7 Things You Didn’t Know about Pediatric Anesthesia

By Dr. Eric Ontiveros,  chair of pediatric anesthesiology at CHOC Children’s

Finding out that your child needs surgery can be scary for parents to hear. You want to know that your child is in the best hands possible, and the nationally ranked surgeons and pediatric anesthesiologists at CHOC Children’s specialize in the care of kids. Your child’s pediatric anesthesiologist is not only an important member of your child’s surgery team but also the entire perioperative experience (before, during, and after surgery).

7 things you may not know about pediatric anesthesia:

  1. Before surgery, the preoperative area is the location where you will meet your child’s full surgical team. During this time, questions about your child’s medical and surgical history will be asked and the perioperative plan is adjusted to fit your child’s medical needs.
  2. It is normal for children to feel anxious before surgery. Premedication for anxiety may be administered, either orally or intravenously prior to surgery. This may require the help of a parent. The goal of premedication is to reduce the anxiety and facilitate a smoother transition to general anesthesia. Evidence shows that easing a child’s anxiety prior to heading into surgery may limit the emotional disturbances felt during recovery after surgery. Child life specialists are also available, and may use distraction, video or music therapy to calm an anxious patient.
  3. Anesthesiologists will use a multimodal approach to pain management when appropriate. In addition to pain management during surgery and in the recovery room, a particular child and surgery may qualify for a regional anesthesia procedure or “pain block” that will help control postoperative pain during the days following surgery.
  4. For younger children who meet specified criteria, an inhalational technique may be used to initiate general anesthesia. This technique administers anesthesia through a mask (with a flavor of your child’s choosing) and avoids the placement of an IV until after your child is asleep. For older children, an IV may be placed in the preoperative area after receiving anti-anxiety medicine in oral form.  This allows general anesthesia to be administered in IV form.
  5. You know you’re not supposed to eat or drink anything before surgery. But do you know why? When general anesthesia is administered, your muscles relax, including the muscles in your stomach and esophagus. The body’s reflex to swallow is also briefly suspended during anesthesia. This combination makes the lungs vulnerable to aspiration of food, which can be very dangerous. Abstaining from food for 8 hours prior to surgery is very important for the safety of anesthesia for your children.
  6. Common side effects of general anesthesia include nausea, vomiting, itchiness and something called emergence delirium. Emergence delirium lasts 5-15 minutes and happens during the process of waking up. It usually goes away on its own but can be very concerning for parents because your child may not recognize or respond to you. If your child experiences any of these symptoms after a procedure, their care team will be available to provide appropriate medication to treat those side effects.
  7. Difficulty sleeping may occur for a few nights after a surgical procedure. Night terrors are a common occurrence in children ages 3-6 who have had ear, nose and throat procedures. This difficulty sleeping is often troubling for parents but will typically resolve after a few days and requires no additional treatment. Maintaining a consistent bedtime routine as well as eliminating sources that may interfere with sleep (caffeine, sugar, high energy activities and electronics before bedtime) may help in dealing with these disturbances.

The more information you have, the calmer you and your child will be prior to surgery. Parents are encouraged to ask as many questions as possible when you meet their child’s anesthesiologist, before or after surgery.

In the video below, a pediatric general and thoracic surgeon answers parents’ most common questions about surgery and anesthesia:

Video: Get answers about anesthesia

 

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Family Medicine Cabinet Essentials

In addition to a first-aid kit, a well-stocked family medicine cabinet can help families contend with a variety of ailments that children of all ages – and adults alike – might experience.

Here, Dr. Jonathan Auth, a CHOC Children’s pediatrician, lists the essential elements of a family’s medicine cabinet.

Family Medicine Cabinet Essentials
Dr. Jonathan Auth, a CHOC Children’s pediatrician, offers tips on family medicine cabinet essentials.

Oral medications

Acetaminophen – Frequently known as Tylenol, this common over-the-counter medication is a first-line defense against fever and pain. He recommends that families stock children’s acetaminophen rather than anything labeled as for infants. Though they used to differ in concentration, formulas are now the same, and children’s versions are typically less expensive than those marketed to infants, Dr. Auth says. Download a parent’s guide to acetaminophen for children to ensure you’re giving your child the right dose.

Ibuprofen – Known in stores as Motrin or Advil, this medication also combats fever and pain. It can also help soothe swelling and other complaints associated with an injury, thanks to its anti-inflammatory properties. Ibuprofen’s effects also last longer than acetaminophen, though it can irritate some children’s stomachs, especially if taken on an empty stomach. Dr. Auth does not recommend it for children younger than 6 months old.

Diphenhydramine – Commonly known as Benadryl, this medication can have multiple purposes, Dr. Auth says. It can help children with mild allergic reactions, as well as those who have seasonal allergies and some cold symptoms. Dr. Auth cautions that it frequently has sedative side effects, and should not be given to children younger than 2 without first consulting a pediatrician.

Calcium carbonate – Known as Tums, these chews can help soothe upset stomachs. Dr. Auth recommends consulting your pediatrician before using them in children younger than 6, however.

Dimenhydrinate – Commonly sold in stores as Dramamine, this medication is good to have on hand for travel with children who are prone to motion sickness.

Topical treatments

Multipurpose antibiotic ointments – Commonly known under the brand names Neosporin or Bacitracin, these topical medications help reduce the risk of possible infections from scrapes and mild skin abrasions, Dr. Auth says.

Hydrocortisone, 1 percent – This low-potency topical steroid cream can help soothe itchy rashes or irritated skin.

Antifungal cream, 1 percent – Commonly known under the brand name Lotrimin, this cream is good for treating yeast diaper rashes, ringworm, and athlete’s foot, Dr. Auth says.

Sunblock – Dr. Auth recommends families keep plenty of sunblock on hand: Barrier forms, which contain compounds like zinc oxide or titanium dioxide and block out the sun are safe at any age. UV A and UV B light absorbers containing PABAs can be used in children after age 6 months old. Dr. Auth also recommends families choose SPFs around 40 or 50. Anything marked higher than that shows minimal additional benefit.

Diaper cream – For families with newborns and young infants, having a diaper cream on hand is valuable, says Dr. Auth, who also recommends choosing a cream containing zinc oxide.

Petroleum-based ointments – These treatments can be helpful as a barrier, Dr. Auth says. For example, they can protect a cut against infection or can lock in moisture on chapped lips or dry hands.

Miscellaneous

Nasal saline solution – Dr. Auth recommends these products to help relieve infants’ stuffy noses or older children’s congestion.

Thermometer – Dr. Auth generally suggests families have a very basic and inexpensive digital thermometer that can be used orally for toddlers and children and rectally for infants.

Nail clippers and files – These are a necessity to keep children’s fingers groomed. When it comes to trimming infants’ nails however, files are safer and less intimidating for new parents, Dr. Auth says.

Bulb suction devices – These products are helpful in removing mucus from newborns, as well as in children who can’t yet blow their noses.

Humidifier – This can be helpful for children suffering colds, Dr. Auth says. However, he cautions families to properly maintain humidifiers to prevent mold production or limescale build-up, which can worsen problems. Also, whether to use a warm or cold mist is generally a matter of preference, Dr. Auth says.

A word of caution

Safely store medications so that they are inaccessible to children.

With any medication, parents should pay special attention and adhere strictly to dosing instructions.

Every household should have the phone number for poison control readily available: 800-222-1222.

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Know the Dangers of Food and Drug Interactions

By Jennifer Nguyen, clinical pharmacy resident and Grace Lee, clinical pharmacist at CHOC Children’s

Most of us appreciate food for the pleasure of smell and taste, but the food you put in your body, and feed your children, affects far beyond the taste buds. Compounds packed in foods give you energy and provide nutrients to maintain your overall health. However, these compounds also have the potential of interacting with other substances such as medication.

Food and medications can interact at different parts of the body:

  • Absorption: Medications can interact with food when they mix in the stomach. Sometimes this helps the drug get absorbed into the body, but in other cases, medications are blocked from being absorbed and then may be completely ineffective.
  • Metabolism: Foods may affect the levels of proteins in the liver involved with breaking down the drug. This may cause a medication to be metabolized faster or slower than if it was taken alone and influences how long the drug affects the body.
  • Elimination: Ingesting excessive amounts of certain acidic or alkalinic (basic) foods can change the pH levels in the intestines and kidneys, which are organs involved in drug excretion. Changing these environments can speed up or slow down how quickly a drug is eliminated from the body.

Sometimes, the chemical effects of food can enhance or interfere with a medication response. For example, if your child gets a sugar rush from eating sweets while taking a stimulant medication such as Ritalin they may become excessively hyper by this interaction. On the other hand, the side effects from some antibiotics and over-the-counter pain relievers are better tolerated with food in your stomach as a buffer.

Important food and drug interactions you should be aware of for your child are listed in the chart below, organized by food:

Food & Beverages Medications Interaction Symptoms to recognize
Dairy or calcium-fortified juices Some antibiotics:

  • Ciprofloxacin
  • Doxycycline
  • Minocycline
  • Tetracycline
Calcium contained in dairy or juices may decrease antibiotic absorption in the stomach Infection not improving or taking longer to see improvement
Soybean and walnuts

  • Soybean flour can be found in various baby milk formulas
  • Soy is also found in some dietary supplements as a composition of the capsules
  • Levothyroxine
Soybean increases elimination of thyroxine through the gastrointestinal track.   Caution is indicated for patients requiring thyroid hormone therapy Decreased effect of levothyroxine, or low thyroid levels
Caffeine

  • Coffee
  • Soda
  • Teas
  • Chocolate
  • Energy Drinks
Some bronchodilators:

  • Albuterol
  • Theophylline (specifically the once daily, sustained-release formulation)

 

Some antibiotics:

  • Ciprofloxacin
Caffeine can increase side effects of excitability, nervousness, and rapid heartbeat from bronchodilators by mimicking the same effect

Ciprofloxacin slows the  metabolism of caffeine in the liver leading to increasing effects of caffeine on the body

  • Excitability
  • Nervousness
  • Rapid heart beat
  • High blood pressure
Grapefruit juice
  • Fexofenadine (over-the-counter allergy medicine)

 

  • Amlodipine
  • Levothyroxine
  • Carbamazepine
  • Statins (Atorvastatin, Lovastatin, and Simvastatin)

 

  • Amphetamines (Adderall)

 

Grapefruit juice blocks the absorption of fexofenadine in the stomach

Grapefruit juice slows the breakdown of these drugs in the liver,  leading to  longer duration of drug action and side effects

Acidic juices such as grapefruit juice lessen amphetamine absorption in the small intestine.

  • Decreased effect of antihistamine (more allergy symptoms)
  • Increased carbamazepine levels, leading to dizziness, drowsiness, headache
  • Increased amlodipine side effects increased irregular heart beat
  • Increased statin toxicity includes muscle soreness and dark cola colored urine
  • Less drug effect from Adderall
Tyramine-containing foods:

  • Aged-cheeses
  • Salami, sausages, pepperoni
  • Avocadoes, figs, dried fruits (prunes, raisins)
  • Sauerkraut
  • Soy sauce
  • Caffeine
  • Monoamine Oxidase Inhibitors (MAOIs):
    • Phenelzine
    • Tranylcypromine
    • Selegiline
    • Rasagiline
  • Linezolid
  • Isoniazid (TB medication)
Tyramine increases the release of brain chemicals that can boost your blood pressure.

MAOIs block the breakdown of brain chemicals that also have an effect on blood pressure, leading to an additive effect

Linezolid and isoniazid are also MAOIs, in addition to their other antibiotic effects

Sudden, dangerous increase in  blood pressure
Histamine-containing foods:

  • Tuna
  • Tropical fish
  • Isoniazid
Isoniazid blocks the metabolism of histamine in the body. Increased histamine in the body leads to the same effect as having an allergic reaction
  • Headache
  • Sweating
  • Fast or irregular heart beat
  • Flushing
  • Low blood pressure
Foods with high amount of vitamin K:

  • Brussel sprouts
  • Broccoli
  • Kale
  • Spinach

Cranberry juice

  • Warfarin
Foods high in vitamin K counteract the effects warfarin has on clotting, making it less effective
  • Potential for increased clotting
  • Swelling in one arm or leg (from a blood clot)
Food
  • Non-Steroidal Anti-Inflammatory Drugs (NSAIDs):
    • Ibuprofen
    • Aspirin
NSAIDs can cause side effects such as stomach upset or stomach bleeds. Taking food at the same time can help protect the stomach  Stomach upset relief

While most foods have neutral or minimal effect on drug effect, consult your child’s pediatrician or pharmacist before starting a new medication. The best way to avoid drug-food interactions is to take medication with plain water and space medications at least an hour before or after a meal. If food must be used to mask the taste of medication, consult with a pharmacist to determine what is compatible.

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The Importance of Early Sensory Experiences in Development

By Erin Karavedas, occupational therapist at CHOC Children’s

As a baby crawls around a room touching objects, playing with toys, listening to their mother or father sing songs, or putting things in their mouth, they are doing much more than simply playing. They are using their senses to learn about and explore their environment. Parents can enhance this learning by providing positive sensory experiences.

Sensory play or experiences are activities that allow your baby to interact with their surroundings and learn about their world. Through this type of exploration and play their brains grow and mature as connections are made in the brain.

When a child is born, their brain is ready to absorb information about their environment. They’re already learning long before they are walking and talking. This learning takes place through touch, hearing, sight, taste, smell and movement. They hear our voices, chew on toys, love bouncing and touch anything they can.

The more positive sensory experiences a baby has, the stronger these connections become.  By providing your child with a wide range of experiences that involve their senses, they develop strong brain pathways. Sensory play not only positively impacts your baby now, but the connections that are made help to support learning and development even into adulthood. A baby who is not given the same diverse set of opportunities and is kept in a swing all day or is kept in a very dark quiet environment can have their learning and brain development stunted by lack of exposure to sensory stimuli.

Parents can have a direct impact on the development of their baby’s brain through providing a variety of positive sensory experiences such as:

  • 0-3 months: Singing, bouncing, talking, swinging, bath time, massage, hanging a colorful mobile for the baby to look at, placing rattles in baby’s hand for exploration
  • 3-6 months: At this point you can add tummy time, play with food (purees), reading, encourage baby to touch fabrics with different textures, and shaking rattles
  • 6-9 months: Now you can start to blow bubbles, play in different positions on the floor, play with cause and effect toys and games such as play peek-a-boo
  • 9-12 months: Now is the time to add water play, crawl/walk/play on grass or sand, play on swings and slides, tasting and exploring a variety of foods, finger painting, play-dough

It is important to note that children can become over-stimulated or overwhelmed when given too much sensory input. A child might enjoy some sensory play and become very uncomfortable with another type of sensory play. If your child is having a hard time tolerating an activity, don’t avoid it altogether. The best option is to take a break and then try to gradually expose your child to that specific input. For example, some children have a hard time with messy play (this can be playing with food, finger painting, shaving cream, wet sand, etc.). Instead of forcing them to engage in messy play you can start in the bath tub, with just a small amount of shaving cream where they have the ability to wash it off; or you can just put 1 drop of paint on the paper and encourage them to touch it as opposed to pouring it all over the paper and placing their entire hand in it. Your child’s behavior will let you know how comfortable they are with an activity.

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3 Easy Ways to Sneak More Veggies in Your Kids’ Diet

By Becca Janda, registered dietitian at CHOC Children’s

Including more vegetables in our diet can have loads of health benefits. They are packed with vitamins, minerals and phytochemicals and offer more micronutrients per calorie than any other food group. The Dietary Guidelines for Americans recommends getting in 2.5 -3 cups per day. Here are a few creative ways to add more servings of veggies to your weekly routine—you may not even notice they are there!

Cauliflower Rice

Rice is a staple ingredient in American home cooking and countless other ethnic cuisines. A new product you may be seeing in the produce or frozen section of your local grocery store is cauliflower “rice.” It is created from shredding or processing cauliflower into small little “rice-size” pieces that closely resemble white rice using a food processor or even a hand cheese grater. This “rice” can be substituted in place of real rice OR in combination with real rice as a nutritious addition to many of the recipes you currently make at home. Just by swapping out 1 cup of white rice with 1 cup of cauliflower rice you increase the fiber content of your dish from 0.5g to 3g per cup. You’ll also eliminate  100 calories considering just one cup of white rice contains almost 150 calories whereas cauliflower rice has only 33! Cauliflower rice has been making headlines in cooking magazines & health food blogs alike. Just one search on Pinterest will bring up numerous recipe options including cauliflower fried rice, cauliflower pizza crust, even cauliflower hashbrowns—the list goes on. One tip to remember when you start using it in place of rice—the goal is to keep the texture slightly firm to ensure it maintains the mouth-feel of rice. To do this, make sure to add it at the end of cooking, just to warm it up and slightly soften it.

Veggie-full smoothies

Dark leafy greens are packed full of nutrients crucial to our health and wellbeing. They are high in calcium, iron, potassium, Vitamin A and other phytonutrients which act as antioxidants.[1] Many of us feel stumped on how to include them in our diets: we cook them in soups, eat them in our salads, and some of us avoid them altogether because we don’t like the taste. One delicious way to include them in one more meal of the day is to enjoy them in a smoothie! Next time you’re making yourself a smoothie with blueberries and other fruit, try throwing in a cup of spinach or other mild flavored green. Once blended, you may not even notice it’s there! You can also add shredded carrots to your tropical smoothies: just throw a handful in your blender with some frozen banana, mango, and pineapple. They are delicious and packed with fiber and beta-carotene, which helps maintain healthy skin and boost eye health.

Butternut squash “cheese” sauce

Most of us can admit to craving cheesy comfort-food staples like macaroni and cheese or cheesy baked potatoes at one point or another. Next time the craving hits you, consider using this butternut squash “cheese sauce” recipe to boost your veggie intake while indulging your craving. Butternut squash is a great source of fiber, potassium, and vitamins A & C.  Its beta-carotene content gives it the look of orange cheddar cheese which makes it a perfect vegetable to sneak into those cheese-heavy recipes. The sauce consists of cooked butternut squash pureed with onion, garlic, chicken stock, seasoning and a little bit of butter. When you’re ready to use it in your recipes, heat it up until warm enough to melt cheese into it and add a small amount of milk. Poor it over baked potatoes, steamed broccoli, or bake it into some elbow macaroni pasta. And there you have it, comfort food remodeled with some hidden veggies! See recipe below.

Recipe for butternut squash cheese sauce:

2 ½ cups butternut squash, cubed

½ yellow or white onion, chopped

2 cloves of garlic, minced

1 ½ cup chicken stock (or broth)

1 Tbls Butter or olive oil

2 Tbls all-purpose flour

½ cup milk

1 ½ – 2 cups of sharp cheddar cheese, shredded

Salt and pepper to taste

Directions:

Heat oil in pan on medium heat, add onions and cook until translucent. Add butternut squash, garlic, and chicken stock; bring to a boil and cook until squash is softened, about 15 to 20 minutes. Carefully transfer ingredients to standing blender or use an immersion blender to puree ingredients until smooth and creamy. Return to pan and reheat on low-medium. Add milk. Coat the shredded cheese with flour before stirring it into sauce small handfuls at a time until fully melted. Use more milk or chicken stock to get sauce to a desired consistency. Season to taste.

Recipe adapted from All Recipes.

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Skin Lumps: When Parents Should Worry

Noticing a skin lump on a child can be scary for parents, and it’s easy to automatically assume the worst. Fortunately, most skin lumps are benign and not a major cause for concern, according to Dr. Saeed  Awan, a pediatric general and thoracic surgeon at CHOC Children’s.

skim lumps
Dr. Saweed Awan, pediatric general and thoracic surgeon at CHOC Children’s, offers advice on skin lumps

Some children are born with skin lumps, and some lumps appear later. The majority of patients with skin lumps will not have any other symptoms, but they can include pain, bleeding, redness, loss of appetite and night sweats. Surgery is often recommended in order to remove these skin lumps, to avoid the risk of infection.

Lymph nodes are the most common lumps that parent notice and worry about. Most parents find lymph nodes in the neck area but can also notice them around the ears and at the back of the skull.

“A pea-sized, rubbery node beneath the skin is nothing to worry about,” says Dr. Awan. “Healthy lymph nodes fluctuate in size- they grow and they shrink, but bad lymph nodes keep growing and are not subtle.”

A lymph node over one centimeter in diameter needs further investigation by a medical professional, especially when associated with loss of weight or appetite, fever or night sweats.

Dermoid cysts, another common lump, typically appear at the part of the eyebrow closest to the temple, but can occur in the middle (midline) of the neck or in the upper chest area. They are rubbery and the size of a pea. These cysts generally do not pose a hazard to your child’s health, but are typically removed to prevent infection. A midline dermoid cyst on the scalp needs more investigation from a pediatric surgeon.

Another common lump is pilomatrixoma, which usually appears on the face, neck or arms, and originates in the hair follicles. It usually manifests as a solitary, asymptomatic, firm nodule.

Hemangiomas develop in the skin when there is an abnormal buildup of blood vessels. This can occur at birth or shortly after. These lumps may increase in size during the first year and then go away on their own over the next three to four years. Most of these do not require surgery unless they are blocking the airway, vision or nostril. Lymphangiomas are rare, but are characterized by swelling on the side of neck.

Thyroglossal cysts are the most common cause of midline neck masses and are generally located just below the hyoid bone, yet these neck masses can occur anywhere along the path of the thyroid gland.

Branchial cysts and sinuses are swelling on the side of the neck. They are typically removed in order to prevent infection.  There are pre-auricular sinuses or skin tags. All of these need to be removed to prevent infection

If you see a skin lump on your child, consult your primary care doctor. If the lump changes size or color, or there is pain associated with the bump, or your child also experiences weight loss or appetite loss, night sweats or a fever, urgent evaluation and further investigation is needed.

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Child Life Supports Family on Hospital Journey

Two-year-old Aliyah Islava was fighting what her family thought was a mild stomach virus. When the symptoms did not improve, mom Rosemary took her, at the recommendation of her pediatrician, to the emergency department. Within 24 hours, Aliyah was undergoing brain surgery at CHOC Children’s Hospital.

The diagnosis of stage 4 medulloblastoma, a fast-growing, aggressive brain tumor, shocked Rosemary and her husband Hector and propelled the entire family, including Aliya’s siblings Branden, 10, and Miranda, 5, on a life-changing journey. The family had the support of the entire CHOC care team, which to their surprise included the Cherese Mari Laulhere Child Life Department.

Trained professionals with degrees in child life, child development, human development or recreation therapy, CHOC’s child life specialists strive to normalize the hospital environment for patients and their families. They help make things like medical equipment and procedures feel less strange so that patients and their families feel more at ease in the hospital.

Rosemary recalls with fondness the first time she met Ashley, an oncology child life specialist, shortly after Aliyah was admitted.

“Everything was happening so fast. We were in shock and terrified. Ashley helped explain everything and calmed our fears. She also explained to our other two children what was happening, so we could focus on Aliyah,” says Rosemary.

Aliyah spent almost seven months in the hospital. Child life specialists used distraction techniques and medical play to help her every step of the way. They also helped Branden and Miranda by continuing to explain what was going on with their little sister and giving them opportunities for play.

“Child life helped normalize the entire experience for Aliyah, Branden and Miranda, and made sure they didn’t miss out on just being kids. Even more amazing, they were never afraid, not even Aliyah,” says Rosemary.

A big part of childhood is birthday parties. Aliyah was very ill in the oncology intensive care unit when she was about to turn 3. Rosemary wasn’t sure her daughter would be permitted out of the unit. But as soon as Aliyah got clearance from the doctors for a short visit to the playroom, child life organized an impromptu birthday celebration.

“I will never forget the party that child life planned. In a short amount of time, they managed to make a poster, collect presents and sing to her,” remembers Rosemary.

Following Aliyah’s last chemotherapy treatment, more than a year after her diagnosis, child life specialists sang once again; this time, “Happy Last Chemo.”  They continue to support Aliyah today as she faces additional health challenges. Most recently, a child life specialist accompanied Aliyah into the operating room. Aliyah didn’t even need medication to keep her calm. She was comforted knowing child life was by her side, says Rosemary.

“Their patience, their understanding, their compassion…these are just some of the things that make child life specialists so unique,” she explains. “They bring you hope and step in when we as parents are overcome by worry and fear. I am very thankful for having them as part of our journey.”

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Patients Say the Darndest Things

In celebration of Doctor’s Day, we asked a few of our physicians what’s the funniest thing a patient has ever told you?

doctor's day
Left: Dr. Mary Jane Piroutek. Right: Snow White, her doppelgänger.

Dr. Mary Jane Piroutek, emergency medicine specialist

Q: What’s the funniest thing a patient has ever told you?

A:  Kids say funny things all the time. One of my favorites was a little 4 year old girl that had ingested coins and they were stuck in her esophagus. When I asked her what happened she shrugged her shoulder and with a mischievous look in her eyes said, “I ate the money, I’m not supposed to eat the money.”  Also recently a patient told me I looked like Snow White (which I don’t) and she called me Dr. Snow White the whole time I took care of her.

doctor's day

Dr. Gary Goodman, medical director, pediatric intensive care unit, CHOC Children’s at Mission Hospital

Q: What’s the funniest thing a patient has ever told you?

A: Just recently, I had a patient, who has a mild developmental delay, call me “the boy.”  I would stop in the patient’s room each morning, at which point I’d get asked, “What do YOU want?”

doctor's day

Dr. Kenneth Kwon, emergency medicine specialist

Q: What’s the funniest thing a patient has ever told you?

A: An adage in pediatric emergency care is when a child comes in with a nosebleed, you don’t ask if he picks his nose, you ask him which finger he uses. When I asked this question to one of my pint-sized patients, he answered that he used all of them, and then proceeded to demonstrate by sticking each of his 10 fingers in his nose individually. It was priceless.

doctor's day

Dr. Maryam Gholizadeh, general and thoracic surgeon

Q: What’s the funniest thing a patient has ever 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!

doctor's day

Dr. Jennifer Ho, hospitalist

Q: What’s the funniest thing a patient has ever told you?

A: From a 3-year-old girl: “I want to be a doctor like you … but only for unicorns and fairies.”

doctor's day

Dr. Andrew Mower, neurologist

Q: What’s the funniest thing a patient has ever told you?

A: “I don’t eat apples, doctor.”

“Why?”

“Because they keep the doctor away, and I like you, Dr. Mower.”

doctor's day

Dr. Laura Totaro, hospitalist

Q: What’s the funniest thing a patient has ever told you?

A: I was examining the mouth of my patient when he proudly showed me his loose tooth and whispered to me that his family had a secret. He then excitedly admitted that his mom was the tooth fairy!  His mother looked at me quizzically and then burst out laughing when she realized what had taken place. Earlier she had admitted to him that she played the role of tooth fairy at home but her son took this quite literally and believed it to actually be her secret full time job for all children.

doctor's day

Dr. Mustafa Kabeer, general and thoracic surgeon

Q: What’s the funniest thing a patient has ever told you?

A: A patient asked me what my first name was, and I told him it was Mustafa. He then promptly told me that was the name of his pet lizard!

doctor's day
Dr. Taraman, pictured with his apparent doppelgängers, Linguini from “Ratatouille” and Flint Lockwood from “Cloudy with a Chance of Meatballs.”

Dr. Sharief Taraman, neurology

Q: What’s the funniest thing a patient has ever told you?

A: One of my patients told me that I look like the character Flint Lockwood from Cloudy With A Chance of Meatballs and another one thinks I look like the character Linguini from the movie Ratatouille, both of which I found very funny.  Apparently, I give off the nerdy guy vibe.

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Meet the CHOC Follies Cast: 20-year Veterans of the Show

Now in its 20th year, the CHOC Follies has become one of Orange County’s most popular fund and friend-raising events. With a cast and crew of more than 100 enthusiastic members, all singing and dancing to raise much needed funds for CHOC Children’s, this original musical production is made up of one-of-a-kind individuals all coming together to benefit CHOC. Today, meet Diane, Mia and Skipper Tim, three beloved cast members who have been part of the show from the very beginning.

Q: How did you get started as a CHOC Follies cast member?

Diane: I was one of the first people to join the inaugural CHOC Follies show. I belonged to a tap dancing group, and the CHOC Follies founder Gloria Zigner wanted me to recruit my class members. Because I’ve been in it from the beginning, I’ve been able to see how the show has changed and evolved over the years.

CHOC Follies
CHOC Follies cast member Diane

Mia: I was singing at a fundraising event for CHOC, and Gloria approached me afterwards and shared her vision of an event that would eventually become CHOC Follies. Although most cast members don’t have a background in musical theater, I did, and the rest is history.

Skipper Tim: My boss at the time received an invitation to participate in the first CHOC Follies, and I went on his behalf. I had a history in community theater, and I’ve been part of the CHOC Follies ever since!

Q: How do you balance the time commitment of rehearsals and fundraising efforts of cast members?

Diane: The directors have rehearsals down to a science and they know how many weeks it will take to learn certain aspects of the show. Different groups practice at different times and the directors are respectful of our other commitments. The cast is like a family!

Mia: Directors work around our schedule for rehearsal calls. It’s important to attend as many rehearsals as possible so that we can present a quality performance to our donors.  A plus to the time spent there is that great friendships are formed among cast members.

CHOC Follies
CHOC Follies cast member Mia, pictured center as the good witch in a past performance of The Wizard of OC.

Skipper Tim: We rehearse for up to eight weeks prior to the show, but the commitment is minimal compared to how it benefits the community. As for selling tickets, as a process server, when I’ve served papers for example, I’ve asked “Have you heard of the Follies? Want to buy tickets?” I’ll do whatever it takes!

Q: What does CHOC mean to you?

Diane: I had always known about CHOC but hadn’t known anyone that needed to be treated here. I was a guild member before a CHOC Follies cast member, and I love giving back to the hospital. Just to know that you’re giving so much back to the children is very heartwarming.

Mia: When I first got involved with CHOC Follies I took a tour of the hospital and that touched my heart. Seeing the kids and children that benefit from treatment at CHOC made me want to be part of raising money for the hospital. Ever since then, I just enjoy doing it so much that I can’t imagine not taking part. I’ve been blessed with healthy children and grandchildren so I’ve never had to experience my family being treated there. Through Follies I have come to understand the impact CHOC has on families, and it has touched my heart.

Skipper Tim: I come from a family in healthcare- my mom was a registered nurse and volunteer army nurse at end of WW1, and my dad was a gastroenterologist. I’ve been around the medical field my entire life, and to see the work being done at CHOC is just outstanding.

CHOC Follies
CHOC Follies cast member Skipper Tim

Q: What is your favorite memory from 20 years of participating in CHOC Follies?

Diane: Having the chance to perform at important venues around Orange County has been very special. It’s fun to remember way back when to the first show and how different our costumes were! The veterans in the cast also love to welcome new cast members.

Mia: The second year of the Follies my daughter Monique was able to participate. The theme was The Wizard of OC, and she was selected to play the lead, and I was the good witch. It was so fun to perform on stage with her in that particular role.

Skipper Tim: I’ve had a lot of great memories; it’s hard to pick just one. I’ve played everything from Scooby Doo to Phyllis Diller, the late actress and comedian. One time on opening night, while on stage and standing on a riser, my line was up, when suddenly my heel got caught on the riser. I almost fell into the audience! The audience thought it was funny and part of the show of course.

Q: Why should the CHOC community attend CHOC Follies?

Diane: The majority of people don’t have a background in musical theater or vocals, but by the end of the show everyone is singing and dancing with the rest of the group. We are giving back to the community by doing something that we love.

Mia: Those supporters who have attended the Follies are always quite surprised at the amount of talent and energy by those in the community who volunteer their time for such a wonderful cause to benefit the precious kids at CHOC. The CHOC Follies is really a ‘fun-raiser.’

Skipper Tim: There are a lot of talented people in the show, from dancers to singers, and they’re all great. The focus is on the kids at CHOC. We’re just the messengers.



Come celebrate 20 years of singing and dancing for OC's kids. Buy your tickets now.




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    Ashlie and her husband created CHOC Walk’s Team Hope in honor of their son Noah, a graduate of CHOC’s neonatal intensive care unit.
  • Meet the CHOC Follies Cast: Shawn
    The CHOC Follies has become one of Orange County’s most popular fund and friend-raising events. The 100 person cast and crew raise much needed funds for CHOC Children’s.
  • Jesse’s 200 Mile Run
    Jesse’s 200 mile run will raise money for CHOC Children’s. He hopes to inspire others to pursue healthy lives. Learn more about the ultramarathon runner who is inspired by the ...

How RSV Changed the Way I Parent

By Alexandria Salahshour, CHOC parent and mom of Andre, four months

This story is about my son who got sick with Respiratory Syncytial Virus (RSV) at three weeks old and was hospitalized at six weeks. I’m sharing our story so other parents are aware of the dangers of RSV and know what to look for. It’s important to always follow your own instincts no matter what. YOU know what’s best for your child. You are your child’s voice.

RSV
Andre, diagnosed with RSV at three weeks old and hospitalized at six weeks, was treated at CHOC Children’s at Mission Hospital.

What is RSV?

RSV is a highly dangerous respiratory infection. It can be a potentially deadly virus if not taken care of in time. Most children will catch RSV by their second birthday, but the younger they are, the worse it can be. RSV is primarily spread through child care centers and preschools due to being in close proximity to many children. For most children, RSV will cause nothing more than common cold-type symptoms, but for some  children like my son Andre, it can lead to more serious life-threatening problems such as bronchiolitis, pneumonia, collapsed lungs, respiratory failure, airway inflammation and even death.

The early signs of RSV

This roller coaster started when Andre was three weeks old. Before Andre was born, I made everyone in my family get the whooping cough vaccine along with the flu shot if they planned on touching Andre. Paranoid? No. Proactive? Yes. When Andre came it was so exciting! It was the best day of our lives.

Though we allowed people to hold the baby, I would always say “Don’t forget to wash your hands first.” After Andre got sick, I realized that the REAL questions I should’ve been asking were “Are you sick? Have you recently had a cold? Are your children sick? Are people at your work sick? Are children you are around sick?”

When Andre got sick with RSV, it came as a shock. How did he get so sick so fast? I had a healthy pregnancy, and Andre was born healthy. At three weeks old, he became congested and his breathing sounded off. It wasn’t wheezing, but more like a grunting sound. The morning after he started showing symptoms, we brought him to his pediatrician. I brought recorded videos of Andre’s breathing so the doctor could hear the congestion and grunting.

Our pediatrician didn’t think there was anything going on. He advised us to run the humidifier and to use saline drops. He thought Andre would be just fine, but told us to come back if he got worse, or got a fever with wheezing. Andre never ran a fever. We did the saline drops and humidifier, but it didn’t seem to be getting any better.

That night after our first pediatrician appointment while Andre was sleeping, we had noticed that would choke on his phlegm, be uncomfortable and would occasionally stop breathing. We continued to follow our pediatrician’s recommendation of using the humidifier and saline drops, but it wasn’t helping. I knew that there was something more serious going on.

A few days later, Andre started to wheeze and have breathing problems in his sleep. We rushed him to the hospital where I had delivered him. It was scary to be there because we didn’t know what was wrong with our baby. I had never heard of RSV before, but when I researched his symptoms it kept coming up. The doctor tested Andre for RSV and it came back positive. We were discharged with the same instructions his pediatrician had given, and told to come back if it got worse.

A couple of days went by, and Andre wasn’t getting any better. We took him back to the pediatrician for an after-hours appointment. He was their first RSV patient of the season. The pediatrician let us know that RSV is like a roller coaster, especially in someone so young like Andre. We were once again told to use saline drops, a humidifier and aspirations, but Andre continued to get worse.

Caring for a sick baby during the holidays

At this point the holidays were right around the corner, and my family had arrived from Dubai. This vacation meant the world to me, but unfortunately, it was short-lived. As soon as my uncle held Andre for the first time, he could tell something was seriously wrong. He felt vibration sounds through Andre’s back, almost as if whatever he had was in his lungs.

Suddenly, Andre took a turn for the worse. He was starting to sleep a lot more and just seemed so “out of it.” We decided to take Andre back to the hospital. We took him to the closest hospital to where we were at the time. I told the nurse that Andre was diagnosed with RSV about a week ago, and we were told he would get better, but that he was getting worse. I told him that his retractions were so bad you could see his ribs, and that he was congested, looked like he couldn’t breathe, and had been choking on his phlegm. The doctor said he no longer had the virus and that he may have caught a different virus that was causing this to happen. Even though his retractions and wheezing were so bad, she didn’t see it as anything alarming. They did an X-ray to be sure to make sure it wasn’t pneumonia, and thank God it wasn’t

The next day I saw that Andre’s hands were pale and extremely clammy. Even his lips looked somewhat discolored. I didn’t want anyone to think I was crazy or a hypochondriac, especially because every time we went to the doctor for this virus, we were sent home and told it would get better.

The nightmare begins

Two days before Christmas, our nightmare really began. We woke up in the morning and it was as if Andre had somehow taken another turn for his worse. He seemed so out of it, wasn’t eating well, and had zero interest in breastfeeding. Andre stayed asleep a majority of the day, and didn’t have as many wet diapers as he normally did. By the end of the day he looked beyond lethargic, and almost lifeless.

I did more research about RSV and found that a baby should have 50-60 breaths per minute. Andre was only at 40 breaths per minute. We called the after-hours number for our pediatrician, which is initially probably what saved my son’s life. They immediately connected us with the on-call doctor: Dr. Barbara Petty, a CHOC Children’s pediatrician.

I didn’t know this pediatrician at the time, but I’ve told myself that one day I’ll make an appointment with her just to thank her. She got on the phone and was so kind and soft-spoken, she seemed so concerned and you could tell that she probably has the most incredible bed side manner. She was giving us the most information we have heard thus far. Luckily, while on the phone with Dr. Petty, she was able to listen to Andre, heard the way he sounded and listened to how much he was struggling.

She told us that we needed to get to the hospital right away. We let the doctor know that we’ve already gone to two different hospitals, and she told us that we should take him to CHOC Children’s at Mission Hospital. When we got off the phone with her we couldn’t thank her enough. That phone call will forever mean the world to me.

I remember it was raining that night. We quickly rushed out of the house and went to CHOC at Mission. It was a busy night in the emergency department and there were doctors and nurses everywhere. Our nurse checked Andre’s oxygen levels and found it was only at 70. A healthy, full-term baby’s level should be closer to 100!

RSV

The doctor came in looked at Andre and just kept saying everything was going to be alright and that they were going to take care of him. He told us that it was good we brought him in because his oxygen was so low. They gave Andre an IV, hooked him up to a heart monitor, and gave him oxygen. It was incredible how quickly a team can work to get a baby stable.

A diagnosis at last

He tested positive for RSV again, but he was also diagnosed with bronchiolitis, rhinovirus and respiratory failure. Finally, Andre was in a relaxing state hooked up to the monitors, oxygen, IV fluids and tons of steroids. When the doctor came in and let us know what was going on, he said that because Andre was so young he needed help breathing to fight off this virus. The doctor admitted Andre into the pediatric intensive care unit (PICU) so that they could keep a close  watch on him. When we got into our room, three nurses immediately came in to help care for our baby boy.

Celebrating Christmas at CHOC

The next day was Christmas Eve, our first Christmas as a family, and we were still in the hospital. It was sad being in the PICU and seeing our son struggle in the state that he was in, but we knew Andre was in the BEST place he could be and getting the best care.

Thankfully, Christmas Eve was special at CHOC. A dog named Piper from their pet therapy program visited all the children. We woke up in the PICU on Christmas morning and there was a big bag full of presents for Andre. The tag read “To: Andre, From: Santa.” It was the kindest thing I’ve ever seen.

RSV
Even though Andre and his parents spent his first Christmas at CHOC due to RSV, Santa still managed to find him.
RSV
Andre’s presents from Santa were delivered to his room in the pediatric intensive care unit despite his hospital stay due to RSV.

Though we were in the PICU, CHOC did an incredible job at making a not-so-normal Christmas feel normal. We were so thankful for CHOC and all of the wonderful donated presents from incredible people. Andre got so many toys for Christmas! Because of these kind people, this became a Christmas we will never forget and forever be SO thankful for. It still brings tears to my eyes every time I think about our experience at CHOC Children’s.

When the nurses came in on Christmas, they told us that Andre was doing better and we could start the process of slowly weaning him off the oxygen. His oxygen level was stable, his heart was stable and his retractions were better. It was so nice to see improvements on our little guy!

The next day he tolerated more weaning, and we got to leave the PICU for a room in the regular pediatrics unit. GREAT NEWS! He continued to improve as the days went by. A new doctor came in to give us a run down on what was going on and gave us so much helpful information.

He explained that this virus usually comes from day cares, preschools, and school-aged children and then it’s quickly passed on to others. He let us know that this virus is a roller coaster; it gets bad and then gets better, it gets bad and then it gets better. There’s really no way of telling you when the virus will expel from the baby’s body, especially when they are so young. The doctor told us because he’s so young, the virus can last in his system up to a month!

Bring our boy home

Andre was still doing great and had life back in him. He even smiled for the first time! It was so special and it was the sweetest smile I’ve ever seen. I’ll never forget it. His care team was continuing to wean him off oxygen.

RSV
While he was hospitalized for RSV, Andre smiled for his parents for the very first time.

As they got closer to letting him breathe on his own, I was so nervous  since that would decide if we got to go home or not. The night went by and our little champion did amazing! I was scared to bring him home but the nurses and doctors knew best, and I knew I had to learn to trust their decision since they’re professionals Before we were discharged, the nurses came in and asked us if we had any questions. They let us know that if Andre started to decline, to come back right away. The hospital was great. They had an incredible staff and we were treated so well! When we left, they gave us a few extra pacifiers, a bunch of swaddles, a nice blanket with bears on it, and a pack of diapers. It was nice to have stuff to go home with in case we were out of anything.

Thankful for CHOC

I can never thank the staff at CHOC at Mission enough for taking care of Andre the way that they did. They made us feel like we were at home, even though we weren’t. Everyone was so comforting and understanding. If we ever have another emergency, which hopefully we will not, we’ll be returning to this hospital.

I hope that no one else’s child has to go through what our baby went through. But just in case, parents should know the symptoms of RSV, be prepared and trust your instincts.

RSV
Today, Andre is a happy and healthy three-month-old baby, after his bout with RSV.




Learn more about the CHOC RSV Program




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