Get to Know our Staff: Conchita Arroyo-Sanchez, Medical Translator

Get to Know our Staff: Conchita Arroyo-Sanchez, Medical Translator

by | Jan 11, 2021 | Spotlight

What is your role at Scottish Rite for Children? 
My role is to help the staff, family, kids and whoever else needs me with interpreting and translation communication services. I translate from Spanish to English or vice versa, in person, over the phone and/or with written communication. 

I believe I am doing more than simply translating words – I am able to help different groups of people deeply communicate with each other. Often times, this process of sharing knowledge helps relieve people of their fears or worries. The interpreting process is always a learning experience.

What led you to Scottish Rite? How long have you worked here? 
By the grace of God. I needed a change in my life, and I have now been able to serve others in a meaningful way for the past 23 years, 7 months and 6 days.

What do you enjoy most about Scottish Rite for Children?
I realize that communication is important and being able to help others with this gift has been priceless. As an interpreter, not only am I able to experience helping change people’s lives, but also help ease the burden of families being in a potentially scary situation. It has been wonderful to be a part of experiencing the thousands of great miracles and changes of life that take place throughout this organization. 

I once had a little boy tell me, “Thank you for your help with translating for us. Can you tell the doctor and nurse that because of my leg, no other kids will be able to tell me that I cannot play baseball with them.” This was one of my first experiences translating at Scottish Rite and it has stayed on my heart and mind ever since. Because of this experience, I will continue to help whoever is in need. 

I also enjoy being able to share the good news about Scottish Rite wherever I go. We change lives here! 

What was your first job? What path did you take to get here?
My first job was when I was 16 in Puerto Rico. I was fully bilingual and worked as a clerk answering phones in a real estate office.
During my third year of university, I was in a car accident in a foreign country. Luckily, I was able to find someone who spoke Spanish and Polish. Since I spoke Spanish and English, I was able to receive help, as well as the English-speaking Americans who were also with me. This experience was my wake-up call that I had been given a second chance at life and should use my language talents to help others.

What do you like to do in your spare time?
I love to hike different Texas State Parks and find areas in nature where I can sing. I call these my singing in the woods moments. For me, being with nature is a way for me to experience gratitude for all of the blessings that God has placed in my life. Especially placing me at this wonderful place of work.

What’s something—big or small—that you’re really good at?
I like being creative and doing crafts. I love to sing. I love adventures in nature and I definitely like to be around other people. I love to help others in need, I am very religious and I consider myself a successful single parent.

When you were a kid, what did you want to be when you grew up?
A secretary or work in an airport as a travel agent.

What’s one hobby you’d love to get into?
Working with wood carving and wood crafting.

What’s the first concert you ever went to?
Puerto Rican Symphony Orchestra in the Fine Arts Theater in Puerto Rico.
And here in the states, the musical 32nd Street on Broadway, in New York City.

Torsion and Angular Concerns: Treatment Options and When to be Concerned

Torsion and Angular Concerns: Treatment Options and When to be Concerned

by | Dec 28, 2020 | Spotlight

This article was recently published in the Pediatric Society of Greater Dallas newsletter. Committed to improving orthopedics care of pediatric patients in all settings, Scottish Rite for Children specialists are regular contributors to this publication for local pediatricians.

Print the PDF

Torsional and angular concerns are common in pediatrics and are often referred to a pediatric orthopedic surgeon for evaluation. An understanding of the normal physiologic changes in typically developing children will provide the practitioner some confidence in discussions with families. While many providers are willing to tell parents the concerns are “physiologic,” this “diagnosis” often leaves the family wondering what is causing the deformities. It is beneficial to demonstrate to parents the source of the difference, discuss the natural history and explain the timeline for improvement.

In-toeing, also known as an internal foot progression angle, is usually caused by metatarsus adductus, tibial torsion and/or femoral anteversion. Typically, metatarsus adductus is seen in infants and is a medial deviation of the midfoot and forefoot on the hindfoot. In most situations, this is a flexible deformity and can be managed by observation alone. Some providers choose to use reverse-last shoes to provide some stretch to the foot, but these are unnecessary in almost all children. More concerning foot positions may be characterized by a deep medial crease, inability to passively push the foot to neutral alignment or a deformity associated with equinus (limited ankle dorsiflexion). If there is worry that the foot position is relatively stiff, referral to a pediatric orthopedic surgeon is reasonable. Once ambulation and shoe wear begin, many of these flexible differences will have resolved.

Physiological internal tibial torsion (Fig. 1) becomes more clinically obvious when children begin walking. A cover-up test on examination (Fig. 3 and 4) will show the proximal tibia is in a neutral alignment with the femur and an obvious bow and rotation of the leg is seen below the knee. The tibial deformity is thought to be due to intrauterine positioning and therefore subtle differences between sides are common. Because of the tibial bow, the child will often appear to be bow-legged (knee varus) as he will widen his stance to reduce foot tripping during walking (Fig. 2). The family can be expected to see spontaneous physiologic improvement by the age of 6-7 years. Be careful when telling families to expect rapid improvement or resolution at preschool ages. Bracing, physical therapy, and other treatments are not indicated in most patients and have never been shown to definitively influence outcome. Should there be obvious asymmetrical torsion or asymmetrical resolution, referral for an evaluation of Blount’s disease would be warranted.

Increased femoral anteversion is normal in infants as physiologic changes are expected in typically developing children. This increased version becomes more clinically relevant as a source of intoeing in the older, preadolescent population. Typical development demonstrates a change in femoral anteversion that continues to improve until early teenage years. In normal femurs, there is 15-20 degrees of femoral anteversion in adults. Femoral anteversion is demonstrated in gait with an internal foot progression angle and families and patients will often notice internally rotated patellae or an ability to sit in the W position. Physical therapy and bracing have not been shown to be effective treatments. Rarely, for teenagers with significant residual femoral anteversion, osteotomies can be performed to improve alignment.

Bowlegged and knock-kneed appearances also may be of concern to families in growing children. In typical growth, children are often born with varus knees (bowlegs) that change to a neutral alignment at approximately 2 years of age and then naturally enter a knock knee (valgus) appearance that can be maximal at 4 years of age. It is advisable to tell families, if the child is seen before 4 years of age, to expect a worsening appearance prior to improvement. A concerned family could take a photograph of the child standing and compare images every six months or so to track changes. Typical adults have approximately seven degrees of valgus and children can be expected to have this appearance by age 7. For these coronal plane differences, asymmetry or failure to demonstrate physiologic improvement are indications to refer to a pediatric orthopedic surgeon.

Physiologic differences in lower extremity alignment are common sources of parental worry. Understanding normal development allows the provider to confidently assuage the concerned parent (and grandparent).

Dallas Morning News: Pandemic forces Cowboys to make annual holiday visit to local children’s hospitals through video calls

Dallas Morning News: Pandemic forces Cowboys to make annual holiday visit to local children’s hospitals through video calls

by | Dec 18, 2020 | Events, Press Coverage

In a season where many things look different, one thing stays the same – creating holiday memories for children. This week, players from the Dallas Cowboys helped to spread holiday cheer as they virtually joined Scottish Rite for Children inpatients. Silly questions and virtual fist bumps will be had by all!

Read the full article. 

Body, Mind, Sport: The Role of Wellness in Recovery and Injury Prevention

Body, Mind, Sport: The Role of Wellness in Recovery and Injury Prevention

by | Dec 15, 2020 | Sports Medicine

This is a summary of a presentation made as a part of the 2020 Coffee, Kids and Sports Medicine education series.

Watch the full lecture here.
Print the PDF

Young athletes are under a lot of pressure to perform. No matter where the pressure comes from, a coach, a parent or himself, an athlete needs support to balance the demands of the sport with the needs of the developing body and mind. Chung and Morrison teamed up to help medical professionals like you address this challenge for young athletes.

Finding the Right Balance

Effective training requires a balance of load and recovery. Here are some definitions that will help with this discussion:

Load is an inevitable result of athletic conditioning, training and competition. If safely managed, load may result in improved athletic capacity and performance as well as reduce risk of injury and illness.

  • External load is work completed by the athlete during training and competition. The load creates physical, physiological and psychosocial demands. For example, number of pitches thrown, distance run, hours training or amount of weight lifted.
  • Internal load is the individual physical, physiological and psychosocial characteristics that respond to an external load. For example, aerobic capacity, mood and muscle strength.

Overload is a load that is excessive or not well managed. This can result in anatomical, physiological and/or psychosocial conditions that will manifest as altered performance, injury and illness. It is important to identify and modify load to minimize overload. This helps with improving performance and contributes to injury and illness prevention.
Recovery is the process and period during which body responds to load.

  • Adequate Recovery = positive adaptations for athletic capacity, performance and injury/illness risk.
  • Inadequate Recovery = negative adaptations for athletic capacity, performance and injury/illness risk.

Balance is achieved when the load is enough to create progress and allow adequate recovery. When overload occurs with intensity or a sudden increase in training, there are consequences seen as a plateau or decline performance and medical issues.

Systems and Functions with Medical Issues Related to Overload

  • Sleep
  • Immune system
  • Cardiovascular
  • Respiratory
  • Hormonal, specifically in female athletes
  • Nutrition

Musculoskeletal Issues Related to Overload or Sudden Increases in Load

  • Bone stress injuries (stress reaction, stress fractures)
  • Physeal injury (skeletally immature athletes)
  • Muscle injury
  • Tendinopathy
  • Youth elbow and shoulder injuries

How Do We Support Young Athletes?

Medical professionals including team physicians, pediatricians, physical therapists, school nurses and athletic trainers, all have a responsibility to support young athletes as they progress through their sport and training. Here is a look at several categories to help with performance and injury prevention.

What is the Role of Nutrition in Recovery and Injury Prevention?

Optimal nutrition supports an athlete managing appropriate training load AND growth. Anything less can leave the athlete short, increasing risk of these and other conditions:

  • Hormone changes
  • Altered menstrual cycle
  • Increased injury and risk of injury
  • Decreased response to training
  • Delayed healing
  • Increased illness
  • Mood changes
  • Fatigue
  • Disordered eating

What is Optimal Nutrition?

  • ADEQUATE ENERGY AVAILABILITY provides enough calories to support training and growth.
  • VARIETY OF FOODS AND FOOD GROUPS ensures macronutrient and micronutrient balance to meet physiological demands of growth and performance.
  • OPTIMAL MEAL AND SNACK TIMING AND FREQUENCY supports training needs depending on each athlete’s schedule.
  • INDIVIDUALIZED HYDRATION PLAN is an important component to nutrition plan and supports the unique needs of each athlete.
  • POSITIVE “FOOD TALK” affects an overall healthy attitude toward food, especially for athletes in “aesthetic” or lean-focused sports.

Find and download sports nutrition resources for your patients here.

A Consequence of Suboptimal Nutrition: Female Athlete Triad

This occurs when energy intake does not adequately compensate for exercise related energy expenditure (under-fueling). Each component of triad exists on a spectrum between health and disease. The components are:

  • Energy Availability
  • Bone Mineral Density
  • Menstrual Function

Athletes who participate in sports that emphasize leanness, aesthetics, weight class sports and gravitational sports are at greater risk for this condition. The consequences of this condition can be irreversible and should be recognized and referred as soon as one or more components are present. When the body is in a negative calorie balance, normal growth and development and other normal physiologic functions are inadequate. Additionally, performance deficits can lead to frustration with training and increased risk of fatigue and injury.
Male athlete triad is becoming better understood and has similar causes and effects on young men. These include:

  • Energy deficiency
  • Impaired bone health
  • Reproductive suppression
  • Low testosterone
  • Oligospermia
  • Decreased libido

The International Olympic Committee has proposed “RED-S” (Relative energy deficiency in sport), consequences of low energy availability beyond the triad. Learn more at www.FemaleandMaleAthleteTriad.org.

What is the Role of Sleep in Recovery and Injury Prevention?

Sleep is important for physical, mental and cognitive well-being. It plays a key role in academic and athletic performance, injury and recovery. Insufficient sleep or poor sleep quality may increase risk for injury in adolescent athletes. Some studies show an increased risk of injury in athletes that sleep less than eight hours per night. Other studies show that recovery from a sport-related concussion is improved with better sleep quantity and quality.

Signs of poor sleep quality:

  • Decreased athletic performance
  • Recovery from exercise/training
  • Decreased reaction time
  • Impaired cognition
  • Changes in mood
  • Increased risk for injury
  • Reduced ability to tolerate load

How Can We Help Manage Stress and Address Mental Health in Young Athletes?

When an athlete is experiencing a training or stress overload, there are consequences that may show up on performance or health. These are often difficult to see but have a profound impact. These include:

  • Slowed reaction times
  • Decreased speed and agility
  • Decreased concentration
  • Mood changes
  • Disordered eating or an eating disorder
  • Sleep disturbances
  • Decreases in lean muscle or difficulty gaining lean muscle
  • Decreased academic performance
  • Relationship struggles

Since 1 in 5 youth meet the criteria for a mental health disorder, it is more important now than ever to recognize these signs and symptoms in young athletes and help connect them with an appropriate support system. Injuries can have psychosocial consequences as well as physical, including mood swings, depression and disconnection from peers.

Download the PDF to share with your patients.

Take Home Points

Athletes need guidance to understand how load, nutrition, sleep and mental health are interconnected. Together the appropriate balance of these can support improved performance and a reduction in injury and illness risk.

Nutrition

  • Three meals + needed snacks each day.
  • At least three food groups per meal..
  • Encourage fluids throughout the day and around/during games and practices.
  • Follow individualized hydration plan, if needed.
  • Positive food and body talk.
  • If a food group is eliminated, seek guidance to ensure nutrition needs still met.

Sleep

  • 8-10 hours of sleep each night for teenagers.
  • Establish a consistent sleep schedule (consistent sleep & wake time, even during the weekends).
  • Set a nighttime routine.
    • Read a book, meditation, take a warm bath.
    • 30-60 minutes prior to bedtime should be a time of relaxation.
  • Set a good sleep environment.
    • Quiet, dark, cool temp, comfortable/calming.
  • No electronics 1-2 hours prior to bedtime.
  • Avoid caffeine and large meals before bed.

Mental Health

  • Make mental health a priority with physical health.
  • Listen without judgement.
  • Question and remind athletes about effective ways of coping with stress, share you own experiences, initiate formal conversations about coping.
  • Early identification and action are important.

Resources for your patients