Surgeons fly to bring specialty care to Wyo. towns

CASPER, Wyo. (AP) — It’s just after 7:30 a.m. when Dr. Ryan Aukerman steps onto the tarmac at Laramie Regional Airport, a cup of coffee in his right hand. His ride to work is here.

A twin-engine turboprop waits under an empty Wyoming sky. The 39-year-old orthopedic surgeon climbs the passenger stairs and slides into a seat. Beside him is Laurie Johnson, the nurse who usually accompanies him.

Pilot Cody Diekroeger follows them on board and seals the cabin behind him. The engines wake; the propellers blur in the morning light.

The three are part of one of the most distinctive orthopedic practices in the country. Rather than operating out of a single location, the doctors at Premier Bone and Joint Centers use a fleet of aircraft to travel the state, providing specialized care in places that might not otherwise have the population to support it.

Premier operates out of Laramie, a town that would normally support two or three orthopedic surgeons with general training. Serving multiple cities allows the group to employ nine doctors, each with their own focus. Aukerman, for instance, concentrates on sports medicine, knees and shoulders.

On certain days, Premier will have doctors in as many as six different towns, from Torrington in the east to Green River in the West.

“We can bring these specialists to a town that would never see a specialist,” Aukerman says.

Below him, miles of scrub stretch out in all directions, disturbed only by empty roads and wind turbines. Off in the distance, mountains rise up from the prairie. In the winter, he says, the peaks can shine like candles.

Aukerman spends two days every week in the air. On Tuesdays, he’ll wake in Laramie, fly to Casper for a clinic, head to Cheyenne for a second, and be back where he started in time for dinner. He’ll treat a few dozen patients along the way.

“You have to be pretty on task,” he says. “It works out pretty well. We’re pretty well-oiled.”

A black Chevrolet Suburban is idling on the tarmac when the plane touches down in Casper. Aukerman and his team are on the road within minutes.

Aukerman started at Premier in 2006 after completing a sports medicine fellowship at the University of Wisconsin in Madison. His interest in medicine began on a ski hill years earlier.

At 16, he tore a ligament in his left knee while riding moguls at a Colorado resort. He underwent surgery and eventually healed.

Aukerman was intrigued. Orthopedic surgery — which concentrates on the body’s bones, joints and ligaments — could fix patients, rather than merely treat them for ongoing medical conditions.

“You can take a physical injury and get people back to their lifestyle,” he says. “That’s one of the things I like about this job.”

Orthopedic surgeons can be as physical as the athletes they treat. They push arms, bend knees and tap elbows. Each movement offers a clue to what’s happening below the skin.

The second patient of the morning comes in with a badly bruised left leg, the result of diving for a ball during a softball game. Mike Lebsock lies back on the table and Aukerman gently twists his knee from side to side.

He suspects Lebsock tore his hamstring and suffered some sort of knee injury. No more softball, Aukerman says.

The doctor doesn’t rush through his appointments. When a patient starts to cry, he offers encouraging words. When they look anxious, he’ll make a joke.

One of his patients is a police officer who injured her left knee in an obstacle race. She winces when he examines the tender joint.

“How far in were you?” he asks.

“I had only a mile left,” she says.

They trade war stories about past races. Aukerman has blown out his own knees three times.

The injuries allow him to empathize with patients, he says later. He knows the pain that follows surgery. He understands what it’s like to be treated by a doctor who shows little compassion.

“It was a terrible experience,” he says. “Now, I spend a lot of time talking with patients . making sure all their questions are answered so they don’t leave here wondering what the heck is going on.”

Storm clouds are drifting toward Casper as the turboprop climbs back into the sky, this time bound for Cheyenne. Pilot Cody Diekroeger flips a switch to retract the gear and banks the plane to the right. The city spreads out below, cut in two by the North Platte River.

Diekroeger’s attention is elsewhere. He spots thunderstorms to the south – directly in the path of the flight.

“It might get a little bit bumpy up here,” he says.

Diekroeger steers the aircraft away from the worst of the weather, but can’t avoid the thunderstorms entirely. The plane starts to rattle. Clouds make it impossible to see in any direction.

The aircraft he’s flying is particularly equipped to handle Wyoming’s weather. The Beechcraft King Air can land in strong crosswinds, operate on snow-packed runaways and knock away any ice that forms on the wings.

The doctors schedule about 1,450 flights each year. Less than 1 percent are canceled because of mechanical problems or weather. An occasional flat tire is about the only thing that stops them.

“And it’s been a while since that happened,” Diekroeger says.

Premier Bone and Joint is almost its own airline. Transporting the doctors requires four airplanes and the same number of pilots.

Every trip must be coordinated so the doctors treat the right patients in the right cities. A car must be ready at every airport. Planes must be fueled and maintained.

And then there is the flying itself. Diekroeger has been a pilot for 37 years, including stints with regional and national airlines. His current job is tougher, he says. The trips are short, meaning takeoffs and landings — the busiest times for a pilot — constitute a much bigger part of the flight. There is wind, thunderstorms and bitter cold.

“It could be blue sky and sunshine on one end and a blizzard on the other,” he says. “We have to be prepared for anything.”

The Blue Bomber is waiting when they reach Cheyenne Regional Airport. That’s what the doctors call the 1976 Oldsmobile 98 they use to get around in the Capitol City. Purchased by a former CEO, the car looks nearly as wide as it is long. People stop and stare as it passes by.

“The heat and the cold have taken their toll on her, but the old girl’s still got it,” Diekroeger says.

When the team arrives at the clinic, they’re greeted by physical therapist Nate Eakins and University of Wyoming kinesiology student Kyle Graves. The therapists play a key role in the rehabilitation process, helping patients regain strength and mobility.

The young men accompany Aukerman for the next round of appointments. Whenever there’s a break, he quickly transforms from doctor to educator.

They gather around a computer screen displaying X-rays of an injured knee. Aukerman quizzes them on the anatomy. When they run into trouble, he pulls out a pen and sketches diagrams to illustrate his point.

“That’s why you’ve got to hang out with docs,” Eakins tells Graves, after the surgeon leaves to greet a new patient. “You learn something.”

The afternoon sees a steady stream of patients. A Little Leaguer whose tendon broke away from his shin bone. A woman in obvious pain after construction materials crushed her right hand.

At 4:30 p.m., the team is finally finished. They pile back into the Oldsmobile for the brief ride to the airport.

The storms from earlier have passed through the area. It’s a smooth ride now as the Beechcraft lifts off for its final trip of the day. In minutes, the city they left 10 hours earlier comes into view.

The plane banks to the left and begins to descend toward the airport below.

“One of the great things about this practice,” Aukerman says. “We cover a lot of area, but we come home every night.”

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Information from: Casper (Wyo.) Star-Tribune, http://www.trib.com

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