When a mystery ailment left Tanya Salinas in a wheelchair last spring, all she dreamed about was attending her daughter’s May wedding in North Carolina — and being able to walk again. Several doctors told her they could find nothing wrong. Until she made her way to Baptist Health Miami Neuroscience Institute, where she not only got a diagnosis, but also avoided certain permanent paralysis.
The icing on the cake? She danced with both her son, Nick, and daughter, Nicole, on the big day.
“It was pure joy that I had the opportunity to see my daughter get married. My son walked me down the aisle and I got to dance. That was a miracle. I call them my dream team,” she said of the Institute doctors, physician assistants, nurses and others who cared for her.
Disabling symptoms
Ms. Salinas, 50, became debilitated after losing feeling in her lower extremities. First, her toes went numb. Then her feet. Over a period of months, the problem worsened and crept up her legs to her hips, sometimes sending painful shocks through her legs. She began to lose her balance and fall, had to stop driving and became incontinent.
Ms. Salinas went from using a cane to a walker to a wheelchair — something that the lifelong athlete who went to college on a softball scholarship could have never imagined.
Richard Morgan, D.O., a physiatrist with Baptist Health Miami Neuroscience Institute who specializes in physical medicine and rehabilitation
Doctor after doctor performed imaging studies of her spine, including MRIs, but could see nothing that alarmed them. Even knowing that her health history included surgery at age 15 to correct her scoliosis with metal rods and screws, they didn’t believe a back problem was the cause of her condition. Then she had an appointment with Richard Morgan, D.O., an Institute physiatrist specializing in physical medicine and rehabilitation.
Searching for an answer a different way
“By the time Tanya came to my office, she’d had a very comprehensive workup from specialists outside of Baptist Health,” Dr. Morgan said. “But I knew something was missing.”
Dr. Morgan realized that the metal in Ms. Salinas’s spine was causing artifact in the MRI, casting “noise” on the images that made it very difficult to clearly visualize the spinal cord. “I decided to take a different approach and ordered a test that no one else had done,” he said.
On Monday, April 1, Ms. Salinas underwent a CT myelogram, which uses a contrast dye and X-rays to provide detailed images of the spinal cord and surrounding tissues. What Kevin Abrams, M.D., a diagnostic neuroradiologist with Miami Neuroscience Institute and Miami Cancer Institute, saw was a large mass on the spine. He immediately notified Dr. Morgan and neurosurgeon Robert Rothrock, M.D., director of spinal oncology at Miami Neuroscience Institute.
Ms. Salinas was admitted to the hospital the same day and had surgery on Wednesday, April 3.
Robert Rothrock, M.D., neurosurgeon and director of spinal oncology at Baptist Health Miami Neuroscience Institute
What is a spinal meningioma?
Spinal meningiomas are typically slow-growing benign tumors that form in the protective membranes that surround the brain and spinal cord. They are much more common in women than men, and while the cause isn’t completely understood, some patients with inherited disorders have a higher incidence. A contributing factor for Ms. Salinas was likely the repeated radiation exposure she had as a child due to her treatment for scoliosis, Dr. Rothrock said.
When a spinal meningioma is small, it usually causes no symptoms. “In Tanya’s case, hers had grown to become very large and was compressing her spinal cord,” said Dr. Rothrock, who performed the surgery. “If undiagnosed, patients can have a very poor quality of life, dependent on urinary catheters and diapers, and becoming wheelchair- or bed-bound.” Sometimes, even non-cancerous meningiomas like Ms. Salinas’s can cause death or permanent loss of function, depending on their size and location.
“These cases are often complex, but Tanya’s procedure was even more challenging because the titanium rods and hooks that had been placed many years before needed to be removed and had bony overgrowth. The tumor itself had become calcified. We effectively had to drill it out,” he explained.
In the operating room, Dr. Rothrock was joined by neurosurgeon Michael McDermott, M.D., chief medical executive and Irma and Kalman Bass Endowed Chair in Clinical Neuroscience at Miami Neuroscience Institute and some 30 other surgical assistants, radiation and surgical technologists, pathologists and anesthesiologists. “This type of challenging case requires a village, or I should say a city,” Dr. Rothrock said. “It started with a keen medical physician, Dr. Morgan, and then Dr. Abrams, a neuroradiologist expert, and then the entire team in the O.R. There are few programs, perhaps no others in South Florida, that have a dedicated interdisciplinary team like ours.”
A family’s strength
Ms. Salinas spent a month in the hospital and then several weeks in in-patient rehabilitation. Her wife and biggest advocate, Marite De Cespedes, never left her side, and her family played a key role in her recovery. “They were my strength,” she said. “They kept me going when I thought I couldn’t do it anymore.”
About a week before her daughter got married, Ms. Salinas returned home and continued her physical therapy so that she’d be stronger for the trip. When it was time to dance, it was more of a shuffle, she recalled with a laugh. But her dream had become a reality.
Today, she is preparing for the next family celebration — her son’s wedding. “Thanks to Miami Neuroscience Institute, I have gotten a second chance at life,” she said. “After the wedding, I plan on getting on an airplane and traveling. I want to see waterfalls again and go to places I’ve never seen before. I want to put on my hiking boots and get them dirty again.”
The doctors agree that seeing Ms. Salinas walk again is very gratifying, especially in a field where there are many unknowns. “Neurosurgery can be very scary for patients. Every patient is unique. After surgery, it can take up to 18 months to see improvement, if there is going to be improvement, but Tanya had a fairly miraculous recovery over days and weeks,” Dr. Rothrock said. “No one wants to go to war, but there are wars worth fighting. When we see patients like Tanya, and a family support system like hers, it is inspiring.”
For more information about Miami Neuroscience Institute, click here.
