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Share Your Story: Caroline’s Curve

Share Your Story: Caroline’s Curve

by | Jun 11, 2019 | Scoliosis & Spine

Meet Caroline, a patient who is treated by our spine experts. Learn more about her journey below.

Blog written by Caroline’s mom, Christina, of Dallas. 

“What’s that little lump on her back?” This is how Caroline’s congenital scoliosis journey began, when she was almost nine months old.

We noticed a small lump on her back, around her spine, when she was leaning forward in the bathtub one evening. This discovery led to a lot of internet research and had me in tears, wondering what it could be. 
 
Her nine-month check-up was approaching, and we had her pediatrician take a look at her back. After his examination, he referred us to a pediatric orthopedic specialist

We were able to get in rather quickly and it was then that she was diagnosed with congenital scoliosis. Caroline had a 24-degree curve, plus a single hemivertebra at L2. When the doctor laid out the X-rays, we could immediately see that her spine was curved. We left that appointment in tears, shocked and terrified by all the things we had just been told. We were completely overcome with worry for our sweet girl and what her future would look like. He then referred us to the experts at Texas Scottish Rite Hospital for Children. Living in Dallas, we were familiar with the hospital.   

We immediately scheduled our appointment. Before our first visit, we did a good amount of research, just like any concerned parent would. We worried, we cried, we prayed, and we hoped for the best. When it was time for our appointment, we were prepared with all of our questions. When we arrived at the hospital, we were greeted with the smell of fresh popcorn and the sound of laughter from other children.

Every single person we saw had a smile on their face and was so friendly to Caroline and our family, putting us at ease.     

 
They took more X-rays of her back and chest, weighed and measured her, and then we waited to see Dr. McIntosh. As soon as she walked in, she told us that Caroline’s case was “not that bad.” She must have seen the extreme concern on our faces because her saying that immediately made our worries go away.  

She confirmed that it was congenital scoliosis with a single hemivertebra at L2. The hospital has a X-ray machine where the child stands upright rather than laying down. This method gives a more accurate reading. Here, her curve was only 19 degrees.
 
We also learned that since her hemivertebra was lower in her spine, it was not connected to nerves and there was no need to worry about possible nerve issues. She advised us to get Caroline’s heart and kidneys checked out since a large percentage of congenital scoliosis cases can also have heart or kidney issues. Her heart and kidneys ended up being just fine! We were so thankful.  

Dr. McIntosh said that she simply wanted to monitor Caroline and see her every six months. At our next appointment, there had been very little progression in Caroline’s curve – this was great news! Dr. McIntosh said that they will usually perform surgery once the curve gets to 40 degrees and the slower the progression, the more time Caroline will have to grow before possibly having to have surgery.    
 
We continue going for check-ups to monitor Caroline’s spine. We’ve been told there is a tiny chance she may never need surgery, but if she does, we feel confident in the doctors at Scottish Rite Hospital and no longer worry about our sweet girl. 

We have had such a wonderful experience and want to help others have the same opportunity. Caroline and I make children’s bracelets and we donate 100% of the proceeds back to the hospital.
 

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

FOX 4: Benjamin Waggoner shares his Eagle Scout journey

FOX 4: Benjamin Waggoner shares his Eagle Scout journey

by | Nov 1, 2018 | Press Coverage, Scoliosis & Spine

Read the original story on Fox 4’s website here.
 

This week was a big one for FOX 4 traffic reporter Chip Waggoner and his family. His son became an Eagle Scout. But it wasn’t easy for him to earn the prestigious title.

Benjamin Waggoner said he’s waited for years to be named an Eagle Scout.

“I’ve been through a lot in my life. I think few would expect to see something like this in existence… a kidin a wheelchair an Eagle Scout,” he said.

Benjamin’s mom and dad were right by his side as he earned the award, just like they’ve always been.

“He’s inspiring. I know, I’m dad. I’m biased. But he’s an exquisite light, unbelievably unique and when he comes into a room, he lights it up,” Chip said.

It’s been a long journey for the Waggoner family. Before Benjamin was born, Chip’s wife Wendy learned the baby boy she was carrying wasn’t developing as planned. Some people suggested she terminate the pregnancy.

“I remember thinking for 1/10th of one second, yes this is what we should do. And it’s like, wait a minute. Who’s in control here? God’s in control. God said he’s going to strengthen us and help us, uphold us with his righteous right hand. He’s going to take something, in control of everything. And if he’s in control of everything, he’s got a plan. And I have to trust that plan,” Chip said.

“It was our first child so we didn’t really know. It was our normal. But it was kinda scary because we haven’t had anyone in either one of our families that have had any kind of challenges like that,” Wendy said.

Even with all the worry, Benjamin’s birth was a beautiful moment.

“We did get to have a brief moment with him, hold him as best we could given the circumstances,” Chip said.

Benjamin was then immediately brought into surgery, the first of about 20 that he’s had in his lifetime.

He was born with a rare form of spina bifida. His spinal column is also tethered, causing him limited sensation in his lower body.

But he has exceeded his doctors’ expectations time and time again. In his world, if he faces a challenge, he figures out a way to conquer it.

That’s how he approached the requirements for his Eagle Scout award. For his Eagle project, he raised the funds and built a nine-hole Frisbee golf course at Camp John Mark, a camp that specializes in helping children with unique medical and physical challenges.

Chip has been a part of the FOX 4 family warning viewers about traffic trouble spots for 22 years. He has spent many nights on hospital cots, working split shifts at FOX 4 with little or no sleep. Still, he often has a smile on his face.

When meeting Benjamin, it’s easy to see his sweet, silly side, just like his dad. The two often turn to laughter to get through all the challenges of life.

“The scout motto being prepared is the biggest thing I’ve learned from scouting because it has applied to my life so much,” Benjamin said.

“He deserves every bit of this celebration. He is so worthy of being marked for this distinction and I can’t wait to see who he gets to inspire next,” Chip said.

The Waggoners are reminding people that life is a miracle and some moments are so so precious.

NBC DFW: Friendship Started With Act of Kindness on Keller Marching Band

NBC DFW: Friendship Started With Act of Kindness on Keller Marching Band

by | Oct 29, 2018 | Press Coverage, Scoliosis & Spine

Read the original article on the NBC DFW  website here.

Grab your tissue box – our patient, Drew, and his friend, Kailey, are making us cry happy tears! Hear how their friendship formed at Keller High School and how they plan to work together to march in the Macy’sThanksgiving Day Parade.
 

For the first time ever, the Keller High School Marching band will be in the Macy’s Thanksgiving Day Parade and they’ll be the only high school from Texas there in 2018.

Freshman member Drew Bell is “very excited, like very excited” to be taking part. He’s been playing the trumpet for four years, but how much has he practiced?

“Not as much as I should,” he said with a laugh.

Right by his side will be senior and section leader Kailey Summons, and she has practiced as much as she should — not to play, but to serve as Bell’s legs during their big performance, all because of a birth defect that left him in a wheelchair. And she’s one of Bell’s biggest fans.

“Oh he’s great, very positive attitude. He’s so funny,” Summons said. I mean he makes the best out of every situation. So, he’s a good, he’s a good kid.”

On a Thursday afternoon at Keller High School, the two are getting ready to perform before the football game in the band’s “Spirit Show.”

“There’s Drew!” she yells as he comes into the cafeteria where the band is gathering. “You’re just gonna be right here,” Summons says to Bell.

She looks after him, and he often needs it.

“Wait, where’s your gloves and gauntlets … do you have your jug?” Summons asks through the course of getting ready.

“I make sure he’s ready for everything, so then it’s just not me focused on me, it’s me and him,” Summons says.

For Bell, becoming a member of this marching band is a big deal. With its 400 members, it’s one of the best in the country.

“When did you know you wanted to be on the marching band at Keller?” he was asked.

“For as long as I can remember. I just like this band,” Bell said.

Before becoming a member of this prestigious group, Bell faced challenges greater than most, including seven surgeries. He has spina bifida, meaning his spine didn’t fully develop in the womb.

“So I was born like this. So, I’m stuck with it and going to be stuck with it forever, till I die,” Bell said.

Are there ever times when it frustrates him? 

“No … because I know that there’s people way worse than me,” Bell said.

And he doesn’t let it get in his way of anything — including the biggest obstacle when it came to being on a marching band. Bell can’t play his instrument and push his wheelchair at the same time. Someone needed to step up.

“And then my private teacher and my band directors were kind of like, ‘Well, if we can just get someone to be his feet and he can be the trumpet player,’ and I was like, ‘I’ll do it!’” Summons said with enthusiasm.

She didn’t hesitate, and the entire band welcomed him with enthusiasm.

“I wasn’t expecting it,” Bell said. “I would think that they would like, maybe not like me, but now I know that they do. So it’s really, it’s really good.”

“You know, you just worry that he’s going to be over on the side or something, you know what I mean?” said Bryan Bell, Drew’s father. “But since the first day I called Mr. McGahey [the Keller High School director of bands], I expressed those concerns and he said, ‘Bryan, no. He’s going to be a part of the band and we’re excited about it.’”

Bell is the first student on the Keller Marching Band to perform in a wheelchair. As a freshman, he’ll play alongside the band in New York City in the Macy’s Thanksgiving Day Parade, which is also a first for the school.

“It’s very exciting,” Summons said. “I never thought that I would be in any parade, let alone the Macy’s Day Parade.”

Summons still gets to perform with the varsity marching band in competitions and at halftime of football games, but for the “Spirit Show,” which is sometimes before a game, she skips playing her trumpet so Bell can be the one to shine.

When they perform together, Summons is the one who has to memorize all of their movements, and she takes Bell where he needs to be on the field.

She doesn’t play so he can. And she means a lot to Bell.

“Well, I wouldn’t be able to march without her,” he said. “She didn’t have to do it, she wanted to—and that means a lot to me, and she doesn’t get to play because of it.”

“I mean, it’s not really a sacrifice when you like doing it,” Summons said. “I just did it to make sure he knew that he always had a place in the band, and he always will.”

Each choreographed step is a symbol of the day-to-day partnership between Summons and Bell, because their individual actions give way to a bigger message.

When asked what Summons has learned from this experience, she said, “Just because someone is different from you, doesn’t mean you have to treat them differently.”

Summons said no matter what field they play on, there are usually obstacles that take them a little longer, but they always find their way together.

“You’re still strapped in,” Summons said to Bell as they waited at the bottom of the stadium’s stairs. “I know,” he answered.

She took his hand and together they climbed the stadium steps together to their seats with the rest of the band.

“She’s doing it because she felt it in her heart that she wanted to do it, and I think it’s blessing her too,” said Bryan Bell. “A lesson is when you give of yourself and sacrifice, it blesses you and it makes you happy, more than it’s helping — more than the other person is happy.”

It’s a friendship that began with a selfless act of service and because the Keller marching band welcomes every student.

Even though Summons is a senior this year, McGahey said he has no doubt that someone else will step up next year to help Bell as he continues his dream with the Keller High School Band.

Scoliosis Awareness Month: Casting for Scoliosis

Scoliosis Awareness Month: Casting for Scoliosis

by | Jun 27, 2018 | Scoliosis & Spine

Casting is a form of treatment for scoliosis and is used to prevent the curve from getting larger when children are young and growing rapidly. The cast works like a brace to control curve progression, but cannot be removed. Casts can be used when doctors are unable to control curve progression with a brace. As with a brace, when the cast is removed, the curve will still be present. Our goal is to keep the curve from getting larger.

Your child will be admitted to the hospital the day before or on the morning of each cast application. Your child will be given general anesthesia and will be asleep in the casting room before the doctor applies the cast. Gentle traction is used to correct the scoliosis curve as much as possible. The doctor applies a T-shirt liner and soft padding to protect the skin before the cast is applied. The cast will have holes (or “windows”) to allow the stomach to expand for eating and to allow plenty of room for breathing.

Your child will be able to go home either the same day the cast is applied or the day after. This cast may have an impact on your child’s balance and walking. Close supervision is important to prevent injuries from falls. Your child will adjust to the cast in a few days.

It is important for the cast to remain dry. If your child wears diapers, you will have to tuck the diaper under the cast at the hips. Your child will not be able to take a regular bath or shower while wearing a scoliosis cast. You will have to sponge-bathe your child during this time, as water will ruin the cast and can damage your child’s skin under the cast. Because of your child’s rapid growth, the cast will have to be changed every two to three months for up to one year. 

How to care for your child’s scoliosis cast:

  • Keep the cast as clean and dry as possible at all times to prevent skin breakdown and damage to the cast.
  • Give your child a sponge bath daily and wash all areas of skin not under the cast. Never give a bath or shower in the cast.
  • If itching is a problem you may use a hair dryer on cool setting to blow into the cast. You can also use distractions, such as games, music, reading, video games or counting to distract your child.
  • Never put anything in the cast to scratch the skin, as this can cause a sore or infection. You can pull the T-shirt liner up and down to relieve itching.
  • Never use powder inside the cast, as it may clump and irritate the skin. Do not use oil or lotion under or around the edges of the cast.
  • Never permit a child around a pool with a cast on or allow him/her to ride in a boat.
  • Do not allow your child to play in sand or dirt.
  • It is OK to draw on your child’s cast or put stickers on it. Be creative. Have fun with the cast.
  • You will be given a cast care book before you go home. The nurse will give you further instructions and waterproof tape and moleskin for cast edges to use at home as needed.

Call Scottish Rite Hospital:

  • If the cast is too tight.
  • If your child has decreased movement or sensation (tingling) in arms or legs.
  • If you notice skin breakdown.
  • If the cast cracks or breaks.
  • If you notice the cast position has changed.
  • If you notice a foul odor (beyond body odor). This can indicate a wound under the cast.
  • If an object (such as a toy, rocks, fork, etc.) gets into the cast and cannot be removed. This can cause a pressure wound under the cast.
  • If the cast is causing pain.
#SRHaccess Facebook LIVE Recap: Scoliosis FAQs

#SRHaccess Facebook LIVE Recap: Scoliosis FAQs

by | Jun 22, 2018 | Scoliosis & Spine

In honor of Scoliosis Awareness Month, clinical manager Jennifer Bowden, R.N., joined us on Facebook LIVE to discuss the most frequently asked questions about scoliosis. Below is a recap of the conversation.

Watch the live segment. 

What is the difference between an ambulatory care and inpatient nurse?

  • An ambulatory care nurse, also known as clinic nurse, is the nurse a patient will see when he or she has a clinic visit.
  • An inpatient nurse takes care of the patient once out of surgery.

At an initial appointment for scoliosis, what can a patient expect? 

  • The patient is seen by their doctor and clinic nurse. They could also be evaluated by a physician’s assistant or fellow/resident.
  • If the patient does not have X-rays on file, it is possible that they may be sent to radiology to have those taken.
  • The doctor will complete a clinical exam to check for scoliosis.
  • Depending on the outcome of the clinical exam, X-rays are checked if there are concerns regarding a potential curve in the back.
  • The doctor will give the patient a time frame of when he or she needs to come back for another visit.

Scoliosis Surgery 
Who do the parents contact if they have questions about surgery?

  • Clinic nurse
  • Families are encouraged to call with any questions they may have at any time.
  • Our staff encourage parents/patients to write down any and all questions.

While a patient is in surgery, where does the parent/guardian wait?

  • Patient will be assigned a room on the inpatient unit – parents can wait in that room.
  • Surgery waiting area is on the 4th floor – quiet and away from hustle and bustle
  • Cafeteria – on the C level by the A elevators
  • While the patient is in surgery, the parent/guardian must stay inside the hospital at all times.
  • Each parent/guardian is given a pager to be notified/updated regarding the progress of the surgery.

Most common updates during surgery

  • It takes about an hour to get the patient prepped before surgery actually begins.
  • The parent/guardian is updated when the surgery actually begins.
  • Updates come every one to two hours
  • Parents are notified when the patient is being closed up.
  • When the surgery is complete, the surgeon will call and speak to the parent.

What does the admission process for spine surgery look like?

  • Most spine patients check into the hospital the day before surgery.
  • Labs and X-rays are taken, if needed
  • Clinical photos are taken so that the patient can remember what he or she looked like before the surgery.
  • The patient and their family are able to meet their care team:
    • Inpatient nurse
    • If needed, a child life specialist and physical/occupational therapist
    • OR nurse
    • Anesthesiologist

What happens after surgery?

  • The patient will be in recovery (PACU) for half an hour to an hour or longer.
  • Once the patient is awake and the breathing tube is removed, the parents are called to see their child in recovery.
  • Parents are escorted to the patient’s room and the recovery nurse will take the patient to their room.
  • Recovery nurse will give the inpatient nurse a report on the child.

Who is the patient seeing after surgery?

  • Inpatient nurse
  • Patient care techs
  • Doctors
  • Residents and fellows

Pain management after surgery

  • Education on pain takes place before surgery
  • Really sore and still after surgery – the nurse teaches the patient how to assess their pain

Will the patient wake up during surgery?

  • No, the patient is fully asleep during surgery.
  • Anesthesia is given to the patient to keep them asleep
  • The patient’s spinal cord wil be monitored throughout the duration of the surgery.

Movement after surgery

  • Physical or occupational therapy can be part of the process after surgery, if needed.
  • Nurses help patients get out of bed.
  • The nurse will teach the patient how to roll over, prop themselves up and turn over.
  • The care taker at home will also be taught how to help the patient get out of bed and move around safely.

Going home after surgery

  • Pain is under control
  • Incision looks good
  • Patient is up and moving
  • Eating and drinking – no vomiting
  • Bowel movement in the hospital – biggest problem after this surgery is constipation and gut issues

The drive home from the hospital: Is there a certain set up needed in the car? 

  • Every patient is different
  • Take pain medication close to when departing the hospital
  • Most patients like to recline in the car seat versus sitting up straight.
  • The nurse will help the patient down to the car and will make sure they are safely situated inside the car.
  • Every hour to two hours, we recommend the patient to get up and move/change positions.

Specific bed set up at home

  • No restrictions on the bed setup at home
  • If the bed is upstairs, recommend sleeping somewhere downstairs
  • No hospital bed is necessary
  • Some patients like being in a recliner, instead of lying flat

Incision care

  • Nurses educate parent/guardian on how to change the dressing covering the incision.
  • No creams or lotions on the incision until told by your doctor.
  • A nurse will provide the parent with supplies to change the dressing.
  • No soaking the incision, showers only – do not want the incision under water because it could cause an infection
  • After shower, remove the dressing, pat area dry and then apply a new dressing

Will the patient have a scar from surgery?

  • Yes, a long and thin scar down the middle of their back.
  • If well taken care of, it will flatten out and look like a faint pencil mark down the middle of the patient’s back.
  • For at least two years after surgery, it is recommended that the scar be covered with sunscreen or a shirt when out in the sun.
Adolescent Idiopathic Scoliosis

Adolescent Idiopathic Scoliosis

by | Jun 18, 2018 | Scoliosis & Spine

Article originally published by staff orthopedist Amy L. McIntosh, M.D., in first quarter, 2018 issue of Pediatric Society of Greater Dallas newsletter. 
What is scoliosis?
Scoliosis is a rotation in the spinal column that creates a “C”-shaped single curve or an “S”-shaped double curve, when viewed from behind (Figure 1). Some cases worsen with time and can result in serious problems such as abnormal appearance in posture, increasing back pain as one ages, and in the worst cases, interference with heart and lung function. Idiopathic (no underlying cause) scoliosis occurs in 2 to 3% of the adolescent population, usually affecting young people between the ages of 10 to 16. Scoliosis onset is usually earlier in girls than in boys—generally, ages 10 to 14 for girls and 12 to 16 for boys.


Figure 1

When should I screen patients for adolescent idiopathic scoliosis (AIS)?
Scoliosis screening is designed to identify adolescents with abnormal spinal curvature. Screening can detect scoliosis at an early stage, when the curve is mild. Most curves can be treated without surgery if detected before becoming too severe. Therefore, early detection is the key to controlling spinal deformities. Ideally, spinal screening should be conducted as a part of the annual examination for females at age 10 and 12 years, and males once at age 13 or 14 years. Signs to watch for include (see Figure 2):

  • One shoulder higher than the other. One shoulder blade higher or more prominent than the other
  • One hip higher than the other.
  • Space between arms and body greater on one side.
  • Leaning to one side.
  • Head not centered directly above the pelvis.
  • When bending forward, thoracic rib prominence or lumbar fullness that is asymmetric to the opposite side. (+ Adams forward bend test) (Figure 3)​

If any of these signs are present, then the child should be referred to a pediatric orthopedic surgeon. Texas Scottish Rite Hospital for Children has a low dose X-ray machine (EOS) that obtains high quality images with significantly less radiation exposure to the patient. For that reason, please do not obtain X-rays. Just refer the patient if clinical signs of scoliosis are apparent on physical exam. The orthopedic surgeon will obtain standing, full length (posterior-anterior and lateral) spine X-rays to measure the cobb angle in both the frontal and sagittal planes. The Cobb angle measurement and the skeletal maturity of the child will determine the treatment.
What are the treatment options for AIS?
Observation:
Routine rescreening or observation by the physician is a form of treatment for mild curves (11-20 degrees). This observation period consists of regular clinical exams and spine X-rays throughout the rapid growth years of adolescence until the spine is mature. It is important to note that more than 90 percent of patients with scoliosis require no treatment other than observation. 

Brace: 
For curves greater than 20 degrees in patients that are still growing rapidly, a brace is prescribed. The brace can prevent the curve from progressing and may eliminate the need for spinal surgery. However, the brace cannot correct the curve that already exists. Bracing is generally recommended for curves between 20 to 40 degrees in adolescent patients with significant growth remaining. The main factor in achieving a high rate of bracing success is the number of hours a day that the brace is worn. Various spinal orthoses are available, with the most common being a Thoracolumbo Sacral Orthosis (TLSO). The TLSO is named by the areas it is designed to stabilize: the thoracic, lumbar and sacral parts of the spine. It is cosmetically acceptable as it can be covered well by clothing. Wearing a brace is not an easy treatment for an adolescent. Even covered by clothing, it is hot, hard and can make the student feel self-conscious. Getting into a daily routine of wearing the brace while participating in activities helps with compliance, which is key to successful treatment.

Surgery: 
Some patients present with severe spinal deformity, and other patients scoliosis worsens despite compliant brace wear.  In these specific patients, surgery can reduce a portion of the curve and prevent it from increasing in the future. Usually, surgery is reserved for adolescents and pre-adolescents who already have a curve of 45 to 50 degrees or more. The most common surgical procedure is a posterior spinal fusion with instrumentation and bone graft.

This type of surgery involves attaching rods to the spinal column to help straighten it. The bone graft between the affected vertebrae encourages fusion to prevent further progression of the curve. Instrumentation refers to the various rods, screws, hooks or wires that are used to hold the spine in the corrected position while the bone fusion occurs. The instrumentation is rarely removed. Following surgery, the fused section is no longer flexible. The average hospital stay is about two to three days, and the student can usually return to school in approximately four weeks. During the first six months after surgery, some limits will be placed on strenuous physical activity. After this healing phase, the surgeon will usually release the patient for all activities, including competitive, low-contact sports.
Does physical therapy help treat scoliosis?
The Schroth method is a nonsurgical option for scoliosis treatment. It uses exercises customized for each patient to return the curved spine to a more natural position. The goal of Schroth exercises is to de-rotate, elongate and stabilize the spine in a three-dimensional plane. This is achieved through physical therapy that focuses on:

  • Restoring muscular symmetry and alignment of posture
  • Breathing into the concave side of the body
  • Teaching you to be aware of your posture

This approach to scoliosis treatment was developed by Katharina Schroth and further popularized by her daughter Christa. Born in Germany in the late 1800s, Katharina Schroth had scoliosis that was unsuccessfully treated with bracing. She developed her own breathing technique and exercises to manage her scoliosis. She and her daughter opened a clinic, where they treated more than 150 patients at a time.
A Schroth-trained physical therapist or specialist should guide you in learning this program. The duration of this treatment varies and the patient is expected to continue exercises at home to keep scoliosis in check.

Scottish Rite Hospital is currently investigating the use of Schroth physical therapy alone and combined with brace treatment for patients with mild scoliotic curves.

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