Get to Know our Staff: Fabiola Reyes, M.D., Neurology and Rehabilitation

Get to Know our Staff: Fabiola Reyes, M.D., Neurology and Rehabilitation

What is your job title/your role at Scottish Rite for Children?
I am a pediatric physical medicine and rehabilitation physician. I work with children who have mobility impairments. Because cerebral palsy is the leading cause of physical disability in in the United States, this population makes up the majority of my practice. My goal as a pediatric physiatrist is to facilitate mobility, function, activities and care for children with physical disabilities using nonoperative means.

What do you do on a daily basis or what sort of duties do you have at work?
I work with an awesome team of physician assistants, nurse practitioners, nurses, medical assistants, orthotists and therapists to assess function and rehabilitation needs of children with cerebral palsy. In my clinics, I help identify and set therapy goals for children. I also treat conditions that may interfere with mobility and function, such as tone. I use a variety of tools, including therapy, orthoses, oral medications, botulinum toxin injections, intrathecal medications and casting to help children be comfortable, active and participate in activities they enjoy. In addition, I also assess and diagnose causes of motor control disorders in children when they come into clinic without a diagnosis.

What was your first job? What path did you take to get here or what led you to Scottish Rite? How long have you worked here?
My first job was doing administrative work in an environmental engineering firm in my hometown of El Paso the summer after my first semester in college. I was inspired by my father — an engineer, and my mother — a nurse, to study biomedical engineering in college. I worked for GE Healthcare after I graduated. My job at GE Healthcare required spending time with cardiologists. This experience helped me see how doctors solve problems like engineers, but they also get to form strong relationships with people of all backgrounds. This led me to apply to medical school. I then chose physical medicine and rehabilitation because it allowed me to follow patients with complex medical conditions longitudinally and help them achieve goals that sometimes seem insurmountable.

What do you enjoy most about Scottish Rite?
My favorite thing about working at Scottish Rite is that we are guided by the CARE RITE values. Specifically, being child-focused allows me to build strong rapport and have fun with my patients in clinic. I always leave clinic with a huge smile on my face and am excited to tell my husband how much fun I had at work. In addition, by putting children and family first, the CARE RITE values promote excellent teamwork and multidisciplinary care of children with complex needs. This means that my colleagues and I are always on the same page — we will do what is best for the patient and families always.

Tell us something about your job that others might not already know.
I completed six years of residency and fellowship training in order to become a pediatric physiatrist. I did one year of internal medicine at Parkland/UT Southwestern. I then did three years of physical medicine and rehabilitation at Columbia/Cornell in New York. Finally, I completed two years of pediatric rehabilitation medicine at Baylor College of Medicine/Texas Children’s in Houston. All this training is needed to help physiatrist learn function from a multisystem perspective. In training I learned about diagnosis and management of bowel and bladder dysfunction due to spinal cord injuries; neuropathies and muscular dysfunction from cancer and cancer treatments; cognitive impairments from traumatic brain injuries; among many other conditions that affect function. The year I spent doing internal medicine at Parkland Memorial Hospital was very challenging, but it gave me a very good perspective on the medical and social challenges some of our patients will face once they age out of the pediatric medical system.

What is your favorite game or sport to watch and play?
Volleyball. I played middle blocker in high school in El Paso. I love volleyball because it requires a lot of practice to develop skills, but it also requires very good communication with your teammates. For example, without letting your backrow teammates know that you are bumping the ball, or letting the setter know that you are ready to strike as a middle hitter, that ball will drop on the floor. In fact, volleyball reminds me of health care — it can be very intricate, requires a lot of coordination and requires players to be excellent at their individual position. Without good teamwork, communication and flexibility, though, a play can easily fall apart. Again, this is why I love working at Scottish Rite. If we were a volleyball team, I have no doubt we would be national champions!

How has your heritage shaped the person you are today?
My family is from Mexico. My parents were born and grew up there. Because of many psychosocial challenges my grandparents faced in Mexico, none of them were able to complete elementary school. My maternal grandfather was a silver miner, and my paternal grandfather was a carpenter. Despite their limited education, my grandparents instilled the values of hard work and education on my parents. Through these values, my mother became a nurse and my father an industrial engineer. Seeing my parents work hard to meet their professional goals when we moved to the United States has been an enormous inspiration for my siblings and me. We have always been so proud of my parents and our heritage for this reason.

Does your family have any traditions that are especially important to you?
My birthday is on Christmas Eve. In Mexico, a lot of families celebrate Christmas on December 24th. Getting together with extended family at my grandmother’s home in Juarez, Mexico, eating tamales and breaking a birthday piñata are some of the most cherished memories I have from childhood. To this day, we still make tamales and break a piñata for Christmas.

What is your favorite meal or recipe?
Chile Rellenos. My grandmother used to make them for us when we would visit her on the weekends in Mexico. And now that we are older, this is one of the meals my mother makes for my husband and me when we visit her in Houston. Chile Rellenos was also the first meal I cooked for my husband when we were dating, and when I started working at Scottish Rite, my mother came to my house to help me cook a big batch for a work celebration. They are very time consuming to make, but they are also delicious in a corn tortilla with beans and salt!

What is your favorite travel destination?
Big Bend National Park. It sits on the Chihuahuan Desert and is on the border with Mexico, similar to El Paso, where I grew up. It is very remote and isolated, so it is easier to find solitude and time to reflect while hiking. Surprisingly, it has a significant amount of bird, insect and plant diversity, as it is the only national park that houses a whole mountain range — the Chisos, a desert and a river. The flora and fauna have to be tough and resilient, but still thrive, and it houses the Mexican Black Bear, which was extirpated, but made a comeback into Big Bend National Park in the 1980s.

What does Hispanic Heritage Month mean to you?
It means connection. Not only to my parents, grandparents and traditions but also to my patients. I chose to practice in Dallas partly because it has a substantial Hispanic population — 41.5% per the 2021 census. Being able to celebrate National Hispanic Heritage Month gives me a reason to celebrate together with a large portion of my patients.

How do you identify within the Hispanic community?
I identify as Mexican-American. While the people with Hispanic and Latino heritage can be very diverse in geography, culture and colloquialisms, I love connecting through our shared values. For example, I love bonding over music with one of our Neurology/Rehab nurses whose family is from El Salvador but grew up listening to the same music that our parents listened to. In New York, being able to communicate with a large population of Dominican patients was also very gratifying. One of my favorite memories in residency was when an Ecuadorian hospital worker brought me Mexican tamales from New Jersey because he knew I was missing my family during Christmas.

What brings you joy about your heritage and culture?
Being able to bond with patients with similar heritage. While doing a botulinum toxin injection, one of my patients was listening to Vicente Fernandez, a Mexican singer and songwriter who is considered one of the greatest by many. After completing the injection, I knew my patient had tolerated it well when he belted one of Vicente’s most famous songs at the top of his lungs. At that point, I had no other choice but to join him in singing!

What does community mean to you?
Community means shared values and beliefs. This in turn helps me find connection and rapport with my patients. By being part of the same community, I hope to inspire my young Hispanic patients to aspire to become doctors too.

What do you enjoy most about your role at Scottish Rite for Children?
Being able to work with a diverse group of people in skill and background with similar goals and values. Every person I have worked with, and those who have supported me at Scottish Rite, have not only shown kindness and excellence but also a strong commitment to deliver the best experience and care for the diverse group of patients we see.

What’s one fun fact about yourself?
I was named after my older sister’s imaginary friend! She had a slew of imaginary friends, and my parents like the name Fabiola.

On The Move: Unstoppable

On The Move: Unstoppable

Article previously published in Rite Up, 2022 – Issue 2.

It is not uncommon to see Michael, of Redmond, Washington, posing like his favorite superheroes. He loves playing Minecraft™, riding his bike, swimming, wearing costumes, acting, dancing and singing. In January 2021, this highly active and vivacious young man had a life-changing surgery performed on his left forearm by pediatric orthopedic experts from our hand and limb lengthening and reconstruction teams at Scottish Rite for Children.

“I have no words to describe the blessing it has been for Michael and myself,” Berenice, Michael’s mother, says. “Scottish Rite is simply amazing.”

Michael was born premature at 23 weeks and stayed in the NICU for four months. At 3-months-old, the family realized he had a bump on his left arm and worked with Michael’s doctors to investigate the issue. Following a biopsy, it was determined that Michael had congenital pseudoarthrosis, which caused a deformity in the bones in his left forearm.There are very few teams that could successfully manage the complexities and intricacies of Michael’s treatment, but Scottish Rite for Children could. “To me Scottish Rite is a place where miracles happen, where the prayers of many parents come true,” Berenice says. “The doctors really care, and all the staff understand you and want to help in any way they can. Somehow you know your child is in the best hands, and you trust they are going to be okay.”

 

Watch Michael’s Story and learn more about Scottish Rite’s extraordinary care.

Read the enitre issue.

D CEO: Ask the Experts

D CEO: Ask the Experts

Previously shared in D CEO Magaizine.

How early will a child show signs of having an orthopedic issue that may need medical attention?

DR. DANIEL SUCATO: Orthopedic issues can present as congenital abnormalities of the bones, meaning the bones were not completely or normally formed in utero. This can occur in the spine or the upper and lower extremities. Often these patients do not require treatment early, or sometimes ever, but they should be evaluated to see if treatment is necessary.

DR. PHILIP WILSON: As a pediatric cartilage and ligament surgeon, we often see children with congenital meniscus or cartilage conditions within the knee. Sometimes these can present as early as toddler age, but more often young school-age with a loss of full extension or occasional limp.

What should I expect at our first visit to a pediatric orthopedic specialist?

DR. DANIEL SUCATO: At the initial visit, the family and patient will first meet with the provider to discuss the concerns and note any family history regarding the issue. A physical and orthopedic examination will evaluate the areas of concern. If necessary, appropriate imaging studies, such as ultrasound, plain radiograph, CT or MRI scan, will follow. Let your child know the imaging studies, if necessary, will not hurt.

DR. PHILIP WILSON: We also make sure the child is directly involved in the discussion. As kids get older, the perception and magnitude may be different for parents than it is for the child. Prior to the visit, parents can help by letting them know we are just going to check their muscles-no shots.

What are common issues in children that fall under the category of “pediatric orthopedics?”

DR. DANIEL SUCATO: Pediatric orthopedics involves anything related to children’s muscles, joints or bones, so that would be conditions like clubfoot, scoliosis, developmental hip dysplasia, and even traumatic or sports injuries. We also have subspecialties in spine, upper and lower extremities, foot and ankle, sports injuries, and fractures.

DR. PHILIP WILSON: Within pediatric sports medicine, conditions involving the cartilage or instability of the joint or injuries affecting the tissues around the joint are common reasons for treatment.

Do all orthopedic issues require surgery? What are other forms of treatment?

DR. DANIEL SUCATO: Most can be treated without surgery. Physical therapy can improve range of motion, strength, and flexibilit. Other treatments include bracing, casting, and anti-inflammatory medications.

DR. PHILIP WILSON: We always reserve surgery for use when other options are not available. In addition to what Dr. Sucato mentioned, sometimes simple reassurance to the family that the orthopedic condition is normal or will improve with age may be all that is required.

Current Concepts: Management of Acute Shoulder Instability in Young Athletes

Watch the full lecture.

Our latest presentation from Coffee, Kids and Sports Medicine covers the management of acute shoulder instability in young athletes. Sports medicine physician assistant Ben Johnson, P.A.-C., dives into the differences in instability patterns between the skeletally immature and skeletally mature shoulder, on-field/acute management of shoulder dislocation and evidence-based recommendations for treatment of first-time shoulder dislocation.
 
Johnson begins the presentation by discussing the epidemiology of shoulder dislocations in high school and collegiate athletes in the United States and explains why it matters. He then shares important insight in how children and adolescents differ from adults physically, especially in relation to the capsular elasticity, a smaller anterior-inferior recess and more. Johnson shows the changes that occur in the shoulder as an adolescent enters puberty, and he discusses how this affects shoulder injuries.
 
Next up, Johnson teaches on-field and acute management of shoulder dislocations in pediatric patients and what medical providers need to know. Acute management includes taking a brief history, initial assessment and considering sport-specific factors. He breaks down when and how on-field reductions should be performed, sharing the benefits of early reductions and red flags to consider.
 
Johnson provides an evidence-based review of external and internal immobilization compliance and outcomes, along with the pros and cons of each method. He then answers questions about operative versus nonoperative treatment, breaking down the consequences of each.
 
To wrap up the presentation, Johnson provides a summary on pediatric glenohumeral dislocation and the steps that should be taken when assessing treatment strategies, as well as sharing a treatment algorithm. The presentation is crucial for sports medicine physicians and other medical professionals who treat young athletes, especially those at a high risk for shoulder injuries.

Thumb Fracture Q&A

Thumb Fracture Q&A

Thumb injuries are common, especially in young athletes, and can occur from direct hits, falls on outstretched hands or hyperextensions. We see them often in football, basketball, baseball and soccer.

Pediatric nurse practitioner Courtney Schneidau, P.A.-C., shares information about thumb fractures and how to handle these types of injuries in young athletes.

Anatomy of the thumb
The thumb is made up of two major bones — the distal phalanx and the proximal phalanx. The distal phalanx starts at the tip of the thumb, underneath the fingernail and extends to the knuckle. The proximal phalanx runs from the knuckle to the base of the thumb, where it connects to the hand. 
 
How do thumb fractures typically occur? 
A thumb fracture can occur anywhere in the thumb and is generally caused by a direct trauma, like from a fall or a hit to the hand. For example, if a player hits his hand/thumb on the helmet of another player while playing football.  
 
What are the main symptoms of a thumb fracture? How do you know if the injury needs medical attention? 
Symptoms can include: 
–    severe pain
–    swelling and tenderness
–    limited motion or inability to move the thumb
–    visible deformity or deformed appearance
–    a numb sensation or coldness in the thumb 

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You should seek medical attention if you are experiencing pain, bruising or swelling. It is important for a professional to examine the injury to determine the best course of treatment.

How is a thumb fracture diagnosed and treated?
Your provider will take a detailed history, including the activity that caused the injury, as well as perform a physical exam. X-rays of the hand and injured thumb will be performed to better evaluate the injury and rule out other injuries.

A fractured thumb can be treated through casting or the use of splints, which limit movement while the bones heal. Surgery is sometimes needed, depending on the location of the break. There are different techniques that are used to hold the bones in place, including the use of pins, plates or screws. Following surgery, a splint or cast is worn to ensure proper healing.

What is the outcome following a thumb fracture? 
Thumb fractures generally have good outcomes, following proper treatment and rehabilitation. Once the fracture has healed, hand therapy may be required to help restore motion.

Should you see a pediatric orthopedic specialist for a potential thumb fracture? 
Scottish Rite for Children treats children who need complex reconstruction following trauma or have hand disorders related to neurological conditions or nerve injuries. That includes fractures (shoulder to fingers), nerve injuries, tendon injuries and complex injuries. Our Sports Medicine team treats the comprehensive needs of athletes and provides management for sport-related injuries and conditions. Young and growing athletes are highly competitive and have unique conditions that require care by a pediatric team of experts. Learn more about our centers for excellence in Sports Medicine and Hand and how board-certified pediatricians, pediatric orthopedic surgeons, physical therapists, athletic trainers, psychologists and other specialists work side-by-side with each patient and their parents to develop the best game plan for treatment, rehabilitation and safe return to sport.

Learn more about our Facture Clinic.