Beating Scleroderma and Actualizing Invention With Grit

Beating Scleroderma and Actualizing Invention With Grit

Previously published in Rite Up, 2024 – Issue 1.

Lino is an inventor who is set on changing the world. “Problems without solutions inspire me to invent,” he says. “I’ve been tinkering with stuff since I was little, but I didn’t realize all this problemsolving was called inventing until I was in the fourth grade.” That was when Lino, of Frisco, invented the String Ring, an adjustable band worn as a ring that protects your finger while playing a stringed instrument. Lino played the cello and wanted to find a way to keep his fingers from blistering without changing the sound. “When you finally solve a problem that is personal to you and that affects a lot of other people, it’s the best feeling in the world,” he says.
 
His mother, Sharon, says that Lino has never met a challenge he does not want to conquer. “Lino is kind, smart and positive, but ‘grit’ is the perfect word for him in everything he does — at school, in sports and through his journey at Scottish Rite,” she says. “How he handled his diagnosis is how he handles his inventions.”

When Lino was 12, his hands began swelling. He could not make a fist, and when it got cold, his hands changed colors, turning red, even purple. His pediatrician referred him to Scottish Rite for Children where he was evaluated by orthopedic hand surgeon Chris Stutz, M.D. Dr. Stutz found nothing wrong with the bones in his hands but suspected a rheumatic condition and referred him to rheumatologist Lorien A. Nassi, M.D.

Dr. Nassi diagnosed Lino with juvenile systemic scleroderma, a rare, chronic autoimmune disease in which the immune system causes inflammation and tissue changes that lead to a tightening and thickening of the skin. The condition affects approximately 3 per 1 million children. There is no cure, and it can progress, affecting the internal organs, such as the heart, lungs and kidneys.

“It felt like an out-of-body experience,” Sharon says. “We walked in with a healthy child, and all of a sudden, we got a diagnosis of something we didn’t understand.” Dr. Nassi and her team, including a psychologist and a child life specialist, consulted with the family, explaining that Lino would need to take a weekly injection. “They told him not to search it on Google,” Sharon says, “that he could take the day off from school, but he was like, ‘No, I have to go to school. I have to give a presentation.’”
 
Lino began taking injections as well as receiving physical and occupational therapy to increase manual dexterity, flexibility and range of motion. “The hardest part was getting the injections and then learning how to administer them myself,” Lino says. “I didn’t like needles, but I got over that, and I feel better now that I’m doing it myself because I feel more in control.”
 
After four years, Dr. Nassi is tapering off the medication. “Lino has had a remarkable trajectory,” she says. “Unfortunately, so often rheumatology diagnoses are only seen as severe, lifelong conditions with significant limitations. I love that Lino shows us that even some of the more serious rheumatologic diagnoses can have great outcomes.”
 
Lino hopes to finish treatment this summer. “I’m lucky they caught it so early, and now it’s better,” he says. “I’m really thankful for that.”
 
“We will be forever grateful to Scottish Rite, Dr. Nassi and Dr. Stutz for diagnosing Lino right away,” Sharon says. “Thanks to them, against many odds, Lino has no moresymptoms and will be medicine-free, an outcome that is as rare as the disease itself.”

But, Lino does not want his success story to be a rarity. He is pursuing becoming a scleroderma advocate who shares his story, creating awareness to raise funds for research, and one day, a cure. He aims to ensure that other kids find the right doctors, get diagnosed early and know that there is hope.

Scleroderma has not stifled Lino’s creativity. By the time he was in eighth grade, he had masterminded four inventions. His most recent — Kinetic Kickz 2.0 — has a patent pending. An improvement on his original Kinetic Kickz, 2.0 is a shoe with a generator built into the sole that collects energy from walking, allowing the wearer to power a device with their shoe. The idea came to him one day after school on the soccer field. He needed to call his mom to come pick him up, but his phone was dead, and he did not have a charger. “I spent months trying to light an LED bulb to prove that I could create enough energy to charge something,” he says.

Invention Convention Worldwide recognized Lino’s genius, awarding him first place in his age group for Kinetic Kickz 2.0 at the 2021 Globals competition presented by Raytheon® Technologies, now RTX. TIME magazine noticed and selected him as a 2021 Kid of the Year finalist.

The 17-year-old continues to improve his inventions as he conceives of new ones. His Scottish Rite journey has inspired him to consider medical-based inventions, and he is debating whether he wants to be a doctor or an engineer. “I’m not sure yet,” Lino says, “but I am sure of one thing. I want to be a world-changer — someone who helps make the world a better place through their actions, or for me, through my inventions.”

Read the full issue.

Share Your Story: Ella Grace’s Extraordinary Journey

Share Your Story: Ella Grace’s Extraordinary Journey

After noticing concerning symptoms like hair loss and skin changes on her forehead, 2½-year-old Ella Grace and her mom Brandi were referred to Scottish Rite for Children for help. When they traveled from their home state of Louisiana to visit us, our team quickly diagnosed Ella Grace with localized scleroderma, an inflammatory condition that causes hard or thickened patches of skin on the body, and Parry-Romberg syndrome, a rare condition that causes a slow breakdown of the skin and soft tissues of the face. Both conditions are rheumatological in origin, so our Rheumatology team was able to begin creating a treatment plan for her right away. 

Now at age 5, Ella Grace has come a long way since first becoming our patient. At first, she was absolutely terrified of doctors, hospitals and nurses. Throughout her treatments including weekly injections, infusions multiple times a month and taking many medications a day, our team has loved and nurtured Ella Grace to help her feel cared for and comforted while at Scottish Rite.

Ella Grace’s condition is not common – Parry-Romberg is estimated to affect 1 in 250,000 people in the general population and does not have a known cure. Brandi says that working with Dr. Elizabeth SloanDr. Lorien Nassi and certified family nurse practitioner Stephanie Armendariz has been nothing short of phenomenal. Not only do they have knowledge about this rare disease, but they also care for Ella Grace like she is their own and are always a phone call away.

Our team is doing whatever it takes to get Ella Grace’s disease into remission while providing Ella Grace with the support she needs to cope with her treatment. Two special caregivers of Ella Grace’s are Jill Black, R.N., who made her comfortable and earned her trust from day one and Hope Wheatcroft, R.N., who has been with her every step of the way and takes the time to play or do arts and crafts with Ella Grace during her infusion appointments. 

According to Brandi, when she and Ella Grace come to Scottish Rite, they are always welcomed with open arms and greeted with a smile. Back at home, Ella Grace stays busy with competitive cheerleading and being the best big sister ever to her two younger brothers. We’re amazed by the progress Ella Grace has made in her treatment journey, and we are proud to be a part of her ongoing care! ❤️

Learn more about our Rheumatology services.

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

How Do I Know If My Patient Has Arthritis or a Related Condition?

How Do I Know If My Patient Has Arthritis or a Related Condition?

Key messages from a presentation by Lorien Nassi, M.D., at Coffee, Kids and Sports Medicine.

Watch the lecture
Print the PDF

To recognize and respond to patterns of symptoms and findings, a pediatric rheumatologist relies heavily on a medical history and physical exam. Imaging (e.g. ultrasound, MRI) is a dependable tool to help rule out other conditions and recognize active inflammation. With a more accurate diagnosis, rheumatologists can use specific disease patterns (instead of labs) to plan the appropriate targeted therapy rather than traditional approaches, which often relied on nontargeted therapies with higher toxicities (e.g., steroids.) In children, arthritis continues to be the number one cause of acquired disability and therefore deserves prudent recognition, classification and proper treatment.

Juvenile arthritis is frequently referred to as juvenile idiopathic arthritis (JIA). Once other causes of arthritis have been excluded, this condition may be diagnosed in individuals less than 16 years of age with a six-week history of arthritis in any one joint.

Key messages when considering JIA in a pediatric assessment:

  • If pain is the chief complaint or redness is present, it is less likely that JIA is the diagnosis.
  • Signs of systemic inflammation (e.g. fevers, weight loss) should be promptly evaluated to rule out other serious illness.
  • Imaging is frequently more accurate and may be more cost effective than lab work.
    • Several labs have false negatives and false positives.
    • Labs will need to be redrawn at the time of treatment.
    • Ultrasound vs MRI is preferred and is ideally read by a pediatric radiologist with musculoskeletal expertise.
  • Uveitis may by asymptomatic, but is an important finding that should be treated in order to avoid permanent vision loss.

Here were some questions Dr. Nassi addressed during the discussion: 

What are activity limitations for children with JIA?

  • Children taking Coumadin or those with c-spine involvement, should not play contact sports.
  • For others, if the activity doesn’t cause pain, no limitations are necessary.

Is there a role for physical therapy or occupational therapy in patients with arthritis?

  • For conditions such as scleroderma, reducing the risk of contractures may require focused treatment.
  • ​For most conditions, provided that targeted treatment is successful, there should be less of a need for therapy to maintain mobility.

When prescribing NSAIDS, do you prefer ibuprofen or Naproxen?

  • Naproxen is more convenient for families to provide twice daily and therefore may be more likely to be a successful treatment. Otherwise, there is no preference.

How do I know if a joint is actively inflamed and I need to refer?

  • Ultrasound, when evaluated by an experienced pediatric musculoskeletal radiologist, can frequently distinguish active inflammation from chronic synovial changes.

What are DMARDS?

  • Disease modifying antirheumatic drugs (e.g. methotrexate, sulfasalazine).

Is there a hereditary component to arthritis?

  • Though there are some markers showing associations, we have not identified any causes. Clearly, genetics are involved, but it’s just part of the story.

What is enthesitis-related arthritis?

  • Enthesitis is inflammation at the tendon or ligament insertion in a bone. Enthesitis-related arthritis is a condition that can present as a single joint complaint that may be initially diagnosed as an apophysitis (e.g. Sever’s disease, Osgood Schlatter’s). Though it is rare, the progression of this condition without proper treatment can result in permanent damage.

Pediatric rheumatology is a very unique and rare subspecialty, and we are pleased to have five of them on our staff at Scottish Rite for Children. This team sees patients at our locations in Dallas and Frisco.

Share Your Story: A Place of Healing

Share Your Story: A Place of Healing

Meet Norah, a patient seen by our Rheumatology experts. Learn more about her journey below.

Blog written by Norah’s mom, Julie of Dallas, TX.

During the summer of 2018 we brought our 3-year-old daughter, Norah, to Scottish Rite for Children with unexplained weakness. Previously a rough and tumble toddler, Norah had stopped running and playing. She requested to be carried everywhere. Her whole demeanor was subdued, and we were desperate to know what was weakening our spunky girl.

The Rheumatology team at Scottish Rite immediately recognized that Norah was suffering from a rare form of childhood arthritis, called Juvenile Dermatomyositis (JDM). JDM is rare enough that many children go months and even years before getting a diagnosis, but Dr. Nassi needed only minutes. The skilled and compassionate nurses began an aggressive treatment course of IV medications that day to slow and reverse the weakness that had overtaken her. 

The initial months of treatment required a very difficult adjustment for our family of five, but it became clear that Scottish Rite was going to have our backs, both medically and emotionally. At her weakest, Norah could not lift her head off the bed or sit without support on her sides. Her swallowing muscles weakened, requiring a nasogastric feeding tube. A port was placed in her chest for her many doses of IV medications. Absolutely everything Norah needed medically, Scottish Rite was able to provide. It was a much needed one-stop-shop for us during a stressful time. For many appointments, Norah and I would stay in her exam room while specialist after specialist rotated in and out to give her the care she needed. Dieticians, occupational therapists, speech therapists, developmental disabilities practitioners, mental health counseling, our heroes in Child Life – the list goes on and on. The level of teamwork across specialties is an inspiration.

It is also an inspiration to know that this level of care is offered at Scottish Rite to all patients, regardless of their ability to pay. 

Now, Norah can run, jump and play again with her two older brothers, plus her new kindergarten friends. She had some hard days and surely those memories are difficult and persistent, but her overall take away is that Scottish Rite is a place of healing and loving attention. Our appointments are less frequent now, but it always feels like we are visiting friends. From the moment we walk in, to the smell of popcorn, to the final minutes when we allow her to finally spend the dime she has been saving all month for the gumball machine, Scottish Rite makes what could be a traumatic day into a treat for her. We credit that atmosphere of positivity mixed with expert care, for her miraculous recovery and continued progress.

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

Rheumatology Overview

Rheumatology Overview

Scottish Rite Hospital’s rheumatology team includes five board-certified pediatric rheumatologists. The team includes staff from various areas of expertise who evaluate and treat patients with a variety of rheumatic conditions including but not limited to arthritis. Rheumatology patients are seen at both our Dallas and Frisco campus.
Under the direction of Marilynn G. Punaro, M.D., the hospital’s Rheumatology Clinic is actively researching advanced treatment methods to discover innovative ways to better care for pediatric patients diagnosed with rheumatic conditions. All Scottish Rite Hospital rheumatology physicians are active members of the American College of Rheumatology, Childhood Arthritis and Rheumatology Research Alliance (CARRA) and participate in the national registry and other research projects.

Common conditions treated:
Scleroderma
Juvenile idiopathic arthritis
Systemic lupus erythematosus
Vasculitis
Dermatomyositis

Services available for rheumatology patients in Dallas:

  • Infusion therapy
  • Digital X-ray and advanced imaging
  • Family Services and Child Life specialists
  • Physical and Occupational Therapy
  • Orthotics
  • Lab Services
  • Psychologists

Services available for rheumatology patients in Frisco:

  • Infusion therapy
  • Digital X-ray and advanced imaging
  • Family Services and a Child Life specialist
  • Physical Therapy
  • Orthotics
  • Lab Services

Rheumatology team of experts
Julie M. Fuller, M.D.
Lorien A. Nassi, M.D.
Tracey B. Wright, M.D.

Watch the latest #SRHaccess Facebook LIVE segment about the Infusion Clinic at our Frisco campus.

Learn more about the hospital’s Rheumatology services.