A Tale of Two Sisters
Ruby and Rachel credit their double success over scoliosis to the family-centered
expert care at Children's Hospital
Most parents do not imagine scheduling a major surgery for their child.
Tim and Angie Amanns found themselves doing just that – not once, but
twice – as their daughters faced crippling diagnoses.
Rachel and Ruby Amanns were both diagnosed with scoliosis in their early
teens. Scoliosis is a condition where the spine becomes curved or rotated.
It is most common in late childhood and early teens, and in some cases,
scoliosis can cause deformities or disabling pain.
Typically, scoliosis can be corrected by wearing a back brace. Back braces
are used to control the progression of the curve; they help most patients
avoid major surgery. But for 25 – 35 percent of scoliosis cases,
the back brace is not enough or their curve is too big, and they must
have surgery. This was the case for both Rachel and Ruby.
“Nothing prepares you for your child going into surgery,” says
Angie Amanns. “But Children’s Hospital makes it better, no
matter how major it is.”
Rachel was diagnosed with scoliosis at age 11. Her younger sister Ruby
was diagnosed at age 14. As they matured, their curves became worse. Both
girls wore back braces for 16 hours a day, every day, for a combined three
years. While the braces slowed the curving of their spines, it was not
enough to correct them. When it became evident that surgery was needed,
the family weighed their options.
“Rachel hates needles,” says Angie. “She has a very low
threshold for pain. But she has always been athletic and healthy, so it
made sense to go ahead and get the surgery when she was young.”
Corrective surgery for scoliosis cannot be performed until a child’s
body has finished growing. Therefore, at age 17, the eldest Amanns s daughter
underwent the surgery first. Three years later, her sister Ruby would
have a similar procedure when she turned 17. Dr. Cameron Sears, an orthopedic
surgeon at East Tennessee Children’s Hospital, performed both surgeries.
MAKING IT BETTER
Dr. Sears and fellow orthopedist Jay Crawford, M.D. perform approximately
50 – 70 scoliosis surgeries at East Tennessee Children’s Hospital
“We are essentially the only doctors in East Tennessee who do them,”
says Dr. Sears. “That includes healthy kids like the Amanns sisters,
as well as children who have scoliosis due to more involved health issues
like cerebral palsy, spina bifida, congenital deformity or other syndromes.”
Scoliosis surgery involves straightening the spine and then placing metal
rods along either side, to help keep the spine from curving or rotating
out-of-place again. In 2014, Rachel’s surgery also included a necessary
bone graft to help fuse her curved vertebrae. Bone grafts are a way of
transplanting bone tissue from one part of the body to another, to help
fix damaged bones or problem joints. When Rachel had her surgery, Dr.
Sears used bone tissue from her hip. By the time Ruby underwent the surgery
in 2017, physicians had switched to a synthetic bone graft.
“This was the biggest surgical change in the three years between
Rachel and Ruby’s surgeries,” says Dr. Sears. “The synthetic
bone graft works just as well in most cases. Plus, it shortens operative
time and decreases pain a bit.”
"Nothing prepares you for your child going into surgery," says
Angie Amanns. "But Children's Hospital makes it better, no matter
how major it is."
TREATING THE PATIENT, BREAKING THE MOLD
Rachel (left) says running helps alleviate lingering pain from her scoliosis
surgery, while Ruby (right) finds relief in art and music.
This new surgical technique is just one of many ways East Tennessee Children’s
Hospital has worked to improve surgeries in the past three years. Children’s
Hospital has evaluated the entire surgery process, from the moment patients
walk in the door to the moment they go home. The hospital’s goal
has always been to keep patients safe while treating them, but they also
want to keep their patients happy. Therefore, the surgery team focused
on treating the individual and shortening recovery time, so that patients
can get back to being kids quicker.
“Rachel was laid up for weeks after her surgery,” says Angie.
“She just laid there. She didn’t want to move. Meanwhile,
Ruby was out throwing a Frisbee around just two weeks after hers.”
“We know every child is different,” adds Tim Amanns, Ruby and
Rachel’s father. “But I really feel the difference in the
way they came back after surgery just shows how much medicine has improved
in three years.”
Dr. Sears notes that the biggest improvements have stemmed from the teamwork
of devoted employees across the hospital.
The rule book for recovery and early education has been rewritten over
the past three years at Children’s Hospital. In an effort to treat
the individual’s needs, staff and surgeons have implemented new
practices to keep kids healthy, happy, and safe.
The years-long process of improving culminated this past March, when Children’s
Hospital opened its new Surgery Center. The center features 14 state-of-the-art
surgery suites, a streamlined pre- and post-operation area, and a colorful,
comfortable waiting area. Alongside room for emerging technology, the
new surgery center incorporates new ways to treat the overall surgery
experience for patients and families.
How has surgery changed in the past three years? Dr. Sears points out that
surgery patients are no longer required to routinely go to intensive care
for the first night after surgery. This speeds recovery because it reinforces
to everyone that the patient is stable and ready to get over the surgery,
not just lie in bed an extra day. He also states that the
pain and palliative care team has provided significant enhancements in the past few years. The use of
various therapies and massages provided by pain management specialists
helps to get kids moving in a way that medication alone cannot.
But perhaps the most important new practice for any surgery is the early
education provided to patients and families.
When a family visits East Tennessee Children’s Hospital, our experts
include them in the care process. Our physicians and nurses talk with
families, because we know that family-centered care requires teamwork.
“I think our current team approach helps,” Dr. Sears reflects.
Family plays a critical role in the recovery and healing process for any
patient. Where Children’s Hospital’s team approach really
succeeds is bringing in the family early in the planning process for surgeries.
Beginning with the specialists’ office, Dr. Sears and his team educate
the family before they even schedule the surgery. Then, families are brought
into Children’s Hospital the day before the operation to go over
physical therapy, pain management, and social work. After the surgery,
a carefully trained team of post-op nurses and pain and palliative care
specialists help get patients up and moving.
“It all comes together to alleviate fears and concerns that patients
and families have about what is a big surgery,” says Dr. Sears.
“It’s a once-in-a-lifetime experience for many of these families.”
For Tim and Angie Amanns, they had to go through it twice in a lifetime.
“When Ruby was diagnosed, I thought, ‘Well here we go again,’”
“I wanted to have the surgery,” says Ruby. “After watching
my sister go through it, I was a little nervous. But it had to be done.”
Both surgeries were successful, and both girls are happy, healthy, and
very active. Rachel, now 20 years old, never sits still. Though still
grappling with mild pain, she loves running and yoga. Ruby is a senior
in high school and an aspiring artist and musician. She hopes to one day
own her own music store.
Many families never imagine having to plan two major surgeries within three
years. The Amanns credit their double success over scoliosis to the family-centered,
expert care at Children’s Hospital.
“Children’s Hospital did wonders for our girls,” says
Angie. “If we can help a family relieve their stress over surgery,”
says Angie, “I can’t say it enough. Children’s Hospital
is the place to go.”
In January 2014, East Tennessee Children’s Hospital put together
a multidisciplinary team of experts with one goal in mind: to improve
care and reduce complications and length of stay for scoliosis patients.
“Surgery can cause any number of side effects, including pain, nausea
and constipation,” says Lorna Keeton, P.N.P., director of the pain
and palliative care program. “For scoliosis patients, any of these
complications could affect their mobility early on. If they don’t
get up and get moving early in the recovery process, they’ll most
likely be in the hospital longer. And we don’t want that.”
Since 2014, Keeton and a multidisciplinary group of experts have studied
the best way to decrease a child’s stay in the hospital after scoliosis
surgery. What they found was that pain medication by itself was not enough.
In fact, they stopped using opioids altogether, and implemented a milder
mix of pain relief medications. These are customized for the individual
patient, and allow the patient to avoid taking narcotics. Alongside this
new approach to medication, the pain and palliative care team began incorporating
alternative pain management solutions like massages, aromatherapy, and
art and music therapy. And the results have been well-documented.
Since 2013, pain and palliative care has helped decrease the length of
stay for scoliosis patients by 46 percent. [PULL QUOTE, if possible] That
means patients like Ruby stay only half as long as her sister Rachel did
three years ago.
Rachel’s surgery came at the tail-end of prescribing narcotics for
post-operative pain. Because of this formerly common practice, she relied
on medication for pain, and was less able to get up and move around after
surgery. By the time Ruby had her procedure, Keeton and her team had devised
new ways to educate patient families about alternatives to pain management
“This education outreach has shown less stress, more satisfaction,
and a greater willingness to participate as a family in their child’s
care,” says Keeton.
“Ruby’s surgery felt like a breeze,” laughs Angie. “Of
course, she got to see her big sister go through it first, so she knew
what was coming. But I really think the new ways you guys do things helped.”
DID YOU KNOW?
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