mercer-Bucks Orthopaedics website, it lists lots of specialties for the good doctor. It is almost like Dr. Hardeski specializes in everything orthopaedic.
Hardeski said when he was a resident, he was drawn to all corners of the orthopaedic world. He explains how it all started:
"When I was doing my orthopedic residency...five years of training with each sub-specialty in orthopaedics in spine surgery, hand surgery, sports medicine surgeons and joint replacement surgeons, oncology...as I'm working my way through, each sub-specialty, I spent a lot of time and I saw there was a lot of repetitiveness. Not to minimize what those guys do in sub-specialties, but I really enjoy having a variety of areas where I'm going to be operating. So I started doing a trauma rotation with a guy by the name of Dr. Tom Lyon at Lutheran Medical Center in Bay Ridge Brooklyn. In one day we would work on a clavicle, then we would work on a foot, then we'd work on a pelvis...
"All over the body you'd have to know the anatomy in each area, you have to learn the personality of the fracture place. It's the keep-you-on-your-toes mentality that is really appealing to me," Dr. Hardeski continued. "I ultimately chose to seek out a fellowship in orthopedic trauma, and I was very fortunate to land myself a position at an institution in Baltimore called the R Adams Cowley Shock Trauma Center which is one of the busiest trauma centers in the country.
"It is actually where the military sends their surgeons to learn, to train in high volume situations where they're going to be constantly stimulated, constantly seeing new things, blunt traumas, penetrating traumas. When I got down there, we would operate from the base of the neck to the bottom of the toes...on a weekly basis. It was just fantastic. I learned a ton down there. As soon as I went down there, the first week of my fellowship, I knew I had chosen the right path."
When Dr. Hardeski sees a patient come into his hands, he sets his goal to get that person back to the point right before he or she was hurt.
"My goal every time a patient comes in after an injury is to give them a scar and a story,” said Dr. Hardeski, who is based out of St Mary Medical Center in Langhorne, PA. “That's how we want everyone to end up."
RUGBY PROVIDES AN OUTLET FOR DR. HARDESKI
Dr. Hardeski attended Bensalem High School in Bucks County. Unlike many of his orthopaedic peers, he did not play sports for the Fighting Owls.
The urge to play sports came later in his life. But he is no less enthusiastic about the sport he chose, in fact, it has become a lifetime passion that continues today.
"I did not play organized sports until I was an undergraduate student at Temple University," Dr. Hardeski said. "I started playing rugby. I was a back, fly half. I played undergrad for four years, then I played for a Med club, the 'Schuylkill River Exiles' out of South Philly for another four or five years. Then I got accepted to medical school, but I did play a year with the Philadelphia College of Osteopathic Medicine (PCOM) club, then I stopped playing."
Dr. Hardeski said he finished Med school, did his five years of residency, and after his fellowship, he came back to this area to practice."
It was at this time rugby found Dr. Hardeski again.
"I had a patient that came in after a motorcycle accident and hurt his foot," Dr, Hardeski said. "He asked when he would be able to get back out to play Rugby again. We started talking a little bit. It turns out there was a rugby team out there I was unaware of in Levittown. He told me they had a game coming up that Saturday if I was interested.
"I woke up Saturday morning, I blew the dust off my boots, walked out to the pitch and said 'hey guys, how ya doing? My name's Dave and I'd like to play rugby with you guys.' I've been with the team ever since...going on my third season now."
Dr. Hardeski said all sanctioned USA Rugby games are suspended because of the pandemic. "I'm hoping to get back out there this spring season."
ACADEMIC EXCELLENCE THAT STARTED BY CHANCE
If you look up the anthropology Wikipedia page it states it is "the scientific study of humanity, concerned with human behavior, human biology, and societies, in both the present and past, including past human species."
That's what Dr. Hardeski said he picked as his college major, pretty much on the run, on the way to practice.
"This is going to sound pretty unusual but I needed to pick a major," Dr. Hardeski said, referring to the counselor's office at Temple. "I got called in the first semester of my sophomore year and they asked me what major I would like to go into. I was kind of messing around with what I planned on doing. I hadn't decided I wanted to go to medical school by any stretch of the means at that point...but I knew I was interested in biology. But I knew I wanted to get out to rugby practice, so when they gave me a list of the majors I could choose from, anthropology was closest to the top, and was the closest thing that had a biological kind of background, so I went with that to get to practice."
According to Dr. Hardeski's bio, here is where that day of impatience to get to rugby practice evolved.
“Dr. Hardeski graduated Summa Cum Laude with a B.A. in Anthropology from Temple University in 1999. He earned his Master’s Degree in Medical Science while attending MCP Hahnemann University. He earned his medical degree from Drexel University College of Medicine and completed his residency training at Maimonides Medical Center in Boro Park, Brooklyn, NY.
Dr. Hardeski completed his fellowship training at R Adams Cowley Shock Trauma Center in Baltimore, MD. He was active in clinical research throughout his training and has a number of publications, including a chapter on pediatric humerus fractures.
Dr. Hardeski played rugby all through college and for the Schuylkill River Exiles and continues to play to this day for the Hibernians.
WHEN DID DR. HARDESKI KNOW ORTHOPAEDICS WAS HIS FUTURE?
Many orthopaedic surgeons say they became interested in the field after a high school sports injury landed him or her in the care of an orthopaedic surgeon and that was where they got the bug.
Was there a moment like that when Dr. Hardeski knew he wanted to become an orthopaedic surgeon?
"Kind of similar but luckily I never really got a major injury except for a couple of broken noses and a dislocated finger," Dr. Hardeski said. "It's the people that I played with, when they had their injuries, of course they would come out to the pitch and watch games while they were recovering. I would see the pictures of their x-rays, the things that were done to fix them: the rods, the plates...all that stuff. That's how I became intrigued with it."
THE CLOSING OF HAHNEMANN UNIVERSITY HOSPITAL WAS HARD TO TAKE
"It was an incredible institution," Dr. Hardeski said. "When I went to medical school at Drexel University, the College of Medicine, the majority of my clinical studies were done at Hahnemann University down at Broad and Vine.
"Every department down there I thought was really, really impressive," Dr. Hardeski continued. "From my rotations with psychiatry, with the orthopaedic department, with general surgery, with internal medicine, they all seemed very knowledgeable and eager to teach. It's really sad to see the institution ended up closing, because I know that it was an area where a lot of Philadelphia residents relied on to get excellent care right in their local community.
"There is a bit of saturation of hospital systems in the City, but I can't imagine Hahnemann isn't very missed by the residents in the area."
THE ADVANCEMENT OF ORTHOPAEDICS IS CONSTANT
Orthopaedics is evolving every day. There are advancements in products used for knee and hip replacements as well as the techniques used in surgery and treatment.
"It's a combination of multiple things," Dr. Hardeski said. "First, one is the surgical technique. There are certain ways to address everything....the approach to the anatomy, the way you treat the anatomy in the operating room. There are certain tendons we used to sacrifice that we don't sacrifice anymore. We found through research (the tendons retained) will benefit the patient in the long run.
"Then there's the type of material used," Dr. Hardeski continued. "Even the metallic elements that they used, the composition of the implants that are used is constantly changing in order to better accommodate function, strength and motion."
There have been improvements in the products as well.
"The implants themselves are changing to be better tolerated by the body,” Dr. Hardeski said. “And as this continues to go, we're seeing the average for knee replacements and hip replacements are twice what they used to be. So the patient that's getting a knee replacement now that's 60 (years old) and relatively active, might be doing pretty well 20 years later, without the need of discussing a revision surgery which is a very big undertaking."
These new products can improve the quality of life and the quality of being employable in lines of work where walking and physical work is required, right?
"Absolutely," Dr. Hardeski said.
THE TRAGEDY OF OPIOID ADDICTION AND WHAT'S BEING DONE
Pain management is a hot topic in every corner of the medical community. Dr. Hardeski did not hold back calling out his industry for its role with making opioid addiction a national crisis.
The question was first raised saying the medical community was probably at fault for the state of opioid addiction in the United States that is now a full blown nightmare.
"It's not probably part of the problem, absolutely the medical profession was contributing to what is now a global epidemic of opioid abuse," Dr. Hardeski said. "I think orthopaedics is either the second or third in terms of the volume of narcotics traditionally prescribed to patients."
Dr. Hardeski said that, although there is a long way to go with treating the addiction problem, there are signs the medical community is headed in the right direction.
“So once we were identifying how bad this was as far as a direct correlation between injury and prescription of opioids and subsequently the development of dependency to these medications, we started taking huge strides to, No.1 have a medical licensing board that is now monitoring who get prescriptions to make sure only one physician is prescribing narcotics at a time (to a patient) and that it's an appropriate amount for their problem.
“We do that so you don't have redundancy where the primary doctor will prescribe a patient oxycodone and then that patient will go to the Urgent Care Center and complain of back pain to get some more oxycodone, then go to their orthopedic doctor and ask for oxycodone (again).
“I've had patients where they would go to three or four different doctors then an emergency room within a week just to fulfill what their body would deem necessary to maintain their opioid dependence. "
Dr. Hardeski said there are new techniques being used before surgery to lessen the need for narcotics after surgeries are performed.
“Within the American Academy of Orthopaedic Surgeons there is a huge push towards what we call multimodal non-narcotic pain modalities. And that's to make sure we're maximizing the potential benefits of pre-operative Tylenol, nerve blocks where mediation is injected into the limb that we are going to be operating on, so that way the amount of narcotics required to keep the pain under control would be minimized."
Good old fashioned exercise right after surgery is beneficial as well.
"To get people up and moving earlier has shown to reduce the amounts of narcotics used in both frequency and doses,” Dr. Hardeski said. “I feel very happy to see that the entire medical community is taking this as seriously as it is to try to reduce the problem of opioid dependency in the United States."
Even with all the problems and conundrums that come with being an orthopaedic surgeon, Dr. Hardeski says he still loves the idea of something new waiting for him when he arrives at work.
“I'd say there's nothing out there that can surprise me anymore that can surprise me anymore, given the fact that I've been in practice for eight or nonce years,” he said. “But I tell you every day I wake up and something else surprises me."
Let's hope doctors like David Hardeski never lose their appetite for healing. *
Follow Al Thompson on Twitter @thompsoniii