In summer 2021, Marco, age 16, was riding his bike in Houston and took a corner too quickly. His tire slipped, which threw him to the ground. Marco braced himself by putting his hand out to catch the fall. He didn’t think he broke anything, but it hurt to grip the bike handlebars, so he walked home.

“My mom took me to the ER that night, and they said nothing was broken. It was just really swollen,” Marco said. “So, we were pretty happy. We later found out I had multiple fractures.”

Marco still couldn’t move his thumb or much of his hand a few days after his fall. Marco’s family knew Courtney J. Amor, MD, orthopedic surgeon with UT Physicians, so his mom scheduled an appointment with him. Amor found Marco’s hand swollen and bruised, with limited mobility. After looking at X-rays, Amor discovered Marco had three different fractures in his hand and wrist. The most severe was a Bennett fracture, which makes the base of the thumb unstable.

“In Marco’s case, the findings were subtle and could be overlooked, if not evaluated by a specialist. A Bennett fracture requires surgery because the basilar joint of the thumb is unstable. We realigned the bones, and used pins and screws to keep them in place so they would heal correctly,” said Amor, assistant professor in the Department of Orthopedic Surgery at McGovern Medical School at UTHealth Houston.

Process of healing

Amor completed Marco’s surgery just days after his first appointment, which is an important consideration in his medical practice. He tries to get patients with a fracture in for surgery within a week for the best possible healing. It also aligned with Marco’s schedule, since he was planning to attend a cross-country running camp in Montana the following week.

“Displaced fractures will start to heal in a bad position after three to four weeks – and may get to the point where they are irreparable,” Amor said. “We want to avoid that, whenever possible. This is especially important in athletes because any amount of time away from training can really impact their performance.” Amor speaks from a position of understanding of the struggles Marco faced, as he is an experienced triathlete and marathon runner, himself.

Marco’s case with intra-articular fractures (ones that extend into the joint cartilage) is always challenging, Amor explained, because there is little margin for error. Bones need to be aligned perfectly to heal correctly and can lead to early-onset arthritis if they are just a millimeter or two off.

“For a 16-year-old patient, that can be a major problem, for which there are no easy solutions,” Amor continued. “So, it’s best to prevent it to begin with.”

Marco also had a couple of other small fractures in his carpal (wrist) bones, but CT scans revealed they weren’t bad enough to need pins.

“Marco’s surgery allowed him to get back to being a great athlete – and quickly,” Amor said. “If he did not have his thumb fixed, he probably would have had trouble gripping handlebars on a bike, for example, and would have had trouble becoming a triathlete. His thumb would never be the same again.”

Succeeding as a college athlete

These days, Marco says he’s definitely more cautious taking corners on his bike. His triathlon teammates tease him, but he’s still as competitive as ever. Marco earned second place in his age group at his first collegiate Olympic triathlon in October 2023, the Pumpkinman Triathlon. This required a 1500m swim, 24.8 mile cycle, and 6.2 mile run. Located in Las Vegas, the route kicks off with an open water swim in Lake Mead. Marco finished strong in just under three hours.

What is Marco most proud of as an athlete? Despite being on varsity four years in high school for running, he appreciates his training work ethic.

“I love waking up early and just getting a good workout in before the sun comes up,” Marco said. “It’s one of my favorite things. Just to say you’ve accomplished something in the morning before your day has even started. I love working out.”

Marco’s bike injury provided a lesson learned for his current triathlon competitions: “Instead of bracing with your hand when you fall, you have to brace with your shoulder, because you have a helmet on to protect yourself.”

While Amor is pleased that surgery helped Marco and his athletic dreams, he said Marco’s success is all due to his motivation and hard work.

“Seeing positive outcomes like this is why I enjoy my job,” Amor said. “It makes all the years of grueling medical training worthwhile.”

“While I always sought to keep a sense of optimism, it became increasingly difficult when going in and out of the hospital, sometimes staying days at a time. My body felt out of sync,” Six said. “While there wasn’t a specific explanation for my health problems, I knew I didn’t want to stay on inhalers, breathing treatments, and anxiety medication forever. I needed a lasting solution.”

Fortunately, an option revealed itself for Six. Serving as a medical assistant at UT Physicians Multispecialty – Bellaire Station, Six would often receive positive feedback from patients who spoke highly of the treatment and counsel they had received from UT Physicians gastroenterologist Pritesh Mutha, MD.

“The praise people were expressing for Dr. Mutha’s care – it genuinely intrigued me. I thought perhaps he could help me as well,” Six said. “Plus, it wasn’t always some formal, extensive plan. He was primarily offering recommendations and guidance on healthy dietary choices and lifestyle changes. It was worth giving it a shot.”

Consultation leads to a new direction

When Six first talked to Mutha, she found him very kind, insightful, and approachable. As they became more acquainted, Six would later inquire with Mutha about his preferences for snacks and food options.

The reply Mutha gave to Six was quite a surprise to her.

“I explained that I adhere to a whole food, plant-based diet (WFPBD), not eating any types of processed food,” said Mutha, associate professor of gastroenterology, hepatology, and nutrition with McGovern Medical School at UTHealth Houston. “To make it simple, I don’t eat any animal-derived products, fried foods such as chips, or food and drink with processed sugars like sodas and candy.”

For Six, meats, dairy, and processed snacks were a regular part of her diet. Mutha suggested that she consider beans, fruits, vegetables, whole grains, nuts, non-carbonated drinks, and using natural herbs and spices to season her meals.

“Honestly, it sounded next to impossible to ween myself off of things like chicken, eggs, and things you might get from a vending machine. But I was willing to do it if it would bring me relief,” Six said.

Mutha’s dietary recommendations for Six were not a formal treatment plan, but more meant to be supportive suggestions. Mutha committed to Six that he would follow up periodically to check on her progress. Additionally, he recommended using mobile health trackers or apps for Six to record her daily eating and other activities.

Real change, both inside and out

Within weeks of Six changing her eating choices and lifestyle, she began to see and feel positive results.

“I worked the meat and dairy out of my diet, one day at a time, eventually down to little or none at all. I switched to meals containing more raw vegetables and fruit-based smoothies,” she said. “I would also check in with Dr. Mutha and send him images of the foods I was eating.”

Within a month of Six’s new regiment, she lost 15 pounds of body weight. She also could readily feel an improvement in her daily energy and greater relief from the discomfort she had felt before in her joints.

“The response to the new diet was truly amazing. I no longer needed to use a breathalyzer or take nebulizer treatments, and I stopped having the spells of dizziness I would experience,” Six said. “My skin didn’t bruise as easily as before, and all my clothes started to fit better.”

Additionally, Six’s need for prescription medications subsided – a milestone that Mutha felt was most significant.

“The fact that Six was able to get off of medications just by a change in her food choices – it really is a powerful story. In essence, you could say that the WFPBD was my prescription to Six,” Mutha said. “As a society, we must consider a shift in thinking that prescription only means pharmacy or that treatment only means surgery. It’s a lesson from which both patients and doctors can learn.”

Thanks to Mutha and Six’s changes to her diet, she has lost to date nearly 40 pounds of body weight and remains prescription-free. For her, the change was not only in her body but also in her outlook on personal well-being.

“The entire experience has been a re-education into strength and commitment toward taking care of myself,” Six said. “With commitment and willpower, I can be an active part of solutions that can benefit me in the long run.”

Jennifer’s gynecologist recommended a mammogram during her annual exam in August 2020 based on a family history of breast cancer, but she elected to follow up at a later date. In April 2021, Jennifer discovered a lump in her right breast during a self-exam after receiving a COVID-19 shot.

The results of Jennifer’s mammogram came back negative. She was advised it may be a swollen lymph node from the COVID-19 shot, but the lump showed no signs of subsiding after several weeks.

“I went again to get the lump checked, and the nurse practitioner used the word worrisome, which I knew wasn’t good,” Jennifer said.

By the start of 2022, Jennifer would learn she had a case of stage 2 case breast cancer. In addition, she discovered she had very dense breast tissue, which made it important to undergo thorough examinations and be fully apprised of her condition.

Steps to treatment

Soon after the diagnosis, genetic testing revealed Jennifer had a BRCA2 gene mutation, which increased the risk of other cancers forming. She also received an Oncotype DX test to determine if chemotherapy would aid in cancer treatment.

“Based on the Oncotype DX test results, the doctors gave an opinion that chemotherapy would not be effective for my treatment,” Jennifer said. “As a first step, they recommended I have my ovaries and fallopian tubes removed, based on the BRCA2 finding.”

Following the ovary and fallopian tube removal procedure, doctors recommended hormone therapy to reduce the size of identified tumors.

Next, Jennifer met with Jessica Treviño Jones, MD, an oncologist with UT Physicians.

“In reviewing Jennifer’s case, we noted there was new information and data on breast cancer in the last six months that we felt should be factored into her treatment,” said Jones, who is an assistant professor with McGovern Medical School at UTHealth Houston. “The form of cancer for which Jennifer was diagnosed normally occurs in older women and responds to hormonal therapy. In this case of an estrogen-positive breast cancer, a strategy for treatment was needed that was more aggressive and would aid in treating her lymph nodes, which had been affected.”

Jennifer made the decision to have chemotherapy – a plan specified for eight rounds at two-week intervals.

“I started chemotherapy in late July and completed it at the end of October. At the end of it, the pathology report that came back found a small amount of cancer remaining in my breast, but very minor,” Jennifer said. “They couldn’t find the lump anymore in my breast, and the tumor in my lymph nodes completely disappeared.”

While chemotherapy was a tiring process, Jennifer’s response was positive and meant that surgery with UT Physicians breast and endocrine surgeon Emily K. Robinson, MD, would be less extensive.

“Due to the BRCA2 mutation, we went forward with a double mastectomy to prevent the development of cancer in the future. Because the chemotherapy went so well in killing the tumor cells, it was only necessary to remove the previously positive lymph nodes and not a full dissection,” said Robinson, who is a professor in the Department of Surgery at McGovern Medical School at UTHealth Houston.

Jennifer’s double mastectomy was combined with a reconstructive plastic surgery procedure.

“Because we were able to save much of the skin and tissue that had been over the tumorous mass, it made the opportunity for immediate reconstruction even more promising,” Robinson said. “Jennifer was able to return home the same day, and she healed very well cosmetically.”

Jennifer was very highly pleased with the outcome, after all that she had experienced.

“Honestly, the results were beautiful. I was just so happy with it,” Jennifer said. “The surgeries performed were magic.”

Following the surgeries, Jennifer did a 30-day cycle of radiation treatment. Additionally, Jones prescribed a regimen of polymerase (PARP) inhibitors and additional hormonal therapy to reduce Jennifer’s estrogen levels. This novel strategy is part of some of the newest methods being used to treat BRCA-positive patients for both breast and ovarian cancers.

“Jennifer’s treatment embodied some of the most up-to-date treatments being offered for young women. By starting with chemotherapy prior to surgery, it allowed the opportunity for tailored surgical and radiation decisions,” Jones said. “Also, the incorporation of hormonal therapy to combat estrogen-positive cancers is showing results in reducing risks of it ever coming back and can be combined with other medicines, if necessary.”

In reflection, Jennifer is grateful for the treatment she received and feels empowered to share a message with others about her path to recovery and being proactive.

“I can’t say enough for Dr. Jones and Dr. Robinson. It was a godsend hearing another opinion, as I think it saved my life,” she said. “Through it all, I learned the power of being an advocate for yourself, and I encourage my friends to closely mind their personal health, performing self-exams and having regular screenings with their doctors. It’s about being strong as women and making each day count. Cancer is not the end of the world.”

“I’m an intense rower, meaning my minimum goal is to row two marathons a week – 50 or so miles,” Reuben said.

Following these passions has translated to many injuries and related surgeries. Reuben’s shoulders were affected in the process, due to falls in the street and other major impact. He previously had a rotator cuff repair on his left shoulder years ago. Reuben wasn’t interested in getting shoulder replacements, he said, until they could guarantee to last 20 or 25 years because he was so active.

Path to healing

Reuben found Robert Fullick, MD, orthopedic surgeon with UT Physicians, to navigate a new path for his shoulders. Fullick discovered Reuben had arthritis in both of his shoulders, and tendons in his rotator cuff were badly torn.

“The instability in his shoulder joints became painful and disabling, and it affected his quality of life,” said Fullick, assistant professor in the Department of Orthopedic Surgery at McGovern Medical School at UTHealth Houston. “He could still row, because that’s below shoulder level, but everything was becoming more and more painful.”

Fullick recommended Reuben begin with guided cortisone injections in radiology and physical therapy. When that didn’t contribute a successful outcome, shoulder replacements were the next step. Double shoulder replacement is actually extremely common, Fullick said, when trauma isn’t involved in one of the shoulders.

“The beauty of Reuben’s case is his motion was relatively good because he has always maintained a high level of activity,” Fullick said. “Strength was not as good because of the damage.”

Fullick performed a reverse shoulder replacement on Reuben’s right shoulder in September 2019. A reverse replacement has a metal ball with a plastic socket that sits on a stem going down the humerus bone. A standard shoulder replacement (anatomic ball and socket) was not an option due to the damage to Reuben’s rotator cuff. Nearly four months later, Fullick did the same procedure on Reuben’s left shoulder, while he was still working to strengthen the first one in physical therapy.

“I knew Reuben wanted full range of motion and was going to put significant mileage on these implants, so I had to be very particular about how I did the procedure to maximize motion,” Fullick said. “That’s different than a sedentary individual who is looking for pain relief and the ability to sleep.”

Therapy for a successful outcome

Reuben’s philosophy is to get with the right physical therapist and do therapy exercises at home.

“Anyone who knows me knows I want to be the best I can be,” Reuben said. “I don’t care if I was close to 76 at the time of surgery. I don’t want to be somebody who can’t be active. I told them in therapy to treat me like a 25-year-old athlete.”

Reuben completed physical therapy at UT Physicians Physical Therapy at Texas Medical Center with Russell Paine, PT, and Christopher Gallina, PT. After his first shoulder replacement, he spent three months doing rehabilitation. He planned to do the same with the second shoulder, but COVID-19 affected the clinic operations. At that point, he got equipment and rehabbed both of his shoulders at home.

By June, Reuben was starting to row a little, and he was back to full strength in September, rowing around 15,000 meters a day. He said he works out about four hours a day, at least five days a week. Reuben attributes his successful recovery to continuing to do everything he learned at therapy at home as part of his routine after he rows. This includes using the pulley on the wall and light weights to keep his shoulders loose. He believes if people don’t rehab well, they won’t have a great outcome.

Mutual praise

Fullick said there are instances where someone can almost work too hard after shoulder replacement surgeries. At times, they had to dial Reuben back, but he was always accommodating.

“Reuben was a great patient from Day 1,” Fullick said. “He did exactly what I asked of him and stayed on the rehab protocol.”

Reuben has strong appreciation for Fullick and his shoulder replacements.

“I think the world of Dr. Fullick,” Reuben said. “He’s the best shoulder guy you’ll find anywhere.”

He also expresses much gratitude for his wife, who has spent half of their married life with him while he has done rehabbing from surgeries. He doesn’t know what he would have done without her.

He laughs that his shoulder replacements will probably last 25 years – until he’s 101 years old!

Surprising diagnosis

“Jude was born 2 pounds, 9 ounces, and Jaden was born 3 pounds, 5 ounces,” said Jeanne Jackson, Jude’s mother. “We were just lucky they made it. We were so happy, I didn’t even think about a cerebral palsy diagnosis, but it should have been obvious.”

Before birth, the Jackson twins had twin-to-twin transfusion syndrome (TTTS). This disease of the placenta causes uneven blood flow between identical twins and can lead to significant issues, such as heart defects. Doctors performed surgery on Jeanne at 16 weeks pregnant to separate the babies. An emergency delivery happened at 31 weeks, because Jude was not doing well.

Life of therapy

Even as Jude’s first two years progressed, Jeanne noticed his delays. Jude didn’t walk until age 2 and couldn’t keep up with his twin brother’s level of activity. His specialist attributed it to being born premature and a brain bleed.  

“Jude’s life pretty much revolved around physical therapy and occupational therapy twice a week since he was two,” Jeanne said. “Cognitively he’s pretty aware, which caused a lot of frustration and tantrums when he would get frustrated with himself.” The turning point came when a diagnosis of cerebral palsy was given.

Looking for a solution

Jeanne read about selective dorsal rhizotomy (SDR) on social media and discovered Manish N. Shah, MD, a pediatric neurosurgeon with UT Physicians, as a noted surgeon for this procedure. SDR permanently reduces spasticity, or muscle tightness, in children with cerebral palsy. Even though they lived in Florida, the family wanted to pursue this procedure in Texas.

Jude was an excellent candidate for SDR, according to Shah, based on the nature of his condition. The MRI revealed Jude had PVL (periventricular leukomalacia) or scarring in the brain.

“This tells us that we know the cause of his spasticity, and the surgery that we perform will help him,” said Shah, associate professor of pediatric neurosurgery, William J. Devane Distinguished Professor at McGovern Medical School at UTHealth Houston, and director of the Texas Comprehensive Spasticity Center.

Shah said procedures like Jude’s are rare, where only one side is affected, and account for roughly 8% of the procedures he performs. He said they’ve found that children around age 4 can best participate in the recommended rehabilitation. Surgery is recommended before orthopedic interventions, so if spasticity is causing joint deformities, they work closely with other specialists to determine the best age.

Before meeting the Texas Comprehensive Spasticity Center team, Jeanne thought Jude would live with repeated Botox injections and a future of tendon lengthening surgery. “I wasn’t expecting Jude to be equal to Jaden, but I wanted Jude to have a chance to keep up,” Jeanne said. “We didn’t want his muscles to fail to grow and atrophy.” The procedure also presented an end in sight for physical therapy, which could eventually transition over to sports and staying active.

Healing hands

In February 2023, Shah performed a 1-level laminectomy for left unilateral SDR, L1-S1. This involves removing the back of one vertebra in Jude’s spine, where the spinal cord ends in the lower third of the back. The incision was about 1 inch long.

“Through that incision, we divide the motor nerve rootlets from the sensory nerve rootlets,” Shah said.  “The sensory nerve rootlets are the nerves that carry the spastic reflex. For Jude, we tested the sensory nerve rootlets on the left and cut the most spastic, leaving sensory nerve rootlets at every level.”

After Jude’s surgery, he was required to lay flat for 24 hours. He couldn’t stand on his own in the beginning. On the second day, Jude was up early to practice standing and other basic functions. While he had lost the spasticity, he also had lost a lot of his core strength.

“The spasticity was gone, and it was good to see his left leg loose,” Jeanne said. “Then, Jude just had to learn to use it.”

Trusting the process

The most challenging aspect for Jeanne was how much Jude regressed. It still surprised her, even though she was told to expect it. His core was strong in the spasticity, but the muscles weren’t really being used because it was propping him up. When it was loose, he didn’t know how to walk.

Jeanne was shocked how fast he recovered from it – how quickly he was able to walk, climb stairs (even without holding the rails), and be self-motivated.

“Jude said, ‘Lefty is so good,’” Jeanne laughed. Jude and his therapist named his leg “lefty,” and he refers to it by that.

A week later, Jeanne said it was amazing how much Jude had progressed, and the family was able to go home after three weeks in Texas.

Shah said the best part of doing this procedure is the immediate change.

“Removing spasticity decreases the deformative forces on the joints and allows that child’s muscles to strengthen without spasticity,” Shah said. “This is a life-changing procedure, and we find the children continue to make gains year after year.”

Power of therapy

The center’s inpatient rehab program is customized. The team evaluates the rehab goals weekly, and discharge dates are made based on need, rather than a one-size-fits-all approach.

In his initial prognosis, Shah believed Jude would return to a very active life – faster than some of their patients who might be impacted by the tone in both legs.

“I was surprised by Jude, as he was one of the fastest discharges from inpatient rehab,” Shah said. “He reached a high level very quickly, which allowed him to return home to outpatient therapies.”

Inpatient therapy, after surgery, was a huge reason Jeanne said they selected Shah. It would be harder for them since they lived in Florida, but it was what needed to be done.

“Dr. Shah is very humble and an equal team member with everyone,” Jeanne said. “His whole demeanor was patient-bedside oriented.”

Feeling grateful

It took a village, Jeanne said, to make the surgery and recovery process work for them since they lived out of state.

“Houston has such an amazing medical community. I didn’t get it until I went there,” Jeanne said. “I wish there had been a story like this done before because it’s what I was looking for. It was definitely worth going to Texas. Jude talks about going back to Texas all the time. He associates Texas with goodness.”

Currently, Jude is doing speech therapy once a week, occupational therapy two to three times a week, and physical therapy three to four times a week, but it should end by kindergarten.

Jude will start attending hip-hop dance class when he turns 5 because he loves music and dancing. He is not afraid these days and doing as much as he can.

“I want him to do less PT and start doing what kids do after school,” Jeanne said. “We just want him to be able to do what other kids have the opportunity to do.”

“I had felt some discomfort on occasion, but it was never seriously painful,” she said. “I’d had a biopsy done over a year ago and the report came back as benign. Still, I felt it was important that I get a more definitive answer.”

Sue’s dentist examined her mouth and noticed that a protrusion had begun to form at the site of the irritation. Concerned with the finding, she was referred to an otolaryngologist who performed another biopsy.

“Though the pathology report came back again as benign, the physician told me he didn’t like the look of the result. He recommended that I speak with someone from oral and maxillofacial surgery at UTHealth Houston,” she said.

Sue met in July 2019 with doctors from UTHealth Houston Oral and Maxillofacial Surgeons, who examined the affected area, which now was showing a mass and signs of bone loss along her upper jaw. After some analysis and discussion, the doctors advised that a more comprehensive biopsy be completed.

For Sue’s initial procedure, she was referred to Mark Wong, DDS, professor and Bernard and Gloria Katz Endowed Chair in the Department of Oral and Maxillofacial Surgery at UTHealth Houston School of Dentistry. The procedure was successful in identifying that the mass was a rare form of cancer.

Sue was then referred to Jonathan Shum, MD, DDS, oral and maxillofacial surgeon and associate professor at UTHealth Houston School of Dentistry.

“After meeting with Sue and learning about her condition, our team came up with a planned, multi-procedural approach for treatment. Surgery to remove the cancer was scheduled, which involved removing the remaining upper jaw and palate, followed by testing and monitoring to ensure the treated area was clear of any cancer or return of infection,” Shum said.

Working with restorative dentistry and prosthodontics expert Joann Marruffo, DDS, a temporary upper denture was created to make Sue as comfortable as possible before her next procedure.

“I’d had some fear the cancer would come back and spread elsewhere in my body. I was glad to know the surgery was successful,” Sue said. “No matter what questions I had during the process, they never discounted them. It really helped me keep a positive attitude, along with a little praying.”

Given the extent of procedures Sue had already experienced, Shum felt she managed her treatment well.

“Given the extensive nature of Sue’s surgeries, a major concern for me was her comfort prior to the rebuilding procedure. With no upper jaw and relying on a denture for several months, simple oral functions were naturally a major challenge,” Shum said. “The way she handled it all really demonstrated a great deal of perseverance and positive spirit.”

The next step would focus on the reconstruction and rebuilding of her upper jaw using a free tissue transfer, or free flap. The procedure involved the transplant of the fibula bone, skin, and blood vessels from the lower leg to reconstruct the upper jaw and palate. Specialized hardware was also designed to hold the transferred tissue in place, plus dental implants for adding a prosthesis for the replacement of Sue’s teeth.

With the assistance of Nagi Demian DDS, MD, professor and Thomas M. Weil Professorship in Oral and Maxillofacial Surgery at UTHealth Houston School of Dentistry, intraoperative navigation techniques were utilized to ensure the reconstruction went exactly as planned, allowing for the placement of the dental implants created for Sue’s new teeth.

Sue has continued appointments and consultations with Shum and other doctors to check on her progress. Along with additional grafting procedures, she has been able to replace the lip tissue and structure that was removed in the earlier surgeries.

For Shum, he is just pleased to have been a part of Sue’s treatment and restoration.

“While Sue’s rehabilitation was long and remains ongoing, I believe the end result ultimately brought a significant change,” he said. “I’m thankful to have been a part of bringing healing and normalcy to her life.”

“It is not easy. While I may be able to eat one minute, the next I may be nauseous or running to a bathroom. Any plans I make, I always have to consider my stomach,” she said. “While there have been a lot of changes, they overall have been for the better.”

Gastroparesis is a disease of the digestive tract where an individual experiences difficulty processing food moving from the stomach to the small intestine. For LaKisha, her symptoms of the illness began in 2018.

“It started as painful stomachaches, nausea, and vomiting. Eventually, it got to a point where I was frequently going to the hospital. I would feel better temporarily, but it would always return,” LaKisha said. “I couldn’t keep down liquids or solids, and my hospital stays kept getting longer. They couldn’t figure out at first what was causing the discomfort.”

LaKisha’s inability to eat and digest food got to a point where she lost nearly 100 pounds in six months, experiencing malnourishment and loss of muscle mass.

An upper endoscopy was done, where undigested food was discovered in LaKisha’s digestive tract. Following this finding, she underwent a four-hour gastric emptying study, where a patient eats radiolabeled food to observe how well the stomach is emptying. When the results came back abnormal, a diagnosis of gastroparesis was confirmed.

“The hospital described it to me like my stomach was partially paralyzed. I had never heard of a condition like that before,” LaKisha said. “I just prayed there was a way to make the pain stop. I was open to just about anything.”

Learning about and exploring therapies for treatment

LaKisha was referred to Brooks D. Cash, MD, a gastroenterologist with UT Physicians. Upon the first appointment, LaKisha learned more about her condition and options.

“At my appointment with Dr. Cash, I finally learned the details about my gastroparesis condition. He actually drew me a picture of what was happening to cause me pain and then explained suggestions for treatment,” LaKisha said. “No one prior had actually sat down with me to describe things. I had seen a lot of doctors before, but now I finally had some optimism for real change.”

Cash asked LaKisha questions about her condition, the symptoms she was experiencing, and how she had been advised to date to manage her discomfort.

“LaKisha was receptive and open to what I presented concerning options. From the outset, she demonstrated a willingness to be an integral part of her care,” said Cash, who is chief of the Division of Gastroenterology, Hepatology, and Nutrition and the Dan and Lillie Sterling Professor in Clinical Gastroenterology with McGovern Medical School at UTHealth Houston. “She understood that even if there wasn’t an immediate cure for her condition, there were ways to live around it.”

Currently, LaKisha takes medication to manage her gastroparetic symptoms of gastroesophageal reflux, vomiting, and nausea. The prescription has made her condition more manageable.

Making necessary changes; avoiding pitfalls

In addition to daily medication, LaKisha also adheres to careful choices in her personal diet, based on recommendations and advice from Cash. She has at least one meal a day, and twice if possible.

“Adjustments to what I eat have been a priority. To put it plainly, I have to make sure it’s not anything that is going to turn my stomach upside down,” she said. “For protein, I generally stick to poultry. I have never really been a beef or pork person, but now I can’t eat that at all because it just doesn’t agree with me.”

LaKisha adds that she tries to enjoy light snacks and salads when possible, but avoids lettuce, broccoli, or high-fiber vegetables, which are difficult to process.

“LaKisha’s avoidance of fatty and roughage-based foods was a step in the right direction. These kinds of dietary modifications are essential to self-care for a gastrointestinal disorder,” Cash said.

Moving forward, LaKisha remains optimistic and continues her consultations with Cash.

“The rough days still occur from time to time, but lately there are more good ones than bad ones,” she said. “I am really grateful for the advice that Dr. Cash has provided to me.”

Likewise, Cash feels an important lesson should be taken from LaKisha’s case of chronic disease management.

“The outcomes of treating gastroparesis are not always perfect, and not the same for every individual. That said, it is a condition which can be treatable,” Cash said. “I give LaKisha a great deal of credit for her commitment and resilience. She’s as much her own doctor as I am.”

When an unexpected head injury occurred during one of her club team matches in April, Gizelle had hoped it was minor and the pain would diminish quickly. What it turned out to be was much more serious, requiring consultation and time away from her favorite pastime to heal.

“It happened during warmups, when one of her teammates came swinging for a ball. They inadvertently missed the ball and struck her in the head,” said Gizelle’s mother, Nancy Guerrero.

After applying ice to Gizelle’s head at the site of the hit, Gizelle still finished competing in her team’s match. In fact, she even went to a friend’s sleepover that evening. It was at the following practice where residual effects of the prior day’s injury surfaced.

“When I got hit the day before, I felt the pain on the side of my head and behind my eyes,” Gizelle said. “I thought it was just hurt a little bit, but it turned out to be worse.”

The club team coach shared with Nancy that Gizelle was complaining of headaches and struggling to play throughout the practice. She recommended that the family seek a medical evaluation.

Following consultation with a primary physician, Gizelle was restricted from sports activity for two weeks. She would later start freestyle swimming in May, but was forced to stop again when the headaches resurfaced, now more painful than during the initial volleyball injury.

Seeking help; getting answers

Acting on the advice of Gizelle’s junior high school coach, Nancy connected with Summer Ott, PsyD, neuropsychologist and concussion specialist with UT Physicians.

“Once we were in contact with Dr. Ott’s office, things moved quickly. The clinical coordinator Carey Goode took a few notes over the phone, and immediately scheduled our first appointment,” Nancy said. “I was so happy to have found a resource to figure things out.”

Within a few days, Gizelle met with Ott to get an assessment. The appointment began with a series of questions to collect details of how the injury first occurred, followed by a physical screening exam to test balance, postural stability, and cognitive ability.

“The family told me about the persistent headaches and dizziness, which sounded as though they had worsened following the volleyball injury due to the swimming regimen,” said Ott, who is an associate professor in the Department of Orthopedic Surgery at McGovern Medical School at UTHealth Houston. “Gizelle also showed signs of cognitive decline, which was in contrast to the information I learned concerning her academic history. Based on my findings, I determined she had definitely suffered a concussion.”

Ott added that she had observed during the physical exam irritation in the nerves along Gizelle’s neck, which was likely from the sudden jolt her body experienced from the hard hit.

“A shock like an unexpected blow to the upper body can cause whiplash, rotating the head in a negative fashion and affecting occipital nerves in the back of the head,” Ott explained. “This can result in painful neck strain and requiring more time to recover.”

Getting expert guidance from Ott greatly relieved Nancy’s concerns.

“While the concussion was naturally not ideal, Dr. Ott’s analysis was great – a definitive explanation of the condition,” Nancy said. “Now we could focus on what to do to get Gizelle better.”

Adjusting to the sideline; sticking to the plan

Once Ott provided a diagnosis, it was time to develop a treatment plan. The first step would involve stepping back from Gizelle’s active sports schedule – news that was difficult to take in.

“When I heard I wasn’t going to be able to play volleyball for now, I just wanted to cry,” Gizelle said. “I was captain for my club team, and I was going to be selected for my school team. I was so looking forward to being on the court.”

Ott gave encouragement to Gizelle concerning what was needed moving ahead and that the temporary break from activity would be for the greater good.

“Seeing Gizelle’s face and the tears – it just brought out the ‘mom’ in me. It’s always hard keeping someone from what they love to do,” Ott said. “I assured her that she was doing the right thing, and she would recover well as long as she kept up with her therapy.”

As part of recovery, Ott prescribed a regimen of incremental physical therapy. As Gizelle’s condition improved over time, the duration of activity could be increased.

At home, Nancy supported Ott’s treatment plan, encouraging Gizelle’s daily adherence to rest and therapy. She also followed up with Gizelle’s pediatrician to update them on the progress, plus connecting the physician with Ott.

“I did give some motivational pushes to Gizelle, when it was needed,” Nancy said. “Most of all, it was about being encouraging. I would remind Gizelle that the treatment would benefit her for the future.”

By midsummer and Gizelle’s next appointment with Ott for retesting, her headaches had stopped. In addition, the results from her physical screening exam were greatly improved from her initial appointment. Ott credits this outcome to a collective effort – from family and providers alike.

“What really impressed me concerning Gizelle’s treatment were the levels of support around her,” Ott explained. “Beginning with supportive parents at home, it was supplemented by the initial care from Gizelle’s pediatrician, the referral from a school-affiliated athletic trainer, and the specialist consultation regarding her concussion, which I was glad to contribute. It was a true case of interdisciplinary teamwork and indicative of the cooperation you would see for a collegiate or professional athlete.”

Back on the court; lessons learned

As Gizelle begins the school year and returns to volleyball, she is in good health and knows better how to care for her well-being.

Likewise, Nancy and Gizelle’s father Chris Rodriguez were extremely proud of how their daughter handled the injury and recovery.

“The entire experience revealed valuable lessons. For Gizelle, she learned how to better listen to her body and gained wisdom in being true to herself. I feel if an injury occurred now, she would be aware of the symptoms and know if she needed to step out of a match,” Nancy said. “For myself, it reinforced my confidence in asking questions. I would tell others that if they see something out of character in their child, don’t dismiss it. Make an appointment with your doctor.”

Activity and adventure are an understatement to describe Roy, age 70, and his zest for life. His active lifestyle through the years includes motocross racing, motorcycle racing, snow skiing, and scuba diving in addition to the water sports. It’s only been recently that he stopped riding his motocross bike.

As a result of his activities, Roy has a history with broken bones. Unfortunate events through the years caused him to break his back, hip, arm, leg, elbow, and most recently his foot, two years ago. All of his broken bones have been on his left side. He also tore the ACL on his left knee. Roy hobbled on his left leg for about 20 years, he said, before he got his ACL repaired in 2000.

“With those kind of water sports, you have to be able to count on your knee, and you can’t really wear a knee brace out there,” Roy said. “I did wear a knee brace water skiing the last 10 years, but not surfing.”

Needing a change

Roy’s knee gave out a couple of times in fall 2022. When it started affecting his life and his daily decisions, Roy decided to explore his options with a physician. He visited Andrew Li-Yung Hing, MD, orthopedic sports medicine specialist at UT Physicians and associate professor in orthopedic surgery at McGovern Medical School at UTHealth Houston. Based on Roy’s condition and goals, Li believed surgery would be a better option than injections to provide a more permanent solution. Roy had a schedule and agenda in his mind based on a big vacation planned to Honduras in June 2023 to scuba dive with family. He wanted to pursue knee surgery in January to have time to get strong again.

Li recommended Roy see Zayde Radwan, MD, orthopedic surgeon at UT Physicians and assistant professor in orthopedic surgery at McGovern Medical School. Radwan diagnosed Roy with tri-compartmental, post-traumatic osteoarthritis, which was likely caused by his prior knee injuries. This is different than traditional osteoarthritis which is often referred to as wear-and-tear arthritis and is the most common type of knee arthritis. Roy was bone-on-bone, especially in his lateral compartment, the outside of the knee. Radwan recommended a total knee replacement.

Radwan’s motto: If you’re not living because of your knee and/or the fear that your knee is going to give out, then you should get something done to continue living. Tomorrow is not guaranteed, he said. 

In January 2023, Radwan performed Roy’s knee replacement surgery. During the procedure, Radwan completed more soft tissue balancing than usual, as a result of Roy’s valgus deformity, or knock-kneed condition. The extra soft tissue balancing was required to get Roy’s knee stable for the type of activities he wanted to return to. This was a unique aspect of Roy’s case.

“Those types of knees are a little more challenging, surgically, to balance and get right,” Radwan said. “Roy also had a higher risk of infection and stiffness after surgery due to his previous operations and poor preoperative range of motion.”

Radwan said patients heal faster and have better range of motion when the surgeon takes the time during surgery to balance the knee, meaning they have the same laxity throughout a full range of motion. He believes that effort, combined with early hard work in therapy, helps patients achieve their goals more quickly and leads to better outcomes.

Focusing on recovery

Roy worked hard in physical therapy to get his knee and surrounding muscles strong, going two to three times a week for several months. One day, the therapist told Roy he had reached his maximum range of motion. His response: “Well, that’s still not enough to go water skiing, so we have to get it all the way like the other one. It can’t be stopping halfway!”

Roy said he’s learned through the years the importance of therapy. “You need a good surgeon, but you also have to do the therapy,” he said. “Otherwise, you won’t get back to where you want to be.”

Radwan said Roy’s quicker recovery also relates to him as a person and his work ethic. He thought it would be at least a year before Roy could do significant skiing on his knee, because he likes to slalom ski about five miles every day. But Roy got back to surfing at three months and slalom skiing at six months.

“I didn’t know if Roy would be able to be as competitive as he wanted, but he’s kind of blown all that out of the water,” Radwan said. “I told him, ‘When I grow up, I want to be like you.’ He’s not your typical 70-year-old who just wants to get to social events, the grocery store, and home,” Radwan laughed. “Every time I see him on the schedule, I know it’s going to be a bright spot in the day.”

Roy is so pleased with the surgical process and results.

“I’m glad I got it fixed. I can ski now without a brace, and it feels strong and solid,” Roy said. “I don’t have to worry about it giving out now. That helps your confidence a lot to have fun!”

“I remember waking up during the night and being restless,” Jamie said. “In the morning, I woke up and had complete peripheral vision loss on the right side. I work for an ophthalmologist, and I knew something was wrong.”

Jamie could still see in front of her, but nothing to the right. There were no other symptoms. She got dressed and went to work, which now she admits wasn’t ideal not knowing her condition. Testing in her ophthalmologist office revealed a neurological issue, not a visual one. Brian Wright, MD, her employer, quickly connected her to Spiros Blackburn, MD, associate professor of neurosurgery at McGovern Medical School at UTHealth Houston. Jamie experienced extra concern as she waited for information, based on her father’s history with brain cancer. Even though her father’s brain cancer was not hereditary, Jamie said her mind automatically went there.

The MRI didn’t show a pituitary gland tumor like doctors initially expected, but that she’d had a stroke. Everything changed at that moment for Jamie. Her biggest concern was if her baby was OK. Jamie became pregnant through in vitro fertilization (IVF), due to her medical history with polycystic ovary syndrome.

“I had gotten to a point in my life that I didn’t know if kids were going to be in my future, although it’s something I always longed for,” Jamie said. “I’d always desired to be a mother. I have two wonderful bonus kids through marriage.”

As a result of her husband’s new job that covered IVF expenses, the path to pursue IVF suddenly opened up for them. She tied it to her faith. “God has the right timing for everything,” Jamie said, “and I think He guided us in a direction that we would be able to financially afford it.”

Understanding the stroke

Doctors transferred Jamie to a stroke unit after her initial diagnosis, where she stayed a week for monitoring and additional testing. Surprisingly, they discovered a hole in her heart, a patent foramen ovale (PFO). All babies are born with a hole in their heart, but it usually closes within the first few months on its own. When it doesn’t close, it’s usually not problematic unless the blood contains a clot.

“The combination of the IVF medication plus the coagulation of blood and the hole in my heart allowed a blood clot to go to my brain,” Jamie said.

Jamie’s maternal fetal medicine doctor, Diana Racusin, MD, OB-GYN with UT Physicians and assistant professor at McGovern Medical School, referred her to Anjail Sharrief, MD, neurologist with UT Physicians. Clinically, Sharrief said Jamie had a visual field deficit on one side but no other neurological impairment. The location of her stroke, in the occipital lobe in the back of the brain, was important to learn because that area of the brain affects vision. Fortunately, she didn’t have the stroke in an area that controls movement, language, or sensation.

“People who are more likely to have clotting disorders may be more likely to have a stroke in association with the PFO, which is basically a communication between the right side and left side of the heart,” said Sharrief, associate professor of neurology at McGovern Medical School at UTHealth Houston.

Pregnancy increases the risk of strokes for a number of reasons, according to Sharrief. First, there are hormonal changes, which in pregnancy, can increase the risk of blood clots that can lead to a stroke. Changes in blood pressure can also be associated with increased risk for stroke and other cerebral vascular or brain complications in pregnancy.

“Older maternal age, obesity, and even migraines are other things that can increase the risk of stroke in pregnancy,” said Sharrief, director of stroke prevention for the UTHealth Houston Institute for Stroke and Cerebrovascular Diseases and director of the Stroke Transitions Education and Prevention (STEP) clinical program she founded in 2014. 

Jamie said Sharrief was great to work with, very knowledgeable, and answered all her questions.

“She made sure I knew what happened, what I needed to look for, and was an important part of the process,” Jamie said.

Delivering a miracle

Jamie was induced at 37 weeks and delivered a healthy boy, Levi, on December 10, 2022 – “7 pounds, 2 ounces of perfection,” as Jamie described him.

“When he came in our life those first couple of days, first couple months, he was truly the missing puzzle piece. He definitely completed it,” Jamie said. “Knowing everything I went through and that he’ll be my only one, I really try to enjoy every piece of motherhood and not take things for granted.”

Collaborating as a team

Jamie’s physician team worked together throughout her pregnancy and after to provide safe and optimal care for Jamie and her baby. All of her physicians were within UT Physicians, which Jamie said she really liked, especially to simplify the process.

“Everyone’s in communication,” Jamie said. “When you’re going from one doctor to the next, you’re not having to tell your story over and over again.”

Part of the teamwork involved providing medication to prevent preeclampsia as well as blood thinner shots to prevent more clots from forming during the pregnancy. And ultimately, closing the hole in her heart.

“It’s really important to have this kind of collaboration during pregnancy,” Sharrief said. “Early in the pregnancy, I worked with her maternal fetal medicine doctors to make sure we agreed on the correct treatment to prevent stroke and managing complications she had during pregnancy. And we consulted with cardiology about medications we were going to use after the PFO closure.”

Abhijeet Dhoble, MD, interventional cardiologist with UT Physicians and associate professor at McGovern Medical School at UTHealth Houston, performed the closure of Jamie’s PFO two months after Levi’s birth. Dhoble said it was a very collaborative effort between the heart-brain team — cardiology and neurology.

“We decided to keep her on blood thinners until she delivered the baby, and then close it,” Dhoble said. “We did not want to expose the unborn child to unnecessary radiation that can happen during the procedure due to X-ray use.”

Dhoble said Jamie had aneurysmal interatrial septum and a large shunt across her PFO that categorized her condition as “high risk.” By closing her PFO, he said it reduced her future stroke risk by more than 60%.

Experiencing life after stroke

The most challenging aspect for Jamie experiencing a stroke was having a blind spot on her right side. The vision has improved, but not completely, in the periphery. She’s made adaptations in her driving, but adjustments were also necessary for just walking around. She said it’s almost hard to admit her challenge, after hearing others speak on their stroke recovery, because she was blessed with minimal impairment.

“I count my blessings every day, because it could have been a lot worse. I could have died,” Jamie said. “I’m able to drive, work, take care of my son, and be a wife – the things I enjoy most.”

Going back to her faith, Jamie said she believes things in life sometimes happen for a reason: to teach us a lesson or affect the lives of others down the road.

“Why this happened to me, I don’t know. God had a plan, and there is a purpose for everything, whether it be that I’m here doing this interview to help somebody else,” Jamie said. “I just had faith that everything was going to be OK. I chose to look at the positive and not the negative. And I had this child to look forward to!”