What are the common cases you see?

I see a mix between benign and malignant tumors around a child’s arms or legs. Patients will arrive with an abnormal lump and in many cases, we’ll monitor the growth over time to ensure it does not grow too quickly or become cancerous. My first step is usually a biopsy and look at it under the microscope alongside our pathologists to find out exactly what it is. That helps decide what the right treatment and surgery will be. One tool we use at Nicklaus Children’s to monitor these abnormalities is the EOS scan, which creates a comprehensive 3D image that is much more accurate than other scans like X-rays that require piecing multiple pictures together to approximate. It is especially helpful for patients needing routine check-ups as it offers shorter scanning times than traditional X-rays while producing a fraction of the radiation. 

What was the journey to becoming a pediatric oncologist like?

I earned my medical degree at Vanderbilt University School of Medicine and a master’s degree in business administration from the Vanderbilt University Owen Graduate School of Business in Nashville, Tennessee. I then moved on to complete a residency in orthopedic surgery at the University of Chicago and then pursued a fellowship in musculoskeletal oncology at Ohio State University and Nationwide Children’s Hospital in Columbus, Ohio. Along with my mentors at Nationwide Children’s, we created a fellowship program and was the first-ever fellow in pediatric-specific orthopedic oncology. 

What made you want to choose to be a pediatric orthopedic oncologist?

I was born and raised in Miami, in Little Havana and Shenandoah and was even at one point a patient at Nicklaus Children’s Hospital. Early on in medical school, I was paired up with an orthopedic oncologist and it was like opening Pandora’s box. I found my calling that same day and spent the rest of medical school in the orthopedic oncology clinic and doing science research in pediatric bone cancer. I pursued my residency in orthopedic surgery with the goal of becoming an orthopedic oncologist. I love working with children and their families. I enjoy the opportunity to have a long term, lifelong relationship with these children. Nicklaus Children’s is one of a small handful of children’s hospitals in the country that can meet the unique needs of kids with comprehensive, pediatric multidisciplinary sarcoma team. 

Can you walk us through the process of planning surgery for bone cancer cases that would otherwise require limb amputation?

Planning a surgery starts with discussing options in great detail with patients and their families to ensure we’re creating a treatment plan that works for their lifestyle and needs. I then implement virtual surgical planning techniques that aid my team and I in confirming whether the implant is the right fit, how it’ll perform on the patient and how we can go into the operating room with clear direction on what steps need to be taken so there is minimal excess time spent in the room. Most of the aggressive and malignant tumors, will require surgery to remove all of the tumor to ensure the cancer does not come back. The traditional surgery was amputation, but we now primarily do limb sparing procedures that reconstruct a functional arm or leg, often times children can walk the same day as surgery. I work with engineers to create custom-made implants, the metal implants we use will even grow while the child grows. 

What are some innovative processes and techniques you’ll play a role in implementing in your role at Nicklaus Children’s?

My job requires a lot of creativity to solve these pediatric-specific challenges. Many of the implants on the market are not the right size for kids or would stop the growth of the limb. My team and I are at times also engineers in creating a customized solution. Sometimes we can get the body to regenerate bone or keep the growth plates intact and incorporate a donor bone to rebuild a new bone. In addition to my role as a surgeon, I also serve as director of Surgical Innovation, where I lead the Nicklaus Children’s 3D Printing and Modeling Program and champion the development and adoption of the latest advances in patient-specific surgical technology. This program uses virtual reality, augmented reality, virtual surgical planning, life-size 3D printed models and patient-specific surgical guides to increase surgical precision and tackle complex cases. This is the type of technology that is a step above robotics in operating rooms as the tools decrease the surgery time, improve the accuracy of the placement of an implant and ensure the customized implants are the appropriate fit for each patient.