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news News Friday, March 27, 2020 Friday, March 27, 2020 12:05 PM - Friday, March 27, 2020 12:05 PM

Brace wear and vegetables

A new outlook on wearing a back brace, shortens the prescribed time

Brace wear and vegetables

Scoliosis presents as a sideways curvature of the spine that occurs most often during the growth spurt just before puberty. The grade of severity is determined by the degree of the curve of the spine. The degree of the curve is determined based on X-ray results. Moderate scoliosis may be treated by wearing a medically prescribed brace, also known as a thoracic lumbar sacral orthosis (TLSO). Pediatric orthopaedic surgeons and physicians at Shriners Hospitals for Children Medical Center — Lexington strongly recommend patients with moderate scoliosis wear a TLSO for 23 hours a day. This serves as a potential treatment to decrease or stop the spine from continuing to curve, which could otherwise lead to spinal surgery.

Ella, a 12-year-old female patient, was diagnosed with scoliosis during her annual well-check pediatrician appointment. Ella’s pediatrician completed a thorough physical exam by asking her to bend forward for a check of her spine. When she bent forward, the pediatrician and Ella’s mom, Amy, immediately noticed one of Ella’s shoulder blades protruding upward when she bent forward.

Ella’s pediatrician pointed out a small curve in Ella’s spine and used a scoliometer to confirm there was an atypical curve in her spine. Ella’s pediatrician immediately referred Ella to Shriners Medical Center for X-rays and confirmation.

During Ella’s first appointment with Rebekah Leet, M.D., at the Lexington Shriners Medical Center, Dr. Leet confirmed that Ella’s spine was in fact curved and that lifestyle changes would need to be made. Dr. Leet prescribed a TLSO for 23 hours a day, and stated that Ella may be wearing the brace for up to four years while Shriners Medical Center staff monitored her continued growth.

“As Ella’s mother, I knew it was my job to show her that all is well with this significant news. I remember simultaneously pinching my leg and biting my inner cheek to keep from tearing up as Dr. Leet said things like 'four years,' 'sleeping in the brace,' and 'friction spots on skin.' I nodded along, taking mental notes, and doing my best to look confident,” said Amy. “I knew my 12-year-old deserved to see a confident doctor and parent, so I sat smiling, nodding, and doing my best to absorb the important information being shared.”

During that first appointment at Shriners Medical Center, Ella was casted for a custom-fitted and designed TLSO by Pediatric Orthotic and Prosthetic Services – Midwest, LLC, located within the medical center.

Ella and Amy state that the most difficult time during the scoliosis journey was the month between the initial diagnosis and receiving the TLSO. “The fear of the unknown is one of the most powerful sources of anxiety for mothers, fathers and daughters alike,” said Amy. “After intense worry, ultimately sanity would prevail. I would take a deep breath and remember the positive comments from our care manager, Allison, and Dr. Leet: 'Not forever,' 'preventing surgery,' 'will feel normal after a while,' 'many others like you,' and 'not alone.'”

The day Ella received the TLSO, she got to work on creating a plan to increase her time wearing the brace each day. She created a calendar for the first week of brace wear, indicating her goals for time each day until she was wearing the brace full-time. Prior to wearing the brace to school, Ella decided it would make her more comfortable if she notified her friends ahead of time. She sent an individual text to eight of her closest friends, letting them know she would be wearing a back brace due to a curve in her spine. She let her friends know she was nervous and could use some encouragement. Ella’s friends responded with lots of comfort, and continued to be a source of encouragement during her journey.

“If you are honest with your friends from the beginning, without trying to hide it, wearing your brace to school is nothing to worry about!” exclaimed Ella.

Ella has been committed to wearing her brace as much as possible. Due to her consistent brace wear over the last six months, Dr. Leet recently informed Ella that her curve has shown some improvement. Dr. Leet told Ella that if her curve continues to improve or remains unchanged at her one year follow-up, she may be able to transition to part-time brace wear.

“I think sleeping in the brace was something we thought was going to be incredibly difficult. Surprisingly, sleeping in the brace was one of the easiest brace-wearing adjustments, and is a worry-free time to build brace-wearing hours into the day,” Amy said.

Ella runs cross-country, runs track and field, plays violin in the orchestra, sings in the choir and participates in school plays, all for her middle school. Outside of middle school, Ella plays violin in the Central Kentucky Youth Orchestra. She was active before being prescribed to wear the TLSO and has stayed active since. While she had to make some lifestyle adjustments and find alternate ways to remain active, wearing the TLSO did not stop Ella from living her life to its fullest potential, nor does it stop her from having fun! “She has been told that the brace improves her violin posture,” said Amy.

Ella and her mom state that the best advice for other patients in a similar situation is to be open and honest about the brace, and show your child that scoliosis is not a topic to avoid for fear of embarrassment.

Clothing is a topic of worry for many teenage patients diagnosed with scoliosis. Ella’s family found the best brace underwear solution was to purchase a role of stockinette from Amazon. They cut several pieces to the length of Ella’s torso. “The stockinette pieces fit perfectly under the brace (armpit to hips), and allow her to wear sleeveless tops because there are no straps or sleeves to contend with. We wash and dry the cut pieces with regular laundry and they hold up beautifully. The entire roll will likely last a year or longer,” Amy said. 

Amy said that she, Ella and their family related wearing the brace to wearing glasses or eating your vegetables. Wearing a brace around your back is no different from wearing glasses on her face or eating vegetables as both are essential, but not always something we want to do. Ella wants other patients to know that after a few weeks, brace wear will become the new normal. “Eat your broccoli, wear your brace and be proud of your beautiful healthy body!”