The Importance of a Pediatric Surgeon

Children are not just “little adults” and when possible, should be treated by a physician who is specially trained in pediatrics. Their physiology is different, and since they’re still developing, their organs are not always in exactly the same location. In this episode of CHOC Radio, Dr. David Gibbs, a pediatric surgeon and the director of trauma services at CHOC, discusses:

Hear more from Dr. Gibbs in this podcast:

CHOC Radio theme music by Pat Jacobs.

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CHOC Patient Named Calif.’s Children Miracle Network Hospitals Ambassador

Eight-year-old Jordin has sickle cell disease, a disorder that means her red blood cells are misshapen, which can lead to reduced blood flow to many parts of her body, and frequent hospital stays at CHOC Children’s for pain management. But for her, it’s also been an opportunity to fundraise and raise awareness of sickle cell disease.

CHOC is proud to be part of the Children’s Miracle Network Hospitals family, a national network of corporate partners and programs whose fundraising allows CHOC to help kids like Jordin, and offer exceptional care and state-of-the-art treatments and technology for patients and families with the most complex needs in pediatric medicine.

Recently named a Children’s Miracle Network Hospitals Champion, Jordin will spend the next year traveling the country and raising awareness of the needs of children’s hospitals throughout the nation, including those of CHOC.  Each year, one child from every state is honored with this ambassador position.

Jordin’s ambassador tour kicked off with a trip to Washington, D.C. where Champions shared their inspiring stories to encourage charitable support for children’s hospitals, including attending Senate meetings on Capitol Hill. The end of her year as ambassador will conclude with a trip to Orlando, Fla. as the ambassadors reunite to thank and further inspire those who support the children’s hospitals the Champions depend on.

Jordin CMNH
Jordin’s family joined her on her ambassador tour to Washington, D.C.

Jordin’s history with CHOC runs deep. When she was 3 years old, Jordin was admitted to CHOC for complications of sickle cell disease. Her care team suspected acute chest syndrome, one of the most common causes of death in sickle cell patients. Due to technology constraints at the time, tests were sent offsite for evaluation and getting results could take up to a week.

As they awaited the results, Jordin’s family made a commitment to help other kids fighting sickle cell disease.

“During that week, we realized that we needed to step up and do something for CHOC, so no other families had to wait this long,” said Jordin’s mom, Karen.

Karen recruited family and friends with event planning, social media and fundraising experience to form Jordin’s Journey, a group of people dedicated to fighting sickle cell disease, and helping Jordin. They raised $32,000 to secure a Sebia Electrophoresis machine, which helps monitor and treat blood disorders efficiently at CHOC.

When she grows up Jordin wants to be a doctor so she can help other children the way she’s been helped.

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Tick Bites: Fact vs. Fiction

Tick bites can be a common summer nuisance depending on where your activities or travels take you. Parents should be aware of common misconceptions related to ticks, says CHOC Children’s pediatrician Dr. Katherine Roberts.

Parents can help prevent tick bites: Fact

There are several things parents can do to help their children avoid tick bites.

  • Stay on a path when hiking
  • Wear long pants, and tuck pants into long socks
  • On clothes, use permethrin spray. On the skin, use insect repellent with 30 percent DEET. Be aware that this generally only lasts on the skin for one to two hours, so reapply often if you’re spending extended time outdoors.

Remove ticks by lighting a match near the arachnid: Fiction

This age-old myth can lead to accidental injuries, says Roberts, and should always be avoided. Instead, dip a cotton ball in liquid soap, and soak the tick for one to two minutes. Then locate the head of the tick and use a tweezers to pull it straight out. If the tick  is still latched on to the skin,  hold the head of the tick straight out for 30-60 seconds and it will release from the skin. Then drop the tick into a jar of rubbing alcohol to eliminate it. If the tick is too small to grab with a tweezers, use a credit card or popsicle stick to slide it off the skin. Most tick bites don’t result in any symptoms or side effects, and removal at home is sufficient care.

Tick bites lead to Lyme disease: Rarely

The likelihood of contracting Lyme disease via a tick bite in southern California is extremely small, says Roberts.  There are many variations of ticks and only one- deer ticks, not commonly found in this region- transmits Lyme disease. Since deer ticks are tiny, they are easily missed.  Always do a full body check for ticks after going outdoors, and pay close attention to the head, neck and scalp, since ticks gravitate to those areas.

Consult your pediatrician if you cannot remove the tick in its entirety, or if your child becomes symptomatic. Lyme disease symptoms include fever, muscle aches, joint aches and headaches. If you were recently in an area known for deer ticks, most notably the northeastern United States or the upper Midwest, watch out for small red rings one to two inches from a possible bite site, which may be a sign of Lyme disease. Treatment includes one to two weeks of antibiotics, and most children make a complete recovery with no complications.

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Summer Safety: What’s in Sunscreen?

By Melody Sun, clinical pharmacist at CHOC Children’s

The skin is the largest organ of the body, and our best protection against the outside environment. Sunlight stimulates the skin to produce vitamin D, however, daily prolonged exposure to radiation from the sun can cause wrinkles, freckles, and, in the worst case, skin cancer. Sunscreen can protect the skin so that it can continue to protect the rest of the body. Remember that radiation from the sun penetrates the skin even on cloudy and snowy days, so it is important to apply sunscreen whenever going outside.

Knowing when to apply is the first step, but what is the difference between products? Navigating your way through the endless number of products can be challenging. The active ingredients, which are listed in the Drug Facts Label, protect the skin from different types of ultraviolet (UV) radiation called UVA and UVB. UVA reaches deeper into the part of the skin that provides support and nourishment to the rest of the skin layers. UVB can damage the part of the skin that contains important structures such as blood vessels and nerve endings. Sunscreen protects the skin by reflecting or absorbing the radiation.  The ‘reflective’ property is not as strong as the ‘absorptive’ property because the UV radiation can hit other areas.

Let the following table be a guide to help you understand the ingredients in your sunscreen, and how each of them is important in helping protect you and your family.

Active Ingredient Radiation Coverage Considerations
UVA UVB
Absorbs radiation
Avobenzone

Best UVA coverage. Must be in combination with other ingredients (ie, octocrylene). However, may degrade other sunscreen ingredients.
Ecamsule ✔ (partial) Must be in combination with other ingredients (ie, octocrylene). Less water resistant.
Oxybenzone ✔ (partial) Can cause allergic reactions, not water resistant
Padimate-O

Glycerol PABA

Most potent UVB absorber, potential for allergic reactions (related to PABA)
Octocrylene Stabilizes other ingredients.
Octinoxate

Cinoxate

Water resistant, avoid combination with avobenzone (destabilizes avobenzone’s UVA protection).
Octyl salicylate (octisalate)

Trolamine salicylate

Homosalate

Stabilizes other ingredients, water resistant, less potent in UVB absorption than others
Ensulizole ✔︎ Less oily application, not water resistant
Reflects and disperses radiation
Titanium dioxide Transparent formulations available
Zinc oxide Leaves whitened layer on skin and clothing

Note: The above chart is not all inclusive.

Consider the following guidelines when making your selection:

  • Make sure the combination of active ingredients covers both UVA and UVB
  • If you’ll be sweating or around water, select a combination that is water-resistant.
  • ‘Water resistant’ labeling means the product retains its activity for at least 40 minutes in water. ‘Very water resistant’ means at least 80 minutes.
  • Will you be in the sun all day? If so, select a higher SPF depending on your skin tone and individual sensitivity to sunburns.

Consult your child’s pediatrician with questions on specific sun prevention mechanisms for your family.

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Coming Soon: A New Food Label!

By Stephanie Prideaux, Dietetic Technician, Registered at CHOC Children’s

“Very soon you will no longer need a microscope, a calculator or a degree in nutrition to figure out whether the food you’re buying is actually good for our kids,” joked First Lady Michelle Obama on the night that the biggest changes to the food label in twenty years were publicly announced.

These updates are made to reflect new scientific knowledge and respond to America’s current state of health. The nutrition facts tell us what is in our food so that we can make healthy choices to fuel our busy lives and prevent disease.

What’s New?

The new rules affect the familiar black and white (and commonly overlooked) nutrition facts panel. Companies can start at any time, but you can be sure to see them by July 27, 2018. Familiarize yourself with the major changes so you can be sure you’re buying the best foods for you and your family.
new food label

Big and Bold Calories
Calories (the amount of energy food contains) per serving will now be bigger and bolder, making them easier to read.

Serving Sizes That We Actually Eat
Instead of the standard portion sizes used in the past, these new servings will be increased or decreased to match the amount that people in the U.S. normally eat. Odd-sized servings, like a 20-ounce bottle of coke, which would previously have read as one and a half servings, will be labeled as one whole serving. Packages with multiple servings that might also be eaten in one sitting, such as a bag of chips, will have two columns: one with nutrition information per serving and another with information per whole package.

Added Sugar
Packages will also start to list how much sugar was added to sweeten the product. Watch out, because every 4 grams added is like putting a whole teaspoon of sugar in your food or drink!

Percent Daily Values (%DVs) Updated and Better Explained
Percentages posted to the right of each nutrient are a simple guide that most people can use to make healthy food choices. Remember that we only need to eat 100 percent of these. So, if all of our foods for the day are adding up to be far above or under 100 percent, you may want to make different choices in your meal pattern. For example, many Americans are eating too much sodium and cholesterol, which can lead to heart disease.

Say Hello to Vitamin D and Potassium
Vitamin D and potassium play important roles in health and preventing chronic disease, but many people are not getting enough. These have been added to help people make healthy choices toward meeting their recommended daily intake.

Goodbye, Vitamins A and C!
These days, it is rare for someone not to get enough of these two vitamins. We still need them, but we can happily say goodbye to them from our nutrition facts panel.

The Bottom Line:

 While these changes are baby steps in the right direction, for many people the new label may not be as user-friendly as we originally hoped this version would be.

Many of the healthiest foods you can find will never even have a food label. Fruits, vegetables, nuts, seeds, whole grains, beans, meats, dairy, and water are whole unprocessed items that will help us reach 100 percent of the nutrients we need to help us feel great, look great and prevent chronic disease.

All foods can fit into a healthful lifestyle. When choosing packaged foods, remember to read the label and be a little like Goldilocks with your nutrients: not too much, not too little, but juuuuust right.

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New Vaccination Law: What it Means for Your Family

Echoing longstanding recommendations from the American Academy of Pediatrics supporting childhood immunizations, a new vaccination law in California eliminates the ability to cite a ‘personal belief exemption’ from mandatory childhood vaccinations. This means that in order to be enrolled in public or private child care centers,  preschools, primary or secondary schools, children must be vaccinated against the following  10 diseases: diphtheria, Haemophilus influenzae type b (bacterial meningitis), measles, mumps, pertussis (whooping cough), polio, rubella, tetanus, hepatitis B and chicken pox. We spoke to Dr. Katherine Roberts, a CHOC Children’s pediatrician, on what this new vaccination law means for children and families.

Dr. Katherine Roberts
Dr. Katherine Roberts

Q: What does California’s new vaccination law mean for children and families?

A: Some parents think that this means vaccines are now mandatory- but for decades, every state in the U.S. has required that children be vaccinated against certain diseases. This change means that personal belief exemptions to these long-standing mandatory vaccines can no longer be applied. It will make schools a safer place for children- those who are already healthy, and those who are immunocompromised. California is not an anomaly in creating a law such as this. Many other states have already adopted similar laws, and results in those places show that they’ve been successful in preventing outbreaks of vaccine preventable diseases.

Q: Why is it important for parents to follow the immunization schedule outlined by the AAP?

A: The current immunization schedule outlined by the AAP and Centers for Disease Control & Prevention has been researched and proven to be the most effective and safest way for children to be vaccinated against potentially fatal diseases. It’s important to know that there’s no existing alternative schedule that has been studied to show it’s as safe and effective.

I get frequent questions from expectant and new parents who are concerned about the number of vaccines given to kids at one time under this schedule. The amount of antigen in the vaccine that is put into their child’s body is 10,000 to 100,000 times less than if they just got a common cold, so there’s no chance of overwhelming their immune system.

Q: How do medical exemptions affect children through this new law?

A: Medical exemptions to vaccines are not common, but children that qualify would still be exempt, as they are immunocompromised, or in even less frequent instances, they have allergic reactions to vaccines. Children with medical exemptions will be in a much safer position because they won’t be surrounded by other kids who could pass on a fatal dose of measles, for example.

Q: How do vaccines fit into a patient’s overall lifelong medical care?

A: Vaccines and proper hand washing, more so than all other interventions, have proven to be among the most safe and effective ways to prevent disease.

Q: Is there anything else you’d like to share with parents about vaccines?

A: All diseases for which kids are vaccinated in U.S. have the potential to be fatal, and we still see instances of these diseases. While some are in higher rates than others, all have increased in frequency in areas where children are not vaccinated, and international travel makes even diseases such as polio a potential risk.

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Keep Kids Safe While Playing Pokémon

Have you or your kids joined the Pokémon Go craze?

The smartphone-based game has picked up steam worldwide, bringing gamers out in droves to hunt for cartoon critters called Pokémon.

While the game is unique and commendable for requiring players to head outside, explore and be active, it has prompted some safety concerns. These simple tips can help parents ensure their children stay safe while playing Pokémon Go.

pokemon go

Don’t use phones or headphones while crossing streets

About half of pedestrian-related injuries in teenagers may be attributed to distracted walking – and the Pokémon trend can only compound these dangers.

Already, according to a 2014 study, among the teens who were hit by a car while walking, 47 percent were listening to music, 20 percent were talking on the phone, and 18 percent were texting.

Parents should insist that children put away their devices and headphones while walking on sidewalks or roads.

Never play while driving

In 2010, about 18 percent of all injury car accidents were attributed to distracted driving. This could mean texting, eating or drinking, talking on a cell phone, grooming, or many other activities that pull attention from the road.

Law enforcement officials say that young and inexperienced drivers are more likely to have an accident because of distracted driving. For a driver of any age, using a cell phone behind the wheel reduces brain functions needed for safe driving by up to 37 percent.

Experts recommend that all drivers turn off their phones or keep them out of reach while behind the wheel.

Be mindful of other pedestrians

Not only are cars a threat as a gamer searches for Pokémon, but other pedestrians can be as well. Be mindful of others’ space and paths of travel.

Further, be watchful for other distracted pedestrians or drivers who might be playing the game and not fully focusing on the road ahead. Make eye contact with drivers before crossing streets.

Don’t play in unsafe locations

Since Pokémon launched in recent weeks, media reports have surfaced of people falling off of cliffs or becoming victims of crimes while playing the game.

To that end, don’t search for Pokémon in locations that are dark, abandoned or otherwise unsafe. Stay in groups and be aware of surroundings.

Rotate screen time with other activities

Children should not exceed more than two hours of screen time each day. Screen time is considered watching TV, playing video games, or using the computer, tablet or smartphones.

Though Pokémon does inspire players to stay active, parents should remind their children of the countless other summertime activities that do not involve screens.

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Child Passenger Safety Tips for Your Next Vacation

Finding the right car seat for your little passenger is an important task for all parents. Recent legislation states all children in California must be in rear-facing car seats until age two. If you’re traveling this summer, consider the following guidelines for passenger safety from the experts of CHOC Children’s community education department.

No matter what your mode of transportation might be, bring your own car seat whenever possible, instead of renting one through a car rental service, says Amy Frias, community educator at CHOC.

“It’s hard to know if that company has really kept the car seat clean, if it was ever involved in a crash, or recalled ,” says Frias.

If you are flying and cannot travel with your own car seat, and you are meeting family or friends, have them bring a car sear to the airport when you arrive.

Children over the age of two must have their own seat on an airplane, and in these circumstances, says Frias, using an appropriate car seat protects kids from turbulence.

When purchasing a car seat, CHOC community educators recommend purchasing a seat that fits well into your vehicle, fits your child and your budget.  Another consideration would be if you travel often by air, you may want a lighter seat.

Summer is also a popular time for recreational vehicle travel. Many parents assume that RVs have the same safety standards as a bus, given their size, which is not true, says Frias.

The most common injuries related to RV travel revolve around projectiles- which could even include cabinetry that appears properly mounted to the interior walls. Loose objects in the RV pose additional dangers.

“If your family is traveling by RV this summer, the safest place for your child to ride is in a car that may be caravanning with the RV, and properly restrained in their appropriate car seat,” says Frias. “RVs are rarely ideal for transporting children.”

Car seats should never be installed in RV seats that face backwards or sideways. For all passengers, make sure they are buckled up when the RV is moving.

“Traveling with kids can be exciting but challenging says Frias. Parents should remember that safety doesn’t go on vacation when you do.”

For questions about the car seat that is best suited for your family, call CHOC’s community education department at 714-509-8897.

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Meet Dr. Maryam Gholizadeh

CHOC Children’s wants its patients and families to get to know its specialists. Today, meet Dr. Maryam Gholizadeh, a pediatric surgeon. Dr. Gholizadeh attended medical school at George Washington University, and completed her residency at Eastern Virginia Medical School. She completed a pediatric surgery fellowship at Children’s National Medical Center in Washington D.C., and a pediatric surgical oncology fellowship at Memorial Sloan Kettering Cancer Center in New York. She is currently the chair of pediatric surgery, and a member of the credentialing, medical executive and medical staff performance committees. She has been on staff at CHOC for 13 years.

Dr. Maryam Gholizadeh

Q: What are your special clinical interests?

A: All aspects of pediatric and neonatal surgery, surgical oncology and minimal invasive surgery.

Q: What are your most common diagnoses?

A: Appendicitis, hernias, lumps and bumps, as well as complex congenital pediatric and neonatal conditions.

Q: What would you most like community/referring providers to know about your division at CHOC?

A: As a general pediatric surgery division, we can take care of a variety of conditions such as hernias, hydroceles, gastrointestinal conditions requiring surgery, thoracic conditions, oncological problems requiring surgery such as neuroblastoma, Wilms’ tumor and teratomas.

Q: What inspires you most about the care being delivered here at CHOC?

A: We have a great group of specialists at CHOC who can deliver a high quality of care to our patients.

Q: Why did you decide to become a pediatric surgeon?

A: I decided to become a pediatric surgeon when I was a third year surgical resident on pediatric surgery rotation. Pediatric general surgery is the only field where you are able to take care of a variety of conditions. I found this field extremely rewarding, at the same time challenging.

Q: If you weren’t a physician, what would you be and why?

A: An athlete. I love the challenge, the discipline, and the fact you are always trying to do your best.

Q: What are your hobbies/interests outside of work?

A: Running, cycling, skiing and playing with my dogs.

Q: What was the funniest thing a patient told you?

A: There was a young child around 8-9 years old and we were going to remove his appendix with laparoscopy. I was standing on his left side because with laparoscopy we make our incision on the left side. Just before he went to sleep he looked up at me and said, “Why are you standing on my left? My appendix is on the right.” I was amazed at how knowledgeable this kid was!

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CHOC Nurse Serenades Patient

A ukulele’s sunny, mellow sounds waft through the hall of the hematology/oncology unit.

The soft music leads to a patient’s room, where nurse Julia Junn sits, plucking strings and singing, as patient Ruben watches on with a smile.

I see skies of blue and clouds of white
The bright blessed day and the dark sacred night
And I think to myself
What a wonderful world

Now on her second serenade, Julia’s performance is just another example of a CHOC nurse going above and beyond for a patient.

Ruben finds the music calming: “It’s very nice,” he says.

While Julia was caring for Ruben recently, the two talked about a television show character who played the ukulele. Julia mentioned that she also played, and Ruben encouraged her to bring it to work sometime.

A longtime piano player, Julia started tinkering with the ukulele two years ago as a nursing student in Maryland. The instrument was compact, and its smooth, happy sound channeled memories of her native Southern California.

“I thought, What’s a better time than now to learn a new instrument that’s fun and portable to keep me company?” Julia says.

Music plays an integral role at CHOC Children’s. In addition to its multi-talented staff like Julia, CHOC has a music therapy program, which addresses patients’ physical, emotional, cognitive and social needs.

Music therapists can create an individualized program to promote better health or encourage a child’s focus on getting better; manage stress; ease pain; express feelings or fears; increase verbal and non-verbal communication; and help increase gross and fine motor movements.

As for the musical nurse, Julia firmly maintains that she is still learning ukulele. Even still, her repertoire already ranges from emo band Death Cab For Cutie to songs from Disney movies. With a strong musical background, she can learn songs quickly – and even takes requests.

“I’m more than happy to play it again,” Julia told Ruben. “Just let me know.”

It sounds like he might take her up on that offer – and raise the stakes.

“Ruben mentioned that he wanted to hear me play piano,” Julia said. “So, all we have to do is find a keyboard!”

Check out another ukulele performance from Julia.

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