When it comes to helping people suffering from debilitating or unsightly hand problems, Dr. Sean Blake thinks of it somewhat as a calling.
The native of Cleveland, Ohio, knew early on that there was something special about hands. It wasn't caring for knees and hips, although his fascination with the human spine was a close second to hands.
"I never knew it until I went back to medical school, but I had just fallen in love with studying the mechanics and the anatomy of hands," said Blake, 41, who was introduced as director of the hand center at St. Francis Orthopaedic Institute last summer. "It is probably the most fascinating example of physics in the human body. It's all levers and mechanics. For us just to move one digit, even though it's connected to the same muscles, it's all intricate movement."
Thus, Blake now finds himself in his element, serving Columbus-area residents as the sole hand specialty surgeon at St. Francis Hospital on Manchester Expressway.
The Ledger-Enquirer talked with the doctor recently about his job, the treatment he provides and what aspires him in his career to offer a helping hand to those whose hands may be hurting or broken. This interview is edited a bit for length and clarity.
As director of the hand center, what are your overall responsibilities?
I am the only hand fellowship-trained surgeon here. So basically I'm in charge of all therapy, all surgery and all hand care of the whole hospital.
What kinds of services does that encompass?
Anything from tendon repairs to fractures to nerve repair. The only thing I don't do here is what we call replants. So if somebody were to bring a finger severed or completely cut off, I do not replant them. I was trained in it. I did do that in fellowship. We're just not staffed here to do it, and having only one hand surgeon to do it is not beneficial for anybody.
Is most of your time spent treating folks rather than handling administrative chores?
It's minimal on administrative and all seeing patients and doing surgery.
Why did you choose hands over, say, knees and hips?
Actually, I was down between the spine and the hand. I loved spine and biomechanics when I was a physical therapist. And then I've always been fascinated with the biomechanics of the hand and fingers and forearm.
My wife still tells me to this day — she teases me — that she would come looking for me during (physical therapy) school and it would be late at night and she would come to the cadaver lab and I would just be dissecting on my own amongst 14 dead bodies, and I would always be working on the forearm. She joked that I would be there humming and singing.
One of the aspects of being a hand surgeon is that during clinic (visits) I get to sit at the patient's level rather than standing above them. Inherent to my examination is holding a patient's hands. This produces a unique patient-doctor relationship that no other surgical specialty possesses.
Do physicians, when they're coming up through the medical training ranks, tend to gravitate to one part of the body over others?
More and more so now, yes. But there are those that have more of a generalist mindset. For instance, Dr. (Bobbi) Farber, she'll do anything — ankles, hips, knees, shoulders, elbows. But it's taken me, sadly, about 35 years to realize that I'm a sub-specialist. I really love to study one area, and not for an ego, but just out of fascination. I love to know the ins and outs and be able to help as best I can.
Folks would think the hand specialist field would be less lucrative than knees and hips and the spine. Is that the case, with some doctors following the dollars?
That's very reasonable, yes.
Doing a carpal tunnel (surgery) doesn't pay as much as doing a total knee. Doing a thumb arthroplasty does not pay near as much as doing a knee arthroplasty. But I love it.
Are there more opportunities for you with the hands than there would be, say, with the knees, although all areas are growing as Baby Boomers get older?
The hands are not necessarily lucrative. There are those (doctors) that will see 80 or 90 patients a day, which I'm not willing to do because there is no way I can spend the time with them. But there is so much in the hand to take care of, anything from tumors and cysts to decreased function and tendon transfers. I do a lot of (the latter) for dysfunction or stroke or even cerebral palsy. But the cerebral palsy I don't treat as much now as I did in fellowship. And I really don't do much pediatric hands. (It's mainly adults and teenagers.)
Are you seeing a good variety of people in the Columbus area with hand problems and medical issues?
Absolutely. There are always hand problems going on everywhere -- definitely carpal tunnel, definitely trigger finger, and even something called deQuervain's (tendonitis). But as the population is aging there's a lot of arthritis and arthritic joints that offer a lot of procedures and necessities that need to be taken care of and that can really help people improve the function in their daily lives. ... I do my carpal tunnels through an endoscopic procedure rather than open.
That's where you insert a camera into the skin rather than slicing into the skin?
Yes. Short term, it's less pain and you don't have a big incision in your palm. It's farther up on your wrist.
What are the common causes of hand pain and issues?
I see everything from high school sports, even weekend warrior sports, arthritis, trauma. Really, there's many causes. I literally had somebody pop a tendon, if you will, from flicking a spit ball. That is a classic story, but it came out well.
Are there some things you cannot treat?
Sometimes, with somebody with a near amputation, it's best just to complete the amputation. But there are some things that are electives. For instance, some folks will come in with deformities of the fingers. Depending on their age and where they are at in their life, the benefits of the surgery may not outweigh the risks. For instance, somebody who has arthritis of the small finger, and they simply don't like how it looks ... the risks could be, in the worse sense, that it could lead to devasculation or amputation of the finger.
What's a typical schedule like for you?
I see patients all day Monday and Wednesday, half days Tuesday, Thursday and Friday, and surgeries I'm doing on Tuesdays and Thursdays right now.
What's the most challenging aspect of your job?
It's helping people get what they need because of insurance coverage. I would say that would be the greatest difficulty.
Can you expand on that?
Absolutely. It would be my pleasure. There's more and more being dictated as to what a physician can order or can do, whether they think it's necessary or not. It's being — for lack of better words — more determined by the insurance companies saying 'That's OK to do or that's not OK to do' even though the physician or the surgeon says it's a necessity.
In what percentage of cases is that occurring?
In terms of blocking it completely, I would say probably less than 20 percent right now. But in terms of making it difficult to proceed forward and increasing the length of time to get special tests done or procedures done or implants received, I would say upwards of 40 percent.
Is there anything that you or the patients can do?
We're always writing letters to the government. But we also attack things even before the patients come. We see what their insurances are. We see what they would be approved for. Our staff is phenomenal and friendly at keeping things efficient for the patient.
What's the most rewarding aspect of your job?
To be very frank, and not to sound cheesy, the whole reason I did all of this with my wife and my kids, is we felt called to do it. Albeit, I'm a hypocrite on a daily basis; (but) I do strive to live by faith.
The reason I went to physical therapy school was I thought I was meant to do it, and I love biomechanics, and I love helping people get back to activities of daily living and prevent (problems). But then to go back to medical school, that was a lot of prayer because we were married, we were going to start having kids. But both my wife and I were on the same page. We really felt as a team, not just me, but as a team, that we were called as a vocation, not as a job, to go back to medical school.
Really, the story continues the same way, just a lot of prayer about being an orthopedic surgeon and that I felt called to do it and serve. ... The greatest satisfaction I get is when somebody is very pleased with what we've done with them, and that they feel that we've improved their life.
What advice do you have for those considering a career as a hand specialist, and the career path they need?
Typically, it's high school, college and medical school. ... I just had a love that was insatiable for the body, to learn and to understand it, and not for pride and ego, just for pure love.
But for somebody who's interested, number one, that they're not doing it for money or for ego or for pride, that they really do enjoy learning and helping. That's first and foremost — a desire to serve will keep you going.
Name: Dr. Sean A. Blake
Hometown: Cleveland, Ohio
Current residence: Midland area of Columbus
Education: 1991 graduate of Solon High School in Solon, Ohio; earned bachelor’s of science degree in exercise science from Miami University of Ohio in 1995; earned doctor of physical therapy degree from Slippery Rock University in Slippery Rock, Pa., in 2001; earned doctor of osteopathic medicine degree from Ohio University College of Osteopathic Medicine in Athens, Ohio, in 2007; completed his orthopedic surgical residency at St. Joseph Health Center in Warren, Ohio, in 2012; completed his orthopaedic hand fellowship at University at Buffalo in Buffalo, N.Y., in 2013.
Previous jobs: Has worked as an exercise physiologist and as a physical therapist with focus on manual therapy.
Family: Bridgette, his wife of 15 years, and children, Bo, 7, Josi, 5, and Tony, 3
Leisure time: Enjoys spending time with his family, lifting weights and working out, and attending worship services at St. Andrews Presbyterian Church in the Midland area.
Of note: Used to coach a U.S. Tennis Association traveling teenagers league, played soccer through high school, and raced cars in the Sports Car Club of America II; he’s also very interested in prevention and wellness through lifestyle modifications, and enjoys teaching people about the structure and function of the human body.