Cover of Monterey Herald Health Matters May 2023 Issue Dr. Samera Kasim

Monterey Spine & Joint’s Orthopedic Surgeon, Dr. Samera Kasim is featured in the May 2023 “Women’s Health” issue of Health Matters, published by the Monterey Herald. Click here to read about who inspired her to pursue a career in orthopedic medicine, why she joined MSJ nearly ten years ago, and how she gives back to our community.

Monterey Spine & Joint Hires Dr. Nico Gularte to Meet Growing Service Demands

Local Specialty Care facility celebrates 15th Anniversary while expanding staff for the future

Dr. Nicolas Gularte headshot

MONTEREY, CA- Monterey Spine & Joint (MSJ), which provides an exceptional medical array of musculoskeletal and neurosurgical care and injury treatment service to the Monterey  Bay community, is growing its staff to meet increasing medical service demand and referrals. Dr. Nicolas Gularte, a Physical Medicine and Rehabilitation (PM&R)and regenerative medicine specialist, will join the Monterey office in August.

“We are excited to announce the addition of Dr. Gularte to Monterey Spine & Joint”, said Jason Wilfong, CEO of Monterey Spine & Joint. “As a native of the central coast, Dr. Gularte returns home and brings outstanding clinical education, experience, and, most importantly, a passion and commitment to patient care.  We are pleased to have Dr. Gularte join the family at MSJ, and he will enhance our ability to continue to provide the best quality community-based care.”

Dr. Gularte is a graduate of the York school in Monterey and the University of California at Santa Cruz, he completed a Masters in Biomedical Science and medical school at A.T. Still University. He completed his PM&R residency at Casa Colina Hospital in Pomona, California and fellowship training at the Bodor Clinic in Napa, California.

Dr. Gularte’s experience also enhances the regenerative medicine services introduced earlier this year at MSJ. To meet the growing service demand another Physical Medicine & Rehabilitation doctor and a Sports Medicine Surgeon have been hired and will start this Fall. This will allow more new patients to be accepted and shorter wait times.

MSJ is also celebrating its 15th anniversary and reflecting on its growth over that time. The increase in business is a result of the strong reputation and prestige they’ve established, especially since the addition of their MRI, Physical Therapy and Urgent Care facilities, making them the largest orthopedic network in the area.

In recent years, the average number of referrals has varied greatly by specialty. Orthopedic and PM&R average over 600 referrals per physician per year. In 2021, orthopedic hand saw a 23% increase with 2,000 referrals. With the addition of 4 new physicians, including PM&R, orthopedic hand, and Sports Medicine, MSJ projects it will be able to handle over 3,000 additional referrals per year.

About Dr. Gularte

Dr. Nicholas Gularte is board certified in Physical Medicine and Rehabilitation (PM&R) physician with fellowship training in fluoroscopic and ultrasound guided interventional spine and sports medicine with an emphasis in orthobiologics. He uses a spectrum of non operative, minimally-invasive techniques from osteopathic manipulation to regenerative medicine to improve function and quality of life.

Dr. Gularte is a native of the central coast from Gonzales, California. Having graduated from York school in Monterey and University of California at Santa Cruz, he completed a Masters in Biomedical Science and medical school at A.T. Still University. He completed his PM&R residency at Casa Colina Hospital in Pomona, California and fellowship training at the Bodor Clinic in Napa, California.

He offers a range of treatments including ultrasound guided peripheral joint and spine injections, fluoroscopically guided spine injections including epidurals and radiofrequency ablation, spasticity management, along with electrodiagnostic studies. He offers platelet rich plasma (PRP), platelet lysate, bone marrow aspirate concentrate (BMAC) and adipose derived orthobiologic therapies.

In his free time Dr. Gularte enjoys trail running in Ventana wilderness, hiking and trips to the aquarium with his daughters, kayaking, antique automotive restoration, and making his own pasta.

Monterey Spine & Joint (MSJ) recently helped several mountain bike racers recover from injuries at this year’s annual Sea Otter Classic Mountain Bike Festival event in Monterey California.

One of those who were injured, Elaine Bothe from Portland, Oregon, recovered with the help of medical professionals from MSJ.

Elaine grew up riding bikes. She raced bikes for over a decade and is currently a professional mountain biking instructor with her own small business, Elaine has participated in the Sea Otter Classic Event for the last 10 years.

“It’s always a fun event, so many people are there—so many manufacturers with new products on display. I can check out all the new bikes and gear and meet people traveling from all over to participate in the race.”

While riding on a trail this year, Elaine went around a tight corner and then immediately encountered an oddly-situated tree on the apex of that corner.

“I hit the tree with my hand and took a tumble,” she recalled. “I ended up breaking my hand and thought I may have had a mild concussion because I cracked my helmet.”

Elaine was able to get clear of the trail and perform preliminary first aid on her hand to treat a laceration to stop the bleeding, and then decided to see the medics. She recalled that the MSJ medical tent was right there at the bottom of the course—not even a half a mile away from where she was on the trail.

This is the first year that MSJ volunteered to support the four-day Sea Otter Classic event. In the medical field tent next to the Ski Patrol he following MSJ medical professionals worked as volunteers: Connor Cole, MS, PA-C, CAQ; Jason Ehrhart, MS, PA-C; Kelsey Whichman, MA; Andie Stevensen; Dave Lacey, AT-C. On site, they treated everything from small injuries such as superficial abrasions (commonly called “Road Rash”) to a variety of fractures as well as more severe open wounds.

“Our hope was to utilize our facilities and medical expertise to give the athletes a high-quality treatment option for those who did not need to be transported to the emergency room,” Connor said. “We are looking forward to participating in this event annually in the future. Previous anecdotal reports are that they would treat 75+ injuries over the course of the weekend. This year, we’re told was atypically quiet due to it being the first year returning after COVID.”

When Elaine Both arrived at the medical tent, Jason Ehrhart, a PA, came to her aid. Jason treated her hand, cleaned it up, and set it in a temporary splint.

“She had a small laceration that needed sutures, and there was a strong concern for a fracture,” Jason recalled. “I kindly explained this to Elaine, and that I strongly felt she needed further treatment as soon as possible for wound closure, X-rays, and definitive care. I explained that MSJ is an orthopedic specialty urgent care—not an ER—where she would likely be waiting many hours to see ER doctors—not orthopedic specialists. She seemed very appreciative and was very pleasant during the encounter.”

At that point, Elaine weighed her options: To go to a local ER room, or pack up and go back to Oregon to get treatment, or go to the Monterey Spine & Joint orthopedic urgent care facility about two miles away.

“After calling Monterey Spine & Joint and talking about the pricing and the fact that they had availability to see me that day, I decided it was going to be smart to have X-rays done, have the stitches taken care of, and get treated before trying to make it home.”

After arriving at the urgent care facility, Elaine’s injuries were examined by Dr. Connor Cole, who confirmed that the bone was broken upon finding an uncommon fracture of the fifth metacarpal (the long bone that makes up the outside of the hand), as well as the laceration.

“Jason’s preliminary diagnosis from the field was spot-on,” Conner said. “The wound came together very nicely, and Elaine’s hand was placed into a more permanent-type splint for the next two weeks. I explained to Elaine that if all went well, the wound and fracture would heal entirely on their own, needing nothing more than some minor wound care and a classic hard cast for six weeks.”

Reflecting on her experience, Elaine says it was fortunate that the MSJ Urgent Care Facility was nearby and able to help her immediately.

“They were incredibly helpful with getting me the information I needed, and pricing information and scheduling me. They were very friendly, very professional, very helpful. It was nice to have that appointment and get seen right away and know that I was on the mend, rather than waiting in an ER.”

Elaine says this is the first time she ever broke a bone, so she had many questions about what could happen and concerns about possibly needing surgery

“I felt really well-taken care of, and I got the information that I needed to heal and move on with my life and get better as soon as I could. It was nice knowing that the extent of my injury wasn’t severe, needing surgery, so that was helpful to know right away. It was nice to have a better splint that would last until I could return home. Without the stiches, there was a chance of infection and it wouldn’t have healed as nicely.”

“People ask me about the Sea Otter Classic venue and where to go ride and what to expect. Now knowing that this urgent care is in existence and easy to get into—and such good care—I would gladly recommend that it’s an option in case something happens.”

Biking Safety Tips

MSJ medical processionals shared this safety advice about how to best prepare for active sports, such as mountain bike racing.

“The most hard fast safety advice of all time is that helmets save lives,” Connor said. “It does not matter if you are riding in the driveway, around a residential neighborhood, or on your local trails you’ve ridden a million times.”

Statistics from insurance institute of highway safety: In 97% of all bicyclist-related deaths, the rider was not wearing a helmet. Wearing a helmet reduces the risk of traumatic brain injury by up to 88%.

“Surprisingly, a majority of the more serious injuries happened before the race during warm- ups, or after the race riding around the classic,” Jason said. “One thing I noticed is that a lot of the hand and elbow lacerations/injuries—even knee—that required intensive wound irrigation, antibiotics with wound closure could have been minimized—even avoided—with personal protective equipment such as gloves, elbow/knee sleeves/pads. It seems riders wore these during races, but not during warmups or after races. My advice is to wear protective equipment all the time. Also, train harder than you race, so when the race comes—you’ve “been there, done that!” Also, stay hydrated. Start days before the race and get good rest days before the race. Nobody performs well when they are tired and over-train.”

“There are many different race disciplines, and riders will prepare very differently for their different events.” Connor said. “The cross country riders go as fast as possible over a very long distance. Their training would be more akin to cross country or marathon runners. The cross country riders will spend lots of time training their cardiovascular endurance, heart rates, and will make their bike as light as possible (sacrificing comfort) to increase their efficiency. Downhill riders will have large heavy bikes with big suspensions to absorb big jumps. They will practice landing their jumps in giant foam pits similar to gymnasts to decrease their injury risk during training.”