Get to Know our Staff: Carlos Monroig-Rivera, Medical Student Research Fellow

Get to Know our Staff: Carlos Monroig-Rivera, Medical Student Research Fellow

Scottish Rite for Children offers a Medical Student Research Fellowship (MSRF) for medical students interested in gaining experience in clinical research. MSRF fellows work with a lead faculty mentor throughout the year and several project supervisors who are pediatric orthopedic faculty at Scottish Rite. They work as a crucial part of the research teams in various centers for excellence at Scottish Rite and are responsible for a variety of research projects.
 
What inspired you to apply for the MSRF position?
What inspired me to apply for the MSRF position was my passion for pediatric orthopedic research. Since meeting Dr. Norm Ramirez, a former pediatric orthopaedic fellow at Scottish Rite, I’ve always been interested in how orthopedic research plays a role in advancing orthopedic knowledge and making a difference in children’s lives.

Have you always been interested in medicine and/or research?
Yes, I am a recent medical doctor graduate from Puerto Rico aspiring to improve pediatric patient care while following my dream of becoming an orthopedic surgeon.
 
 
What is it like working at Scottish Rite for Children?
Working at Scottish Rite for Children has been incredible. The institution’s diverse leadership and commitment to staff and employees make you feel like you belong. Their commitment to the well-being of children is truly inspiring. Scottish Rite for Children’s supportive environment has provided me with invaluable learning opportunities that I will hone to become an ethical and competent orthopedic surgeon.

Can you share a few sentences about someone at Scottish Rite who has been a mentor to you and how they have impacted your experience? What project are you working on with that mentor?
One of my mentors at Scottish Rite has been Jaysson T. Brooks, M.D., a renowned pediatric orthopedic surgeon. Dr. Brooks has had a profound impact on my experience by guiding me through my orthopedic residency application and several research projects related to pediatric spine deformity. One of the projects we are working on together is looking at the effect that a T1 Upper Instrumented Vertebrae has on Proximal Junctional Kyphosis Risk in Adolescent Idiopathic Scoliosis Patients.
                                                                                              
 
How do you think this experience will impact your career path?
This opportunity helps me explore the academic aspects of orthopedics, dive into pediatric orthopedic research and collaborate with renowned experts in the field. This experience reinforced my commitment to becoming an orthopedic surgeon, providing me with the understanding and discipline to excel at my job.
 
What progress have you made toward your career goal since beginning the program?
Since beginning the program, I have contributed to several research projects and developed a better understanding of the complexities in pediatric orthopedics. I’ve also had the privilege of presenting my work at a resident symposium and published research papers in orthopedic journals.
 
What is your favorite project that you are currently working on or have worked on at Scottish Rite?
My favorite project at Scottish Rite has been investigating compliance rates and patients reported outcomes for each type of brace prescribed to treat spinal deformity. It is a challenging and meaningful project that could impact patient care and quality of life. Having the opportunity to work alongside a supportive and knowledgeable team has made me discover a passion for the pursuit of knowledge and the process of curiosity, making me feel fulfilled at work by enjoying the process and making a difference in the lives of children.

What advice do you have for future MSRF participants?
For future MSRF participants, I would advise them to work hard, be proactive and make the most of the resources available at Scottish Rite for Children. Don’t be afraid to ask for help, don’t be discouraged by setbacks or slow progress and stay committed to your goal. Never forget to sharpen the saw. As you step into this journey, continue renewing and improving yourself. Take care of yourself along the way, and take simple steps to sustain your personal growth.

What is one thing most people don’t know about you?
One thing most people don’t know about me is that I’m a fantasy basketball enthusiast and analyst. I’ve always been interested in the strategic components of the game, and this passion always takes me to study the secret world of statistics and strategies when the NBA season begins. I spend nights looking over player statistics, studying trends and predicting breakout performances. I’ve even won a few friendly leagues. The best part is that my love for fantasy basketball has improved my real-life understanding of the game. Fantasy basketball has taught me the art of decision-making, risk assessment, player roles and team strategies. So, if you ever see me with my laptop during the NBA season, don’t assume I’m just catching up on work. I might be fine-tuning my fantasy basketball lineup.

Anything else you would like to add?
In closing, I’m grateful for the chance to be a part of the MSRF program at Scottish Rite for Children, and I look forward to continuing my journey of becoming an orthopedic surgeon with the knowledge and experiences gained throughout my time here.

We’re recruiting Medical Student Research Fellows for 2023! If you are a third-year medical student looking to take a gap year before applying to residency, take advantage of this unique opportunity! Only three positions are available for 2024.

Learn more and apply here on our Careers page.

Share Your Story: Finding Hope and Staying the Course Through Perthes Treatment

Share Your Story: Finding Hope and Staying the Course Through Perthes Treatment

Blog written by Megan, Garrett’s mom

In June 2022, Garrett developed a limp and complained about his right knee hurting. We went to his pediatrician for an X-ray after a few weeks of not getting any relief. He had just attended a basketball camp and is active in many sports.The knee X-ray in June showed no damage, sowe started some chiropractic care to stretch and see if we could determine what was causing his pain. After 6 weeks, nothing changed. Garrett would say that his hip was “tight,” but he said there was no pain.

Garrett had an MRI in August so we could determine the next course of action. It was in the MRI that it was discovered his femoral head was quickly deteriorating, and he had Legg-Calvé-Perthes disease. We went to a local hospital for a consultation, and my son was told not to walk on his own without the help of crutches. The word “nonweightbearing” was seared into our brains.

He started school four days later, and we had to urgently contact his school’s administration to discuss accommodations for him.  There was so much anxiety about attending school on crutches and being asked questions. Garrett didn’t want to tell anyone what was going on, and I dreaded the school year knowing this was going to be the most challenging thing he’d ever faced.

While our local health care options are great, we wanted to get a second opinion since this was such a devastating diagnosis for such an active and energetic kid. I started reading everything I could on Perthes disease. I was up late one night researching the disease, and I found some videos featuring Dr. Harry Kim with Scottish Rite for Children. He just seemed to be the expert in this condition, and I wanted nothing but the best care for my son. 

I requested an appointment online, and we were contacted the next day. Although we live nine hours away, we jumped at the chance to travel to Dallas and get a second opinion. I wanted to talk to a nurse to make sure we really should travel to see Dr. Kim. Despite some doubts, something kept gnawing on me to keep pushing. Dr. Kim’s nurse, Kristen, called me a few days later, and we talked about the situation. She asked me to get the X-ray and MRI files to her for Dr. Kim to review. Soon after, she called me and said Garrett had an advanced stage of necrosis, and he needed to be seen as soon as possible. She set an appointment, and we cleared our calendars to make it to Dallas for a perfusion MRI and consultation with Dr. Kim. 

Dr. Kim reviewed his MRI. Garrett’s femoral head had completely collapsed in a period of about four months. He was a more challenging case, but Dr. Kim felt like we could, with treatment and surgery, get the best outcome if we stayed the course. On our drive home, I remember telling my husband that any guilt I had for seeking additional opinions was gone the moment Dr. Kim started explaining the treatment options. He was both conservative in his explanation but also gave me a sense of hope, too. He was clear that Garrett would end up in a wheelchair for a while, and he would need surgery. He wanted to do a tenotomy and a bone-marrow drilling to relieve some of the inflammation and tightness and then apply a Petrie cast to keep the hip in a certain placement as the first step. I clearly remember crying with Garrett at the thought of this massive contraption on my child. Dr. Kim had an opening for surgery in one week, and we jumped at the chance to get started. 

The first surgery went as planned. Nothing can prepare a child for waking up and being in a double-leg cast. However, the care team at Scottish Rite was amazing from the beginning. The Child Life staff brought in a mobile game console pre-surgery, and Garrett played some video games to take his mind off of the surgery. The day after his surgery, Child Life took him to the playroom area with games, toys, art projects, etc., for a few hours, and it was a blessing for me to get some rest.

Dr. Kim checked on him, and Garrett felt like a VIP by ordering his meals via the phone. As we prepared to leave after a few days, the Occupational Therapy and Physical Therapy staff took great care to show us how to get Garrett in and out of our car and worked with us to get to the bathroom, use the new (and massive) wheelchair, and prepare ourselves to go home and manage this new lifestyle for the next six weeks. 

Garrett couldn’t go to school normally during that first casting. The classroom doors were not wide enough to accommodate the platform that his legs had to rest on in the wheelchair. Every time we had to move him, we had to pick him up, take off the platform, push the wheelchair through the door, reinstall the platform, and then put him back in the wheelchair. It really is as daunting as it sounds. My husband Chad and I were very worried about the social toll this would take on Garrett. His teacher and the school administration were helpful and even had some home-tutoring set up. Garrett went to school for about four hours on a Tuesday each week to get in math and reading instruction.

The six weeks passed relatively quickly, and we didn’t stay inside and stay home. Our family is busy, and that’s an understatement. We run a small business, we work at lots of festivals and events, and we were not going to let this disease just stop us in our tracks. We were determined to make sure Garrett still interacted with people and was part of our lives as always. We took him to events, and he ran the cash register. He went fishing with his cousins. We hosted a video game birthday party with his friends where we just let them take over the living room and stay up as late as they could binging on junk food.His first cast came off in mid-November. It was joyous, and he was able to stay cast-free through the holidays.

We traveled back to Scottish Rite in early January and met with Dr. Kim. Unfortunately, Garrett had developed some stiffness and inflammation, and we couldn’t do an osteotomy as soon as we hoped. After correcting some issues with his brace, Garrett was cleared for his osteotomy soon after. He had to have a triple hip osteotomy instead of a femoral osteotomy. It’s more invasive and requires two doctors to work together to perform the surgery. Dr. Kim’s amazing staff was looking at scheduling for us in advance and noticed there was one appointment available with both doctors … the next week. So, we made another quick trip home and prepared for surgery. 

Because the surgeons knew the danger of falling and damaging the work they were about to do, Garrett would have a spica cast that would encompass his right leg and entire torso. I thought Garrett was going to jump through the ceiling. I calmed him down and promised to get him to a Dallas Mavericks game eventually, if he would just understand that the doctors needed to do this casting to give his hip the best chance of recovery without damage. The surgery went well, and Garrett actually went to school five days a week for five weeks in his spica cast without issues.

Now, we are in the “waiting phase” of this dreadful disease. We hope the surgeries are done. We’re just waiting to see progress and bone growth. We hope surgery and casting is over, but we will follow Dr. Kim’s lead and trust his judgement. We pray every day for strength, patience, guidance and healing. We know this is out of our hands, and we are not in control, but we have picked the best team and talent to help us manage this difficult period. We can’t wait to return to the activities he loves. I know I will cry buckets of tears the day he steps back on the basketball court. As another Perthes mom told me, “This is a disease you never knew about and never thought you’d deal with, but here we are, and at least there are people surrounding you to help.” 

This past summer, Garrett went to Camp Perthes in Minnesota! He got to meet others with Perthes and spend five days at camp doing kid things. The camp was started by Earl Cole, the winner of Survivor: Fiji. Earl Cole had Perthes as a child and used some of his winnings to start Perthes camp. He’s an example of someone who went through this disease, and he wants to help others do the same. And Earl Cole was raised in Kansas City, Kan—-small world! Garrett had a wonderful time spending time with other Perthes kids, enjoying activities like canoeing and rope courses.

Garrett started beekeeping with his dad during the pandemic.  He was in first grade, and he has his own Facebook page where he captured his beekeeping adventures.  We plan to get back to his Itty Bitty Beekeeper page and keep chronicling his adventures when he is released from treatment. His page is here: https://www.facebook.com/ittybittybeekeeper

Right now, with Perthes disease, we allow him way more video game time than we want. However, it keeps him social and interacting with kids on the weekends when he would normally be at a sports practice or outing.  Once we get released from treatment, we will encourage him to return to his beloved sports.  He told him that his focus, when healed, is to become the best basketball player he can be.

DO YOU HAVE A STORY? WE WANT TO HEAR IT! SHARE YOUR STORY WITH US. 

Bouncing Back From UCL Injury Scarlette Soars Higher Than Ever

Bouncing Back From UCL Injury Scarlette Soars Higher Than Ever

Published in Rite Up, 2023 – Issue 3. 

by Kristi Shewmaker
 
It was a nail-biting week for Scarlette, of Coppell, during the fall semester of her high school senior year. She was waiting for a phone call from the head coach of the gymnastics team at Rutgers®. She hoped the coach would invite her to join the team. Years before, she had set her sights on going to Rutgers and competing there as a gymnast.
 
In competitive gymnastics, recruitment for joining a college team begins around an athlete’s sophomore year of high school. During that time, Scarlette visited the campus, attended gymnastics camps and participated in an official visit to get to know the coaches and student gymnasts. All that was left for her to do was wait for “the call” to let her know if her college dreams were coming true.
 
Born and raised in Oahu, Hawaii, Scarlette started gymnastics when she was 4. “She had tons of energy in preschool,” says Bryan, her father. “She was always hanging from the monkey bars and bouncing around.” Her parents enrolled her in a recreational gymnastics class to burn off energy. “We knew nothing about the sport, apart from what we saw in the Olympics,” Bryan says. But, the coaches picked up on Scarlette’s innate ability, and she excelled quickly. At her first gym, they suggested that she try out for a team. “That was the start of my gymnastics career,” Scarlette says. “I was 6 or 7 years old in my first competition.” And in that early competition, she won. Throughout the years, Scarlette kept winning.

By the age of 14, she rapidly advanced to level 10, the highest level in the USA Gymnastics Development Program. During her first year as a level 10, she made it to the national competition in Indiana, an incredible feat for her age. To ensure that Scarlette and her younger sister, who is also a gymnast, could get exposure and compete in bigger, more prestigious tournaments on the mainland, the family packed up and moved to Texas, specifically for the program at Texas Dreams Gymnastics in Coppell.
 
During her sophomore year, Scarlette tripped as she was running into a tumbling pass and rolled her ankle, landing on her arm. “In Hawaii, we have several hospitals but only one main hospital for children,” Bryan says. “In Texas, we didn’t know where to go, but her coaches and other gymnasts’ parents said, ‘You have to go to Scottish Rite for Children.’” At Scottish Rite for Children Orthopedic and Sports Medicine Center in Frisco, Scarlette learned that she had not only sprained her ankle but also would need care for a more complex injury to her ulnar collateral ligament (UCL) in her left elbow. Assistant Chief of Staff and Director of the Center for Excellence in Sports Medicine Philip L. Wilson, M.D., evaluated Scarlette and consulted with her and her family regarding her individualized treatment options.
 

The UCL is a band of tissue that runs along the inside of the elbow and works to stabilize the elbow joint during overhead movements. Baseball players, gymnasts and, occasionally, quarterbacks sustain this injury. “It has to do with the way you use your elbow, either for weightbearing or throwing,” Dr. Wilson says. Baseball players sustain the injury from repetitive throwing, bringing the elbow back at a certain angle repeatedly, causing stress on the ligament. “For gymnasts, it’s a weightbearing issue,” Dr. Wilson says. “We all have a little bit of an angle in our elbow called valgus. Gymnasts develop more of that angle as they grow due to repetitive weightbearing from a young age.” The force of a gymnast landing on her hands over and over causes repetitive stress on the ligament.

For most people, the treatment plan for a UCL injury is nonoperative with a recommendation of rest and physical therapy (PT). For athletes like baseball players or gymnasts, the plan could include surgery, depending on their injuries and their goals. “When we consulted with Dr. Wilson, part of Scarlette’s treatment plan depended on whether she wanted to stay at the competitive level or just do gymnastics for fun,” Bryan says. The direction she chose would determine the aggressiveness of the treatment.
 
“It is always challenging for the family to make a decision about what to do,” Dr. Wilson says. Ligament reconstruction surgery requires a long commitment to rehabilitation, and often takes a year for the athlete to get back to the competitive level. “An important part of our job is to partner with the family, provide quality counseling time and ensure that they have all of the information they need to make the best decision,” he says.
 
In their initial consultation, Bryan said that it was the first time he heard Scarlette say that she wanted to do gymnastics just to enjoy it. “A few months before my UCL injury, I had been struggling a lot in the gym,” Scarlette says, “and when I got hurt, I was like, ‘Is this a sign? Is this telling me to just be done?’” Bryan explained that Scarlette had hit a plateau in her skillset, which is common for competitive gymnasts, and in her mind, the injury was a setback.
 
Scarlette decided to take the nonoperative route, and Dr. Wilson recommended PT twice a week at Scottish Rite. After seven months, Scarlette was back in the gym when she injured her elbow again. “I was doing a release on the uneven bars, but I missed the bar and landed on my hands and knees,” she says. “The pain shot up my whole arm.”

After the reinjury, Scarlette decided to pursue surgery. “I was getting my skills back, and I think I just needed to take a step back and rest my body,” she says. “I was able to think.” The light at the end of the tunnel, Bryan said, was that she would get a new ligament in her elbow, and she would be much stronger.
 
Scarlette underwent surgery the summer before her junior year. Wearing a brace, she started range of motion exercises and began PT within the first week. Over many months, her therapy goals included regaining mobility of her joint and then progressing toward strengthening, endurance and power production. At six months, she went back to the gym while continuing PT, and at eight months, she resumed training but not at full skill level. Finally, the summer before her senior year, she was given the all clear to train without restriction and to fully return to gymnastics that fall.

 

“I learned a lot about myself during my recovery,” Scarlette says. “I had to build my way back up. The basics I received to get my skills back really helped my confidence and my performance. I trusted my care team, their process and everything they did.”

 

“I have massive respect for the program at Scottish Rite,” Bryan says. “Dr. Wilson gave Scarlette the option to do what she wanted to do. He didn’t go right to surgery. The professionalism of him to offer PT first, that he even took that into consideration, is a big deal. For any parent considering a facility for their child’s orthopedic needs, it’s a no-brainer. There’s no reason to go anywhere else.”
 
In the 2023 gymnastics season, Scarlette finally got to compete in all four events — vault, uneven bars, balance beam and floor exercise. “After all that she had been through, it was enlightening to see her compete,” Bryan says. “Her demeanor changed. She was driven and confident, not too deep in thought. She just went out there and did her thing, and let it be in the judges’ hands.”
 
After more than a year and a half of injuries, surgery and recovery, Scarlette said that waiting to hear from Rutgers felt like forever. But, the phone finally rang. She was officially offered a position on the team. And, her answer was, of course, yes!

“I’m excited for a whole new chapter,” Scarlette says. “I get to experience college life as a student athlete and compete on a much bigger stage. I can’t wait to experience that whole new world!”

Read the full issue.

What Is Turf Toe? 7 FAQs About This Common Sports Injury

What Is Turf Toe? 7 FAQs About This Common Sports Injury

A serious condition with a funny-sounding name, turf toe can sideline aspiring and professional athletes alike. It’s a condition that targets one of an athlete’s most important tools — their feet. Learn how you can identify turf toe in your child and the steps you can take to keep it from ruining their season.

What Is Turf Toe?

In very basic terms, a turf toe injury is a sprain that impacts the big toe’s main joint — the metatarsophalangeal joint. It occurs when the joint gets bent beyond its normal range of motion, leading to stretches or tears in the ligaments, tendons and tissues that hold the joint in place.

What Causes Turf Toe?

Turf toe got its name because it was first seen in football players who play on artificial turf. The firm and less forgiving surface can contribute to strains on the big toe during play.

Nowadays, doctors see this injury in athletes who play any sport that involves running, jumping and other activities that place a lot of strain on the foot and big toe. Those sports include basketball, dance, gymnastics, soccer and wrestling.

In those sports, as with football, footwear can play a role in causing turf toe. Wearing shoes with flexible soles that do not adequately support the big toe joint can increase the risk, whereas stiff-soled shoes offer better protection.

What Are Common Symptoms of Turf Toe?

Common symptoms include:

  • A feeling of instability or weakness in the big toe
  • Bruising
  • Difficulty walking or bearing weight on the affected foot
  • Limited range of motion in the big toe
  • Pain, tenderness, and swelling at the base of the big toe

If your child experiences discomfort or pain in the big toe joint after activity or playing sports, schedule an appointment with a sports medicine specialist. It can take time to recover from turf toe, so treating the condition at the first signs of pain can reduce your child’s time on the sidelines.

Diagnosing turf toe begins with a physical exam. Your child’s doctor will measure the toe’s range of motion and look for signs of tenderness and instability. Your child may have an X-ray to rule out any fractures, but sometimes the doctor will order an MRI scan. This type of imaging provides detailed views of the foot’s soft tissues, helping to confirm the extent of the injury.

How Long Does Turf Toe Take to Heal?

The recovery time for turf toe can vary depending on the severity of the injury and how well it is managed. In general, mild cases of turf toe may heal in a few weeks, while more severe cases can take several months for full recovery. To help your child heal as quickly as possible, follow their treatment plan and doctor’s recommendations.

Treating turf toe typically involves a combination of the following:

  • Rest, ice, compression and elevation, a.k.a. “RICE.” The RICE method starts with letting the joint rest and allowing it to heal. Your child should avoid activities that put strain on the big toe joint. Applying ice, compressing the affected area with a bandage, and elevating the foot can help reduce pain and swelling.
  • Anti-inflammatory medications. Over-the-counter anti-inflammatory medications can help manage pain and reduce inflammation, but ask your child’s doctor which medications to use. Aspirin and adult-strength medications may not be safe for your child.
  • Custom orthotics. Depending on your child’s injury and sport, their doctor may recommend custom orthotic inserts to support and protect the big toe.
  • Physical therapy. Physical therapy can restore strength and range of motion in the big toe. A physical therapist can provide exercises and techniques to promote healing and prevent future injuries.

Is It Safe to Walk on Turf Toe?

In mild cases of turf toe, it may be possible to walk with some discomfort, although rest is still recommended. Your child should listen to their body and avoid activities that worsen their pain or discomfort.

What Happens to Untreated Turf Toe?

If left untreated, turf toe can lead to complications and chronic issues, including:

  • Increased pain and discomfort
  • Limited range of motion in the big toe
  • Reduced athletic performance
  • Risk of future injuries or damage to the joint

Can You Prevent Turf Toe From Coming Back?

You can reduce your child’s risk of getting turf toe again by helping them take some simple preventive measures:

  • Wear proper footwear with stiff soles that adequately support the big toe joint.
  • Use orthotic inserts if your child’s doctor recommends them.
  • Practice exercises that strengthen the muscles around the big toe joint to provide additional support.
  • Learn proper running and movement techniques to limit strain on the big toe.

Scottish Rite for Children has the experience necessary to help your child overcome (or prevent) turf toe. Call 469-515-7100 to schedule an appointment with one of our experts.

A Newfound Freedom to Walk

A Newfound Freedom to Walk

KaDeyja, of San Antonio, enjoys watching Cocomelon® and listening to her favorite song, “The Wheels on the Bus.” During her physical therapy session at Scottish Rite for Children, this animated music video set the tone, creating a playful atmosphere and soundtrack to a pivotal day in her life. At 16 months old, KaDeyja achieved a milestone that any doting parent would record in a baby book — taking her first step. But for KaDeyja and her parents, this accomplishment was extraordinary.

KaDeyja was born with limb differences affecting her right arm, left hand and both legs. Hand surgeon and Director of the Center for Excellence in Hand, Scott Oishi, M.D., FACS, manages the treatment plan for her hand. Chief of Staff Emeritus J. A. “Tony” Herring, M.D., manages the treatment plan for her legs.
 
“In the beginning, she couldn’t roll over,” Stephanie, her mother, says. Later, she had difficulty sitting up and keeping her balance. “We would prop her up with a Boppy® pillow,” she says. For many months, Stephanie carried her everywhere. Eventually, KaDeyja figured out how to sit up and maneuver on her own by scooting on her bottom.

When KaDeyja was developmentally ready to begin walking, Director of Prosthetics Don Cummings, C.P., L.P., fitted her for two prosthetic legs. And then, the big day arrived. KaDeyja tried out her new legs with assistance from physical therapist Megan Mendoza. Pushing a baby doll in a shopping cart, KaDeyja took one step and then another.
 
“When she took her first step, I was like, ‘Oh my gosh, she’s doing it!’” Stephanie says. “It was very emotional.” With focus and determination, KaDeyja was walking. Every step was a triumph. As the medical team cheered her on, she walked over to each person in the room and gave them a high five.
 
“Scottish Rite for Children has given us hope,” Stephanie says. “It’s a forever kind of journey at Scottish Rite. They are a piece of our family.”
 
Read the full issue.