Having a hospitalized child can be scary and stressful for parents, especially when that child is a newborn. Between raising a family, working and coping with a hospitalized infant, self-care is often not the first thing that comes to mind for a parent.
In this episode of CHOC Radio, we speak with Karina Ousley, a clinical social worker in CHOC’s neonatal intensive care unit (NICU), Diana Hurtado, coordinator for the March of Dimes NICU Family Support program at CHOC, and Marla Dorsey, patient- and family-centered care coordinator, about the importance of NICU parents practicing self care.
Today, we opened our new NICU with 36 all private rooms.
The 25,000-square-foot unit nearly triples the size of our previous Level 4 NICU, which included an open layout that grouped patients in pod-style beds.
The new unit, located on the fourth floor of the Bill Holmes Tower, creates a homey atmosphere with sleeping quarters and storage space outfitted in warm colors and wooden accents to help parents feel more comfortable while their infants receive highly specialized care for extended periods of time.
“CHOC is proud to offer private rooms to our smallest patients and their parents,” said Dr. Vijay Dhar, medical director of CHOC’s NICU. “No one’s vision of parenthood includes a NICU stay, but our new unit will provide parents with the space and privacy to get to know their new baby, and reassurance that they’ll be nearby while their newborn receives the highest level of care.”
Private NICU rooms are a new standard for improved patient outcomes. Benefits for babies cared for in single-family rooms include higher weight at discharge and more rapid weight gain. Also, they require fewer medical procedures and experience less stress, lethargy and pain. Researchers have attributed these findings to increased maternal involvement.
A private-room setting provides space and privacy sought by parents to breastfeed, practice skin-to-skin bonding, and be more intimately involved in their baby’s care. Private rooms allow parents to stay overnight with their newborn, and give staff more access and interaction with the family and patient.
In addition to private rooms, the new space includes other features that will enhance patient care. Should an infant need a sudden surgical procedure, three rooms within the unit can quickly be converted into space for surgeries. The unit will also include a life-saving extracorporeal membrane oxygenation (ECMO) unit. Rooms that adjoin can be used to accommodate triplets.
Safety features include same-handed rooms, where equipment is positioned in the same location among all rooms to reduce human error; room-adjacent nursing alcoves; and an in-unit nutrition lab for the preparation of breast milk and formula.
This new unit also features a family dining space, a room dedicated for siblings, a lactation room and other amenities to ensure the comfort of the entire family.
For several decades, we’ve had the privilege of serving infants requiring the highest level of care. With the unit’s opening, CHOC’s neonatal services now include 72 beds at CHOC Orange and the CHOC Children’s NICU at St. Joseph Hospital, and 22 beds at CHOC Children’s at Mission Hospital. In addition, a team of premier CHOC neonatologists care for babies at hospitals throughout Southern California.
A suite of specialized services comprises the CHOC NICU: the Surgical NICU, which provides dedicated care to babies needing or recovering from surgery; the Small Baby Unit, where infants with extremely low birth weights receive coordinated care; the Neurocritical NICU, where babies with neurological problems are cohorted; and the Cardiac NICU, which provides comprehensive care for neonates with congenital heart defects.
The CHOC Children’s Foundation has raised $4,381,984 toward the new NICU, including lead gifts from the Argyros Family Foundation, Credit Unions for Kids and philanthropist Margaret Sprague.
As we prepare to celebrate the opening of our all-private-room NICU, say hello to a few graduates of the CHOC NICU.
Dylan & Payton Law
Dylan, age 9, and his younger sister Payton, age 7, were both born 6 weeks premature and cared for by the doctors and nurses of the neonatal intensive care units at both CHOC Children’s and CHOC Children’s at Mission Hospital. Their mom McKenzie shares a thank you to their care teams.
My family will forever be grateful for the blessings CHOC has given us― our children. Not only did Dr. Hanten save Dylan’s life, but all the nurses, doctors, and staff at CHOC took incredible care of Dylan, giving him strength and providing unforgettable emotional support for our family during a terribly scary time. Two years later those same doctors and nurses took care of his little sister Payton, who also spent a month in the NICU. They treated us like family, not just patients. They calmed our fears, held our hands, and loved our babies. CHOC has a special team of angels here to carry our little ones for us when we needed them the most.
When Dylan was born, doctors and nurses swarmed the delivery room. The doctors administered several doses of epinephrine to Dylan, but he didn’t breathe on his own for 22 minutes. They finally heard a faint heartbeat, but told us the likelihood of Dylan making it through the night was uncertain. At 2 days old he was transported via ambulance to CHOC in Orange, where we found out that he had brain damage. It was devastating to hear that our son may not walk, talk or eat on his own. Today, Dylan is a happy, kind, and compassionate little 9-year-old. He has ataxic cerebral palsy and struggles daily with his hands shaking, but that doesn’t stop him from enjoying school, Jujitsu, playing with his little sister, going to church, doing art projects, and playing outside. -Mackenzie Law
Nine hours after Noah was born, a nurse noticed something was off during a routine check-up, and soon the family was sent to the NICU. Noah was diagnosed with a lung infection and stayed in the NICU for almost two weeks. His mom Ashlie pens a thank you note to his care team.
A huge thank you from the Wenrick family to the whole CHOC NICU team for all that you do every day! You made us feel like family while Noah was in the NICU. Being new parents it was scary for us, but you helped us understand every step up to the day Noah got to go home! Now he’s a healthy and active 3-year-old. -Ashlie Wenrck
You first met Ryan, a graduate of CHOC’s small baby unit, in November during #PrematurityAwareness Month. Look at him now! Ryan is a happy-go-lucky boy who recently celebrated his first birthday with a trip to Disneyland. At his Mickey Mouse-themed birthday party for family and friends, his parents set up a CHOC Walk station and encouraged their loved ones to join Ryan’s Sidekicks, their first-ever CHOC Walk team. Ryan’s dad says, “The way my wife and I look at things after going through this experience is that we want as many people and possible to gain awareness and support the CHOC NICU and their exceptional Small Baby Unit.”
Austin, Michaela & Caden Shay
Triplets Austin, Michaela and Caden were born a day shy of 31 weeks and spent 80 days in the neonatal intensive care unit at CHOC Children’s at Mission Hospital. Their mom Jennifer, a clinical nurse at CHOC at Mission, shares a thank you for her co-workers who cared for her children.
On behalf of my entire family, I would like to thank the doctors and nurses that took care of our triplets at CHOC at Mission in the fall and winter of 2009. Austin, Michaela and Caden thrived with the tender loving care provided by the staff. Born a day shy of 31 weeks, Austin weighed 3 lbs. 9 oz., Michaela weighed 3 lbs. 3 oz., and Caden weighed a whopping 2 lbs. 0.5 oz. Despite my nursing knowledge, I was treated first and foremost as a mom. The nurses, doctors, and staff were always very professional in addition to being extremely considerate and attentive to our needs.
We cannot thank you enough for what you have given our family. We truly believe that our children― Caden in particular― would not be here today without the care they received in the NICU. It is because of the dedication of the CHOC at Mission NICU staff that we have three relatively healthy 7-year-olds at home today. What a happy and crazy home it is! Though we can never repay you for all that you have done for our family, we wish to thank you from the bottom of our hearts. You are all honorary aunts and uncles! Without the dedication of this team, I would not be the mommy of four that I am today. You have blessed our family beyond measure. -Eternally grateful, Jennifer Shay
After a healthy pregnancy, Willow was born just after 36 weeks via an emergency c-section. She was immediately transported to CHOC for body and brain cooling, to prevent seizure, stroke or damage to the brain. Her mother Cara shares a thank you note to the team that cared for now thriving almost-two-year-old.
We want to thank you with our entire hearts for truly transforming a nightmare into a beautiful dream. After an extremely healthy pregnancy without any red flags, Willow was born at 36 weeks and 2 days. Twelve hours after my water broke, there was extreme blood loss prompting the nurse to call a code. The on-call OB-GYN at the hospital where I delivered was in my room within seconds. Willow’s heart rate was around 60 beats per minute, only half of what it should be. An emergency cesarean immediately followed. Doctors discovered that I had a very rare condition called velamentous cord insertion where the umbilical cord inserts into the fetal membranes, then travels to the placenta. This means exposed blood vessels are vulnerable to rupture. Willow had lost a substantial amount of blood that required two blood transfusions and she was intubated.
The life-saving, phenomenal level of care that we received from our team at Hoag Hospital quickly continued at CHOC. After a perfectly healthy pregnancy, I never could have foreseen my daughter would be taken via ambulance to a different hospital just five minutes after I saw her for the first time. EVERY single day, I think about our nurses and doctors at CHOC. They were calm, abundantly informative and so gentle. The doctors answered as many questions as we had and we were never rushed. They are truly masters of their craft. Before this experience, I never thought a NICU could be comforting.
The NICU doctor said that Willow had experienced “insult” to her brain; the lack of blood flow had caused hypoxic-ischemic encephalopathy. Fortunately, CHOC has a body and brain-cooling process that is used in situations like this to prevent stroke, seizure and damage to the brain. Our daughter is lucky; her 72-hour cooling process resulted in zero stroke, seizure, or worse.
Today, Willow is 20 months old and thriving! She is a miracle because of all the hands that worked on her. We feel grateful to have spoken on behalf of CHOC over the last 20 months to help raise much needed funds for the new all-private-room NICU that opens this summer. We believe in paying it forward to the future families that now can stay with their baby as they heal. We love our caregivers at CHOC more than they may know. –Love, Cara Dee
Diagnosed at 18 weeks gestation with a congenital diaphragmatic hernia, Faith was born at 40 weeks gestation and spent four months in the neonatal intensive care unit. Today, she is a happy and active six-year-old girl. Her family shares a note of thanks for the team that cared for her.
Our family thanks God everyday and we are forever grateful for the caring and dedicated NICU team at CHOC. Our daughter, Faith was diagnosed at 18 weeks gestation with a birth defect called CDH (Congenital Diaphragmatic Hernia). We learned that 80 percent of her diaphragm was missing and were told that the statistic were not good. Her chances for survival were slim and if she did survive, she would have many health issues. Faith was born at 40 weeks gestation and after ECMO, CDH repair surgery & four months in NICU she pulled through. Faith is now 6 years old and has had a few minor hurdles but continues to defy the odds. She is doing great. Faith loves to sing, dance, play dress up, jump rope and read. Thank you CHOC; you have an awesome NICU team. -Amouroux Family
By Sandra Merino, clinical pharmacist and Jennifer Nguyen, clinical pharmacy resident at CHOC Children’s
Summer is here! That means more time for camping, hiking, and other outdoor activities. With the amount of rain we’ve received this year, Orange County experts are predicting an increase in snake encounters this summer. Part of the reason is flash floods have destroyed many snakes’ homes, forcing them out to look for new homes, shade, and water. The other reason is rain allows for more vegetation, and more vegetation allows for more rodents, and – you guessed it – more rodents mean more food for the snakes! With all this in mind, we encourage parents to learn how to prevent or treat a snakebite, just in case you encounter one on your adventures.
If you or someone you know is bitten by a snake:
Step One: Seek medical attention as soon as possible or call local Emergency Medical Services (EMS). First aid is important, but only to hold you over until you can get medical attention. Do not treat the bite by yourself, since the anti-venin is only available at medical centers.
Step Two: Keep the person still and calm. This prevents the venom from spreading, whereas moving around would allow the venom to spread to other parts of the body. Although it may seem strange, it’s best for the venom to stay in one place if possible.
Step Three: Try to remember the color, patterns, shape and sounds of the snake. These details can sometimes help emergency responders determine whether the snake is poisonous, which may impact treatment. Not all snakes have venom!
Step Four: While you wait for medical attention to arrive, practice these first-aid techniques:
Lay or sit the person down with the bite below the level of the heart
Keep him/her calm and still
Cover the bite with a clean, dry dressing
Step Five: Don’t overthink it. You might start remembering all sorts of crazy techniques that your neighbor, uncle, or childhood friend told you; but remember: the list of good first aid techniques is short. It’s better to do minimal first aid than bad first aid.
Do NOT suck out the venom
Do NOT slash the wound with a knife
Do NOT pick up the snake or try to trap it
Do NOT apply a tourniquet
Do NOT apply ice or immerse in cold water
Do NOT drink alcohol to ease the pain
Do NOT drink caffeinated beverages
What if you’re alone on a remote trail? What if there’s no cell service?
Stay calm. Slowly move yourself 20-30 feet from the snake and find a safe place to sit down. Sitting down can reduce the chances of fainting within the first couple minutes.
Remove any rings, jewelry, or restrictive clothing from the area of the bite.
Try calling 9-1-1. If you don’t have cell service, yell out loud for help. If someone is within earshot, they may be able to help you.
Take a minute or two to come up with a plan.
If you truly find yourself alone on the trails with no cell phone service, start walking to the nearest place where you can get help. This may be the trailhead, a park ranger station, or the last place you had cell phone service. The risk of spreading the venom while walking is less than the risks of staying in one place without medical help.
Signs and Symptoms of a Venomous Snake Bite:
Ulceration, redness and swelling at the bite site
Excessive bleeding or bruising
Low blood pressure
Nausea and vomiting
If you have a marker or pen, mark the area of swelling with the time noted. This can help emergency providers calculate how fast the venom is spreading.
Other dangers of snakebites:
Snake venom can cause bleeding problems. Do not take ibuprofen, naproxen, Aleve, Advil, Motrin or other non-steroidal anti-inflammatory drugs (NSAIDs) to relieve the pain from a snake bite. These medications increase risk of over-bleeding. Acetaminophen (Tylenol) is usually fine.
There is an antidote available at healthcare facilities called CroFab (crotalidae polyvalent immune fab, ovine). This is an antivenin specifically for some venomous snakebites. In the rare situation where you may find yourself needing this antidote, it is important to let your healthcare provider know if you have an allergy to sheep, papaya, papain, or pineapple enzymes. Having these allergies increases your risk of having an allergic reaction to the antidote, which your health care provider needs to take into account to manage treatment.
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Part of their scope of practice, both physical therapists and physical therapist assistants complete coursework in wound management during their higher level education. Several PTs and PTAs at CHOC have received specialized training in wound care and many have gone on to receive board certifications in wound care. With this training, a therapist is able to evaluate wounds, decide on the best treatment, and create a comprehensive wound care plan in collaboration with the patient, family, and medical team.
Physical therapists are able to use their expert knowledge of anatomy, tissue healing, movement and positioning to develop an individualized plan of care that also aims to improve movement and function. Successful wound healing may allow a child to more quickly return to school, participate in gym class and enjoy a summer trip to the beach with their family. The ultimate goal of physical therapy is to restore function and allow people to get back to the things they love doing!
How do PTs provide wound care at CHOC?
At CHOC, PTs and PTAs provide wound care services for kids on both an inpatient and outpatient basis. During an evaluation, a PT will decide how to best clean, dress, and protect the child’s wound, and also provide recommendations to the parent to encourage wound healing and to prevent complications.
Here are some tips to remember when caring for your own minor wounds or skin injuries at home:
Keep dried scabs moist using a healing ointment or petroleum jelly for faster healing time. While it may be challenging, try your best not to pick at scabs!
If a wound is open (appearing wet, bleeding or draining liquid), cover it with some type of bandage. Leaving it open to air will increase the risk of infection.
Common signs of infection include redness, swelling, pain and warmth. Call your doctor if you notice an increase in signs of infection that are not already being treated.
When using over-the-counter antibiotic ointments for minor cuts and scrapes make sure to follow the dosage instructions. It is not recommended to use many of these ointments for more than seven days unless stated by your doctor. Many people have allergic reactions to triple antibiotic ointments. If you notice a wound is getting worse with an ointment, stop using it and talk to a health care professional.
Hydrogen peroxide and rubbing alcohol are commonly used to clean wounds, although both are damaging to your healthy skin cells. Instead, simply use mild soap and water to clean a cut or scrape.
Different types of sandals, shoes, plus foot and ankle braces can all cause areas of redness caused by too much pressure to the skin. If the redness does not go away after 15 minutes upon removing the pressure, the fit needs to be modified to avoid further injury to the skin.
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We participate in CHOC Walk in the Park in honor of our son, Jaxson, who died in 2012 at 4-years-old following a drowning accident at a neighbor’s pool party. Jax was transferred to CHOC Children’s Hospital from another hospital, and the CHOC staff spent the next three hours doing everything they could to save our boy. The grace, compassion and solace that the CHOC staff showed us left an overwhelming mark on my wife and I. We lost our boy, but it was if they lost him with us.
We walk in Jax’s memory. It’s a way to honor his life and the way he touched so many people in his short time with us, all the while helping to raise money for the hospital. We first started walking in 2012, just a few months after Jax passed away. A friend of mine worked at Disneyland and had worked on the event before, and mentioned it to me. I don’t think we signed up until about six weeks before the event, and we just figured our family and maybe a handful of friends would join us. We ended up with over 75 team members and raised more than $10,000.
I’ll always remember that first year. There were so many emotions – we were in the thick of grieving, the rush of scrambling to get a team together in such a short time – but we felt a sense of pride on how we honored our sweet boy.
We are most inspired by the compassion and grace that the CHOC staff showed to our family. That is what we will always remember.
In addition to providing high-quality medical care, physicians and staff at the Julia and George Argyros Emergency Department at CHOC Children’s Hospital strive to make the experience less stressful for children and families. One physician has a few tricks to ease his patients’ fear and anxiety. Dr. Seth Brindis, a board-certified pediatric emergency medicine specialist and medical director of informatics, performs magic for his patients.
“For me, magic makes my job easier, instantly transforming what can be a scary experience for children to something fun. I incorporate magic into my physical exam as it makes the exam easier and more reliable when patients are comfortable with me and distracted. I tend to use coin tricks because they appeal to a wider range of ages, with the added benefit that the coins can be disinfected between patient contacts.”
Luckily, it doesn’t have to be an emergency in order to see Dr. Brindis’ magic. With help from child life, he occasionally puts on impromptu magic shows in the CHOC theater for inpatients, their siblings and parents.
Dabbling in magic since childhood, Dr. Brindis’ interest in magic was revitalized while in residency at Harbor-UCLA Medical Center, where he realized that simple tricks with cards and coins could help make connections with patients and staff. Since then, he has continued to study magic, even taking courses tailored for magic in medicine. Seeing thousands of patients each year, Dr. Brindis gets ample time to try out new tricks and help patients and their families leave with positive experiences and smiles on their faces.
Exclusively dedicated to the treatment of pediatric patients, CHOC’s ED features 31 exam rooms, including two trauma bays, and three triage suites. The ED is staffed with doctors who are board-certified in emergency medicine and specially trained nurses who provide the very best patient- and family-centered care. Child life specialists work with patients to help them feel safe and secure, and make the process a lot less stressful for the entire family.
“The ED is often the gateway for many families who are coming to our organization for the first time. We’re working together to deliver the best care to those who need it most. My job is to understand what is distressing to a parent in the middle of the night and either educate and reassure the family or intervene when called for.”
As the only trauma center in Orange County dedicated exclusively for kids, CHOC is ready to treat injuries 24 hours a day. The trauma team is trained to care for children and their unique physiological, anatomical and emotional needs, and CHOC’s protocols and equipment are specially designed for pediatrics.
The ED saw over 49,000 patients in the first year it opened. This year, it’s on pace to see more than 85,000 patients – an incredible rate of growth, which Dr. Brindis credits to the coordination and cooperation between the ED physicians, EMSOC leadership, and nursing, as well as CHOC administration.
“I love being a part of this team. I feel like we provide exemplary care to every person who enters our doors. Often, I feel like the conductor of an orchestra of care. There is no way I could do my job without the incredible people I work with. It really is impressive to watch our team working in concert to stabilize a really sick child.”
Dr. Brindis received his medical degree from Vanderbilt University. He completed his pediatric residency and pediatric emergency medicine fellowship training at Harbor-UCLA Medical Center in Torrance. In addition to caring for patients in the ED, he is actively involved with the training and teaching of pediatric and emergency medicine residents as well as fellows.
In his spare time, Dr. Brindis enjoys spending time with his wife, son and daughter. He also enjoys cooking, painting and, of course, working on his magic.
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By Laura Clapper, clinical dietitian at CHOC Children’s
Yogurt consumption has increased dramatically in recent years, especially Greek yogurt, for good reason. It contains important nutrients such as protein, calcium, potassium, and some are fortified with vitamin D for additional bone health. Current dietary guidelines recommend children consume 2-3 cups of low-fat dairy per day.
Many cultures around the world have consumed yogurt for over 2,000 years, but now the yogurt industry is taking over the dairy section of today’s local grocery stores. A few years ago, the yogurt choices were fruit on the bottom or mixed. Now, it can be overwhelming with so many options!
Some are packed with sugar, and some have more nutritional value than others. How do you know the right kind to buy for your family?
Made by heating milk, cooling it, adding live cultures (or probiotics, which are considered “good bacteria”) and letting the mixture ferment until lactic acid is formed and the product gains a thicker consistency. This process is the base for many other yogurts. It retains liquid whey, which is high in calcium. It also is the mildest form of all the yogurts, which makes it an appealing option for children. Look for a seal on the label that says “Live and Active Cultures” to ensure the product was manufactured with a minimum of 100 million cultures per gram. These can be beneficial to the gut and immune system.
Made using the same process as plain yogurt, but most of the liquid whey is strained away. Nutritionally, Greek yogurt has more protein, less lactose and fewer carbohydrates than regular plain yogurt. Manufacturers will often add back calcium which is lost with the whey. It is thicker, creamier and has a more tangy flavor than regular yogurt.
Pronounced Skeer, and commonly referred to as Icelandic yogurt, special Skyr cultures from Iceland are used to ferment nonfat milk. Water is strained away for a thick and creamy texture, leaving a high-protein product that has the same flavor as Greek yogurt, but a milder flavor and mouthfeel.
Kefir is a tart and tangy drinkable yogurt, using grains of a yeast starter to begin the fermentation process. It can be an acquired taste for some people, but those who prefer this kind enjoy the carbonation and thin consistency. People with lactose intolerance might be interested in giving this one a try, as it contains a very low amount of lactose.
Also known as stirred yogurt, this type of yogurt is thinner and creamier than Greek yogurt. It is made from cultured milk that is incubated and then cooled in a large container. Watch out, though: Swiss yogurt can have almost double the sugar and carbohydrates than Greek yogurt!
According to the USDA, what you do get from organic dairy products is the benefit of knowing that no growth hormones or antibiotics were used on the animals that produced the dairy. It contains no pesticide residue from added fruits, and no GMOs.
It refers to yogurt made from the milk of cows that have been grazing on grass, with no grain, corn or soy as part of their diet — good for the cows, and good for us. It’s a nutrient-dense yogurt which is rich and higher in omega-3s.
Be aware of added sugars in yogurt
Within each of these categories you can choose nonfat, low-fat or full fat versions, creamy, whipped, soy milk, fruited flavors, or added fibers. But whichever one you choose, take time to glance at the label. All yogurt will have sugar listed because all yogurt naturally contains the milk sugar lactose. Expect around 7-15 grams of naturally occurring sugar for a six-ounce serving. The new labels starting to come out this year differentiate between naturally occurring sugar and added sugar. Skip the added sugars by adding your own sweetness with fruit, cinnamon or a touch of honey.
Drinkable and squeezable yogurts are often marketed to kids but contain added colors, sugars and artificial flavors. Look at the added sugars in this nutrition label of a popular tube yogurt for kids:
Yogurt can be used in a variety of ways and at any time of the day. For breakfast, try it as a spread on toast or as part of a smoothie. For lunch or dinner, use in place of sour cream, heavy cream, or mayonnaise in recipes for pasta, tuna or potato salad. Mediterranean dishes feature dips and sauces such as raita, tzatziki and labreh made with yogurt and spices. For dessert, try freezer-mold popsicles with equal parts yogurt, nonfat milk and fruit. Or for a parfait, layer yogurt with fresh fruit, berries, or angel food cake and top with a sprinkle of high fiber granola and serve in clear containers. Any way you serve it up, your kids will love this delicious, healthy treat.
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CHOC Children’s wants its patients and families to get to know its specialists. Today, meet Dr. Francois Lalonde, a board certified pediatric orthopaedic surgeon.
Q: What is your education and training?
A: I attended medical school at University of Toronto School of Medicine. I completed my orthopaedic surgery residency at the University of Ottowa, and a pediatric internship at Montreal Children’s Hospital/McGill University. I completed a pediatric orthopaedic surgery fellowship at both Children’s Hospital of Eastern Ontario/University of Ottawa, and San Diego Children’s Hospital and Health Center/University of California San Diego.
Q: What are your current administrative appointments?
A: I am president of the CHOC Orange medical staff; medical director of the hip program, CHOC Orthopaedic Institute, member of the CHOC board; and president of Adult & Pediatric Orthopaedic Surgery medical group.
Q: How long have you been on staff at CHOC?
A: 11 years.
Q: What are your special clinical interests?
A: My clinical interests include infant, child, adolescent and young adult hip conditions (DDH, Perthes, SCFE, impingement); pediatric fractures and musculoskeletal injuries; pediatric foot conditions and reconstructive surgery; general pediatric orthopaedic conditions; limb lengthening; surgical treatment of bone deformity in osteogenesis imperfecta; and cerebral palsy.
Q: What are your most common diagnoses?
A: We see a variety of conditions, including forearm and elbow fractures; developmental dislocation of the hip in infants; Perthes disease; slipped capital femoral epiphysis (SCFE) condition of the hip; joint, extremity pain in children, adolescents (overuse, growth related); idiopathic adolescent scoliosis; among others.
Q: Are you working on any current research?
A: Yes, on Legg-Calve-Perthes research. We are looking at our five year experience with patients treated with open hip adductor lengthening, range of motion, nighttime orthosis and limited weight bearing protocol. Our patients have maintained femoral head sphericity and containment with congruent hip joint with very limited surgery. Many patients have been back to sports without any symptoms.
Q: What are some new programs or developments within your specialty?
A: Orthopaedic surgeons are better able to diagnose hip impingement based on radiographic and imaging assessment and depending on severity of underlying findings or condition, treat this condition with arthroscopy or surgical hip dislocation with femoral head/neck osteochondroplasty and/or acetabular rim trimming. In doing so, we are better able to differ the onset of premature degenerative changes (arthritis) of the hip.
Advanced hip joint preservation surgical techniques such as the Ganz periacetabular ostetomy and relative femoral neck lengthening have emerged to treat the sequelae of developmental dysplasia of the hip and other childhood conditions. In the appropriate setting, these surgical techniques are able to relieve hip pain and significantly delay or prevent the onset of premature degenerative changes (arthritis) of the hip.
A modular magnetic intramedullary nail (Precise nail) is now available to allow orthopaedic surgeons to lengthen the femur or tibia by up to 8 cm in patients with moderate or large limb length inequality. This internal device is being better tolerated by patients with less soft tissue irritation.
In addition, for several years now, the Fassier-Duval telescoping intramedullary nail has been used at CHOC to correct severe deformities of the femur and/or tibia in patients with osteogenesis imperfecta. This modular implant which is anchored at the top and bottom telescopes as the bone grows and has helped avoid multiple revision surgeries in childhood due to migration of the implant and refracture.
Q: What would you most like community providers to know about your division at CHOC?
A: Our division covers the entire spectrum of subspecialties in pediatric orthopaedics (fractures, upper extremity, spine, hip, lower extremity, sports medicine, foot/ankle, bone tumours, neurosmuscular conditions – cerebral palsy, spina bifida, muscle disease, osteogenesis imperfecta, brachial plexus injury, concussion). We have three offices in Orange, Irvine and Mission Viejo, in addition to the CHOC Clinic. We try to see our referral patients promptly, and are accessible by phone for questions from physicians.
Q: What inspires you most about the care being delivered at CHOC?
A: I’m inspired by the expertise, drive and dedication of our physicians, nurses and support staff, as well as our state-of-the-art facility, the wide range of subspecialists within pediatrics, the emphasis on patient safety and experience, and the emphasis on delivering high-level quality care to our patients.
Q: Why did you decide to become an orthopaedic surgeon?
A: I decided to become a doctor as a teenager. I had a part-time job as a lifeguard at local pools and beaches in Ottawa, Canada, in which I was required to take first aid courses, and that piqued my interest. Later, while attending university, I worked as a children’s swim instructor and gained interest in pediatrics and pediatric orthopaedics. I became interested in orthopaedic surgery as a medical student during a pediatric orthopaedic surgery rotation when I was exposed to a great role model.
In addition, my uncle, who is an obstetrician and gynecologist, was an early role model. I often listened to him talk about his work and schedule during the summer. I used to spend the entire summer at my parents’ cottage in the Laurentians in Quebec, Canada. My uncle’s cottage was right next door. I liked the diversity of his daily routine. His days were busy either seeing patients in his office for initial consultation or follow-up, or performing surgeries or delivering babies.
Q: If you weren’t a physician, what would you be and why?
A: I would have become a marine biologist. I became interested in this field by watching documentaries, taking biology classes, and by scuba diving.
Q: What are your hobbies/interests outside of work?
A: I enjoy playing ice hockey, as well as watching or attending all sports events.
Q: What have you learned from your patients?
A: I have learned that making funny noises when I examine babies’ hips really distracts them and elicits a smile and lets me conduct my exam more effectively and reliably. With older kids, I have learned how challenging it is to treat great athletes, who present with joint or extremity pain often from overuse, and they can find it difficult to commit to a period of rest, which is often necessary to allow for recovery.
Q: What was the funniest thing a patient told you?
A: One of my patients keeps asking me, “Where is your gold tie?” The first time he met me I was wearing a gold tie. Every time he sees me now, he asks me about my gold tie. I keep asking him to call me the day before so that I can wear it on the day he comes but he keeps forgetting to call.
For most American families, the Fourth of July ignites thoughts of fireworks, barbecues and outdoor fun with friends and neighbors. For the Thompsons, the summer holiday sparks memories of nurses, doctors and the intensive care unit.
It was July 3. The Thompson family, Eric, Kristen and their two young daughters Kaylee and Sarah, were getting ready to celebrate Independence Day in their close-knit Los Alamitos community. Eight-year-old Sarah was feeling a little under the weather, but was just as eager as the rest of her family for the festivities to begin.
Without warning, party preparations were interrupted by a horrific scream. Kristen raced to find her youngest seizing on the floor. She called 911, and the ambulance brought Sarah to the nearest emergency department. There, Sarah’s high heart rate led doctors to believe she had an arrhythmia. They decided to transport the young patient to CHOC Children’s Hospital.
Shortly after arriving at CHOC, Sarah’s health dramatically declined. Her heart stopped. The cardiovascular intensive care unit (CVICU) team took turns performing CPR with high quality compressions on Sarah for 95 minutes, while another specialized team placed her on ECMO (extracorporeal membrane oxygenation), state-of-the-art technology that supports the heart and lungs by taking over the heart’s pumping function and the lung’s oxygen exchange.
Eric and Kristen watched as 15-20 physicians, nurses and respiratory care therapists worked on their daughter; those performing CPR would rotate after a couple of minutes at the direction of critical care specialist Dr. Francis Kim. After she was placed on ECMO, Sarah was taken to the cardiac catheterization lab, where she was diagnosed with myocarditis. Inflammation of the middle layer of the heart wall, myocarditis can affect both the heart’s muscle cells and its electrical system. It’s usually caused by a viral infection and if severe, can weaken the heart’s pumping action. Sarah’s family was in disbelief.
“Sarah seemed to have just a mild cold, and nothing that would have prevented her from enjoying our holiday plans. It was surreal seeing her in the ICU, hooked up to all of the equipment and surrounded by so many specialists,” recalls Kristen.
CHOC kept Sarah on ECMO for five days. Her family and friends waited around the clock, hoping the feisty girl they loved would come out of the traumatic ordeal okay. Hospital staff offered encouraging words, telling Sarah’s loved ones that she was clearly a fighter. And, a scan of her brain looked good, though a complete neurological evaluation couldn’t be completed until she was awake.
Kristen got the first glimmer of hope when, after her daughter’s breathing tube was removed, Sarah said, “I want to go home.” Soon, Sarah started to get bossy with her family members – a sign she was on the mend. Even better, her heart recovered and she suffered no neurological injuries.
Dr. Kim, the primary physician overseeing Sarah’s care, credits the skill and expertise of CHOC’s CVICU staff for her outcome — acknowledgement shared by the Thompson family. “We have an incredible, high-functioning team with vast experience in caring for the most critically-ill children. In Sarah’s case, it took skilled teamwork to put her on ECMO while performing CPR,” explains Dr. Kim. “There’s no room for error. We are thrilled she’s doing so well and has returned to pursuing all of her favorite activities.”
A straight A student, Sarah loves to read. Her dog and sister rank high on her list of favorites. She also takes jazz and hip hop classes, and plays soccer. And, she still looks forward to holiday celebrations with friends and family.