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A Parent’s and Patient’s Perspective on Scoliosis – Allison’s Amazing Journey

A Parent’s and Patient’s Perspective on Scoliosis – Allison’s Amazing Journey

by | Jun 7, 2024 | Scoliosis & Spine

Lisa, mom of Allison, shares what it was like for her daughter Allison to be treated at Scottish for Children for scoliosis:
 
What brought you guys to Scottish Rite?
Allison was 8 years old when we went to her pediatrician for back pain she had recently been experiencing. At her appointment, the doctor noticed a curve in her spine and diagnosed her with scoliosis. After confirming her condition with an X-ray, Allison was referred to Scottish Rite for Children by her doctor. We were also told by others to go to Scottish Rite for the best care possible. From the moment we walked in the front doors, the sense of peace we felt was so overwhelming. We knew our decision to come to Scottish Rite was the right one!
 
What was your experience like with Dr. Ramo and the Scottish Rite staff?
The compassion Dr. Ramo, his nurse Marivel and his entire team showed us is something we will never forget. As parents who were very concerned about this diagnosis, Dr. Ramo explained everything thoroughly. He answered all our questions and addressed our concerns, which made us feel very confident in the treatment and surgery plan for Allison. With her very young age and significant curve, her treatment plan was to insert MAGEC® growing rods which would be lengthened every six months to allow for more growth before her spinal fusion. With Dr. Ramo’s expertise and knowledge, we knew we would get through this.

Do you have any advice for parents whose children have recently been diagnosed with scoliosis? 
Remember that as worried as you might be for your child, your child is scared and worried, too. Encourage them to write down or ask questions they may have about their treatment plan and surgery. Dr. Ramo would always ask Allison if she had any questions for him. He would answer every question looking directly at her, so she understood. Him taking the extra time to do all of this made her feel better and settled her fears. 
 
What’s it like to see Allison where she is today? 
Seeing Allison where she is today fills us with such gratitude. The doctors at Scottish Rite are unmatched in their skills. God has given them their knowledge and expertise in their chosen field and helps them perform miracles every day. We feel blessed to have been a part of these miracles. 

What do you want people to know about Allison’s accomplishments?
We are so proud of Allison’s accomplishments. She has been on the honor roll since she first started school. She recently graduated high school as a member of the National Honor Society, AP Ambassadors, and she was enrolled in Dual Credit and On Ramps classes. Because of her high academic achievement, she has qualified for automatic acceptance to the University of Texas at Austin and Texas A & M. She has also been accepted to SMU, UNT, Baylor and TCU. She recently made her decision to commit to TCU to further her academic career by majoring in marketing. She is excited to experience college life living in the dorm and meeting new friends. 
We are also proud of her involvement with the Peer Support program at Scottish Rite. She has talked on the phone and on FaceTime with other patients – walking them through the process of scoliosis surgery. She has said, “If I can help someone else by answering their questions in hopes of making them feel better and easing their fears, than every minute I’m on the phone with them is worth it. Hopefully, they can see and hear that I did it, and they can too!”
 
Is there anything you want to say to Dr. Ramo and his team?
We are eternally grateful to Dr. Ramo and his team. They are like family to us. We recently returned to Scottish Rite to see Dr. Ramo for her final follow up. Walking through those doors again felt like coming home! Marivel changed her schedule to be there when we came just so she could see Allison and catch up on her progress! What a great visit we all had! Scottish Rite will always hold a special place in our hearts! 
 
Allison, a former patient treated by Brandon A. Ramo, M.D., for scoliosis, shares her experience at Scottish Rite and what other kids should know:
 
Tell us about your journey with scoliosis and Scottish Rite for Children.
My journey with scoliosis and Scottish Rite for Children started when I was in second grade after I began to experience severe back pain. Even though I was very young, I knew that something was wrong. My parents took me to Scottish Rite, and I had growing rods put in to straighten my spine. About every six months, I would have my growing rods lengthened as my torso grew. When I was in fourth grade, I had my final spinal fusion. In the beginning, I was very scared about my situation since there were so many uncertainties. Scottish Rite for Children helped me tremendously through everything by having phenomenal staff who supported me through my journey. I felt comfortable throughout the entire process, which made my journey a lot easier and helped me through my fears. 
 
What would you tell other kids about Scottish Rite?
I would tell other kids that Scottish Rite is the best hospital and has some of the best people you will ever meet. No matter what you are going through, they will be there to support you in any way possible and help you have an easier experience. There are fun things to do that give you things to look forward to when you go. You will meet staff who are the most compassionate and caring people you have ever met. Overall, Scottish Rite is an amazing place with outstanding people and resources. 
 
What is your advice to other kids who have been diagnosed with scoliosis?
I would advise other kids who have been diagnosed with scoliosis to not be afraid. I was very afraid when I was first diagnosed, but my fears were eased when I realized what amazing people would be taking care of me and helping me through my situation. It may seem scary at first, but trust me, it will become a lot less scary. Remember that you have people supporting you and wishing the best for you! 
 
What is your favorite thing about or favorite memory of Scottish Rite?
One of my favorite things about Scottish Rite was the dogs that visit you every week in the Inpatient Unit. I can remember how excited I was to pet the dogs, especially since I never had a dog. I was amazed that the dogs were so intelligent. Many of them knew all kinds of tricks, and one of them could even tell you it’s age. This was a memorable experience for me since I was really scared of having surgery, and having the dogs visit me helped me calm down and feel better about the situation. 
 
What are your plans after high school graduation?
After high school graduation, I am going to be attending college at TCU and majoring in marketing. I am really excited for my new home as a frog, and I am ready to get the education I need to make a difference with my future career. I am also looking forward to living on campus and making new friends. I am thrilled to be able to further my academic career at college. 
 
Some patients with scoliosis are worried surgery will cause them back pain when they get older. Can you share a little about your experience?
In my experience, my back pain became significantly better after I had surgery. Before I had surgery, I would get random episodes of extreme back pain. As I have gotten older and since I have had surgery, I have little to no back pain. The surgery for me was life changing in terms of pain. I can sit and stand for long periods of time, which I wasn’t able to do before. Now, I don’t even think about my back anymore in my daily life since it doesn’t really hurt anymore. 
 
Is there anything you would want to say to Dr. Ramo and his team?
I would want to tell Dr. Ramo, Marivel and his entire team thank you for everything you have done for me. They did an exceptional job treating me and helping me through my scoliosis journey. There are not enough words to describe how thankful I am for the team and how they supported me. They were always there for me and answered all my questions regarding my scoliosis. I always felt at ease at Scottish Rite because of my confidence in Dr. Ramo and his team and their outstanding skills and capabilities.
 
Learn more about our expert scoliosis care and our Center for Excellence in Spine.
 

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Let’s Be More Specific About “Non-Specific” Back Pain

Let’s Be More Specific About “Non-Specific” Back Pain

by | May 28, 2024 | Scoliosis & Spine

This article was originally published in a 2021 newsletter for the Pediatric Society of Greater Dallas. Written by physical medicine & rehabilitation physician Jason R. Petrasic, M.D., FAAPMR

Watch Petrasic give a lecture on this topic a Navigating Back Pain in Adolescents.  It should be no surprise that prevalence numbers for back pain in adolescence steadily increase with age and are nearly identical to that of the adult population by the age of 18. However, young patients and their parents are often surprised when formal evaluations of their insidious onset back pain symptoms yield unremarkable results. Then comes the common “diagnosis” that seemingly no one wants to hear: non-specific back pain. However, arguably this is not a diagnosis at all. The term suggests to the patient that there is no identifiable cause of their symptom. As a patient, or a parent, I want to be able to attribute the symptoms I’m feeling to a diagnosis and know there is an available treatment for my diagnosis. Furthermore, I want to know the underlying cause of my symptom or diagnosis so that I can potentially try to prevent its recurrence in the future. Clearly there are countless cases where a vague symptom or complex of symptoms is not associated with any obvious underlying diagnosis, but my suggestion is that adolescent non-specific back pain is more often a diagnosis of myofascial pain syndrome.
 
Pain is a subjective symptom, and, therefore, is influenced by a multitude of factors including actual tissue injury, previous experiences, mental health disorders, sleep quality, and central processing of pain signals. All of these can influence the intensity and duration of pain experienced from any underlying cause. In the absence of identifiable tissue injury, consider the possibility of unidentifiable tissue injury (i.e., at the cellular level) like the concept of delayed onset muscle soreness (DOMS) which is the typical muscle soreness, or pain, suffered after an intense bout of exercise in individuals not acclimated to such workouts. There may be a source of pain that is not a result of obvious structural injury and is not observable on currently available imaging modalities, nor is there a routinely used lab study to identify or screen for it. However, there may be a source of stress and tension on the supportive spine muscle(s) in a growing skeleton with disproportionally lower muscle strength, muscle endurance, and flexibility (or any combination of the three) involving key muscles that when the stress exceeds the back’s ability to support it the affected area becomes painfully symptomatic. This is most typical of myofascial pain syndrome where the problem lies at the muscle cellular level. Insidious onset neck, upper, or lower back pain are the most common presenting complaints with symptoms usually being described as intermittent and exacerbated by prolonged sitting and/or standing/walking. Rest or lying down often alleviates symptoms. Common exam findings include full range of motion of the affected area with or without tenderness to palpation, and bilaterally or asymmetrically tight hamstrings (best tested by checking popliteal angles with patient examined in the supine position with ipsilateral hip flexed to 90deg) and/or hip flexor muscles (best tested by performing the Thomas test).

Watch Petrasic demonstrate a thoracolumbar exam in an adolescent.

It is still key to consider more serious structural problems with the spine elements or muscles (or with other adjacent organ systems) when a thorough history, physical examination, and available lab or imaging studies suggests them, but when it is believed or confirmed that those problems are absent or much less likely, then myofascial pain syndrome should be more strongly entertained. This type of diagnosis offers both a long-term treatment, but often more importantly it also offers reassurance that something more serious is not developing or lingering. It should also be noted that myofascial pain syndrome can affect an adolescent competitive athlete seemingly just as easily as their more sedentary counterparts. Physical activities or competitive sports do not necessarily equate to adequate resistance training and stretching as is often assumed, especially in active, growing adolescents. Often kids involved in athletics put even more demand on their “core” and supporting musculature further exacerbating the deficit. A well-rounded, consistently, and persistently performed home exercise program is key to treating this problem along with emphasizing continued exercise and physical activity, and in some cases arranging for supplemental guidance by a physical therapist knowledgeable in spine/back care can help to optimize and accelerate recovery of more constant or severe symptoms.

Comfort level in diagnosing musculoskeletal conditions can often be understandably uneasy when musculoskeletal complaints are being fielded by primary care providers or specialists in other unassociated fields of practice. Myofascial pain syndrome is merely being suggested as a potentially likely benign diagnosis for an otherwise very common complaint that offers improved clarity to families and may help limit anxiety about what may be going missed or undiagnosed.

Learn more about Spondylolysis: A Common Cause of Back Pain in Young Athletes.

Scoliosis Physical Therapy for Stronger, Straighter Spines

Scoliosis Physical Therapy for Stronger, Straighter Spines

by | Jan 2, 2024 | Scoliosis & Spine

If your child has scoliosis, chances are you’ve already discussed many treatment options with a pediatric spine specialist. The specialist may have recommended a “wait and see” approach to determine whether your child’s curve gets worse or stays the same. You may have learned about braces and casts to keep the spine straight, and you’ve likely researched surgeries that can correct the condition. One option you may not have considered is scoliosis physical therapy. 

This specialized form of physical therapy allows kids and their families to be actively involved in their treatment by addressing muscle and posture issues that can develop due to scoliosis. 

How Physical Therapy Helps Kids With Scoliosis 

Scoliosis is an abnormal curvature of the spine. In children with the condition, the spine may twist or be shaped like a C or an S rather than straight. You might notice your that your child has uneven hips or shoulders, but the condition does not always cause symptoms. When it does, children may complain of back pain, difficulty breathing and shoulder pain. 

With scoliosis physical therapy, children work with specially trained therapists to learn scoliosis-specific exercises that correct posture and retrain muscles. These programs help slow or prevent the progression of a spinal curve and may counteract the effects a curved spine can have on the body. Physical therapy can also reduce pain and improve breathing.

Exercises your child learns may focus on improving:

·       Functional movement, so your child can go about their daily activities

·       Range of motion, as kids with scoliosis may have limited mobility 

·       Strength in the muscles surrounding the spine, hips, shoulders, head and lower body

The Schroth Method 

There are a few different scoliosis physical therapy programs that have been developed. At Scottish Rite for Children, several of our physical therapists have completed specialized training in one type, known as the Schroth method. 

Physical therapists use this method to teach children exercises and breathing techniques that strengthen muscles throughout their bodies. The intent is to improve their posture and ability to perform typical daily activities, such as sitting, standing, lying down and walking. 

During these sessions, physical therapists often have children stand in front of mirrors so they can see how scoliosis affects their posture and movement. The therapist asks the child to breathe in specific patterns or tighten his or her muscles to elongate and stabilize the spine. Sessions can last 45 to 60 minutes, and children can continue the exercises at home between sessions.

Schroth exercises help treat another spine condition many adolescents develop — kyphosis. This spinal disorder happens when a curve causes rounding in the upper back. 

Planning a Physical Therapy Program for Your Child 

Many websites offer exercise tips for people with scoliosis, but working with a dedicated physical therapist helps ensure your child performs exercises specific to their needs.

Before the sessions begin, your child will have an evaluation with a pediatric spine specialist, who can determine the type of scoliosis your child has and the magnitude of the spinal curve. 

The physical therapist uses this information to determine which exercises your child needs and teaches him or her the correct way to do each exercise. As your child improves, the therapist will adapt the program to ensure your child gets the most benefit.

The amount of time your child needs scoliosis physical therapy depends on his or her diagnosis. Even after your child completes the recommended number of sessions, the therapist may provide instructions for a home exercise program to relieve symptoms and prevent the spinal curve from worsening.

Combining the Schroth Method With Traditional Physical Therapy

Traditional physical therapy focuses on the side-to-side curve of the spine. Schroth exercises address this issue from a three-dimensional perspective, straightening the spine from back to front and side to side and correcting spinal twisting. 

For this reason, a scoliosis specialist may combine traditional physical therapy with the Schroth method as they work with your child. 

Scoliosis Care Beyond Physical Therapy 

Some children do well with physical therapy alone. Typically, however, a child will have physical therapy along with wearing a scoliosis brace. 

For some kids, more care is needed. Children with spinal curves greater than 50 degrees often require surgery. Children whose curves have worsened despite wearing a brace may need surgery as well. 

Still, children who need surgery may benefit from a scoliosis physical therapy program. Physical therapy can help regain movement and muscle strength as they recover.

Like any form of exercise, physical therapy has many benefits. While it can’t cure or “fix” your child’s curve, physical therapy strengthens your child’s muscles and helps him or her better manage scoliosis, which can make a big difference in everyday life. 

The scoliosis team at Scottish Rite for Children has years of experience treating children with varying degrees of scoliosis. For more information about physical therapy for scoliosis, schedule an appointment to discuss scoliosis care. 

A Shared Passion to Protect and Serve

A Shared Passion to Protect and Serve

by | Oct 25, 2023 | Scoliosis & Spine

Published in Rite Up, 2023 – Issue 3. 
 
Last summer, the Inpatient Unit at Scottish Rite for Children had extra security and cuteness overload in the form of a 4-year-old patient lovingly referred to as Policeman Joseph. Donning a police vest, badge, walkie-talkie and binoculars, Joseph, of Gonzales, Louisiana, made daily rounds to keep his fellow patients safe. “He’s got a huge personality stuffed inside a little body,” says Randi, his mother.
 
Joseph has congenital kyphoscoliosis. In utero, his vertebrae formed differently, which caused both kyphosis, or an outward spinal curve, and scoliosis, a sideways curve. At age 2, Joseph was referred to Scottish Rite for Children where he received expert care from pediatric orthopedic surgeon Amy L. McIntosh, M.D.

When Dr. McIntosh evaluated Joseph, his curve measured more than 80°, which was beyond the point when surgery is recommended. “For young children who have severe congenital curves, bracing or casting doesn’t help because of the abnormal vertebrae,” Dr. McIntosh says. “You have to wait until they’re big enough to surgically fit an implant in them.” Dr. McIntosh monitored Joseph until he was 4. When his curve reached 100°, she recommended six weeks of halo-gravity traction followed by surgery.

Halo-gravity traction gently stretches and straightens a significantly curved spine in a slow, safe manner. “It’s like taking a spring that’s coiled up and slowly uncoiling it over time,” Dr. McIntosh says. While Joseph was under anesthesia, Dr. McIntosh applied the halo by attaching it to his skull. “I didn’t even feel it,” Joseph says. “It was super magic!” With the help of his care team, Joseph could fasten his halo to a traction device on a pulley system that connected to his walker, wheelchair or bed.
 
While in traction, Joseph participated in therapeutic recreation, physical therapy (PT) and fun activities in Child Life. “He made friends with everyone, especially the security officers,” Randi says, “and he loved growing his muscles in PT, so he could keep his new friends safe. Scottish Rite became our second family, a home away from home.”
 
When traction was complete, Joseph underwent surgery. Dr. McIntosh inserted a magnetic growing rod, also known as the MAGEC® System, on one side of his spine and a sliding traditional growing rod on the other side. After a successful procedure, his curve measured 42° — a correction of almost 60%. “He got almost two inches taller,” Dr. McIntosh says.

 Going forward, the rods in Joseph’s back will be lengthened as he grows. Rather than undergoing multiple surgeries, an external magnetic device will be used to locate the magnet inside the rod to lengthen it. “The magnetic rod acts as a motor to drive the traditional rod that will slide,” Dr. McIntosh says. This hybrid construct will control the correction of Joseph’s spine until he stops growing and ultimately receives a definitive spinal surgery. “Joseph’s care has been top-notch,” Randi says. “Dr. McIntosh is absolutely the best, a true godsend.”
 
On his last day at Scottish Rite, Policeman Joseph made his final rounds, protecting the kids and doing a celebratory safety dance on his way out.
 
Read the full issue.

Megan E. Johnson, M.D., Appointed Program Director for Pediatric Orthopedic Surgery Fellowship

Megan E. Johnson, M.D., Appointed Program Director for Pediatric Orthopedic Surgery Fellowship

by | Oct 24, 2023 | Scoliosis & Spine

We are honored to announce the appointment of Megan E. Johnson, M.D., as program director for the Dorothy & Bryant Edwards Fellowship in Pediatric Orthopedics and Scoliosis at Scottish Rite for Children. The Edwards fellowship is one of the oldest and largest fellowships in the country and has an alumni of nearly 200 surgeons.  
 
With this new appointment, Dr. Johnson will be responsible for attracting outstanding candidates from diverse backgrounds and training them to be skilled clinicians and surgeons. Dr. Johnson will ensure ongoing maintenance of a high-quality educational curriculum for our fellows and provide leadership and direction to our orthopedic faculty who take part in education. She will have a key role in ensuring our curriculum is undergoing needed innovation through regular program evaluation and quality improvement.
 
Dr. Johnson received her medical degree and completed residency training at Vanderbilt University in Nashville, Tennessee. She completed her pediatric orthopedic fellowship at Scottish Rite for Children in 2015, and following her fellowship, she returned to Vanderbilt University Medical Center. She joined the Scottish Rite for Children staff in 2020 as a pediatric orthopedic surgeon. Her clinical practice focuses on spine deformity in the pediatric population. She also treats patients with spina bifida, not only for their spine conditions but also for lower extremity issues. Dr. Johnson also serves as the Medical Director of Ambulatory Care and is an assistant professor of Orthopaedic Surgery at UT Southwestern Medical Center. 
 
“Dr. Johnson is an excellent clinician in the outpatient, inpatient and surgical setting and is an extremely talented surgeon who takes on both the straightforward as well as the complex deformities,” says Chief of Staff Daniel J. Sucato, M.D., M.S. “Not only is she a great leader, but she also has a natural ability to educate and is one of the favorites of our fellows to work with in the operating room and clinics.”
 
Dr. Johnson succeeds Dr. Sucato, who has served as program director of the Pediatric Orthopedic Surgery Fellowship program for the past 10 years. Dr. Sucato will remain Chief of Staff of Scottish Rite for Children as well as the director of Scottish Rite for Children’s Center for Excellence in Spine.

Share Your Story: Connor’s Comeback

Share Your Story: Connor’s Comeback

by | Sep 1, 2023 | Scoliosis & Spine

Meet Connor, a strong and determined athlete whose journey with Scottish Rite for Children began when he was just 10 years old. His scoliosis was first noticed by his mom when she noticed his clothes hung differently. She asked his pediatrician, who referred them to Scottish Rite spine experts. Visiting Chief of Staff Dr. Dan Sucato, Connor’s scoliosis was identified as a 30-degree curve at the time, prompting regular monitoring every six months.

As Connor grew and got more into school sports, his scoliosis curve increased too. His curve was 60 degrees, causing him discomfort. Frustrated with the limitations his condition imposed, Connor decided at 15 that he was ready for a change and opted for surgery.

Last summer, Connor underwent spinal fusion surgery. He spent three nights recovering in our inpatient unit. The support he received from our medical team eased his worries, making him feel at ease about the surgery. His quick recovery amazed everyone, allowing him to celebrate his 16th birthday with friends just two weeks later.

The transformation was remarkable. His shoulders were even, and his T-shirts fit properly. His dedication to recuperation and determination to regain his active lifestyle paid off. With his scoliosis corrected, Connor joyfully rejoined the high school junior varsity football team and played in his first game after taking a year off.

But it wasn’t just the surgery. Connor found comfort at Scottish Rite, from our yummy popcorn to our caring staff who he says felt like family to him. Dr. Sucato didn’t just fix his scoliosis; he brought back normalcy. With no more limping due to his hip pain, Connor got his life back. He’s loving football, golf, hiking and rafting. Watching sports and eating out with friends now brings him joy, as he embraces his new freedom without limitations.

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