Lessons Learned During a Senior Year Spent Fighting Cancer


By Claire Nakaki, CHOC Children’s patient

Hello there! My name is Claire Nakaki. I am a freshman in college, but a little over a year ago, I was a soon-to-be high school senior when I was diagnosed with osteosarcoma, a type of bone cancer. I was a healthy, active volleyball player and I could not understand why this had happened to me. The initial shock was debilitating; cancer had never been something I saw in my future and certainly not my present. I began chemotherapy the month before school started, knowing that I was going to be completing my senior year of high school from a hospital bed. However, after my head and heart had cleared from the turmoil that my diagnosis had brought upon me, I realized that the upcoming year was really just a year. While cancer was something that I knew was going to affect me for the rest of my life, I refused to let it control my life. My surgeon Dr. Nassif asked me before my big surgery (which removed the tumor and replaced the bone with a prosthesis) to set some goals for the upcoming year. Two prominent goals immediately came to mind: I wanted to walk at graduation with my class, on time, without a walker, a wheelchair, or crutches, and I wanted to attend a four-year university after that. These goals did not seem far off, but I unknowingly delved into the hardest year of my life.

I found myself wanting to meet other patients my age almost immediately, begging the Child Life staff to introduce me to any other teens on the floor. I found so much comfort in knowing that there were other teenagers like me experiencing something similar. While no one’s story is identical, discussing the things we do have in common definitely helps soothe an anxious mind. I attended an AYA (Adolescent and Young Adult) support group meeting in my first few months of treatment and then the next following few months, then as often as I could. I had no idea it was even a support group until almost six months in. It felt more like a group of friends who coincidentally have this one big thing in common rather than a solemn meeting to talk about our hardships. Sure, we occasionally brought up things we were going through when someone needed support, but other than that it was just a safe space to be accepted with open arms. This AYA group has become like a second family to me, a fun group of people in all different stages of treatment and survivorship with whom I feel comfortable discussing anything and everything with. I do not know where I would be in my survivorship without this group of people, as well as the entire Child Life staff and AYA facilitators.

I am often asked if the experience was difficult and if I am sad that I missed my senior year of high school. I always have the same answer. Yes, of course it was difficult. I had no idea how difficult it would be. And I am painfully aware that my treatment went much smoother than most. I stayed on the same treatment plan and had very few bumps along the road. I am sure that my classmates enjoyed their senior year at school, but I would not trade this past year for any other situation. I truly mean that. I have learned so much from the genuinely kind and empathetic people that I met at CHOC, both patients and staff members. I reiterate time and time again that I feel so lucky to have had 17 years of life before cancer entered my life and I know that I have many more to come. I met so many younger kids during my stay at CHOC, mainly just a “hello” in the hallway, but there were a small few that I really got to know personally. These kids hold such a special place in my heart. I served as somewhat of a mentor to a few, due to my age and stage in my treatment, what kinds of procedures I had undergone, and what kinds of machines I was attached to. The kids I got to know made such a huge impact on my general attitude towards life and I truly hope that I made a positive impact on them. One piece of advice that I want everyone who goes through cancer to grasp is that no matter how bad you feel or how hard it is to meet your daily goals, your journey is always just one day at a time. It is so important to remind yourself that every day is just 24 hours. All you have to do is just get through the day. Take every step of the way just one day at a time. Soon enough, you will begin to see the light at the end of the tunnel.


As I mentioned in the beginning of the post, I am now a first-year college student, which means that yes, I did meet my goals. I finished the last step of my treatment and was released from the hospital on June 9th and walked at my graduation without a wheelchair, a walker, or crutches one week later. I was accepted to college in the middle of my treatment, and completed all of my required courses in order to attend in the fall. I achieved these goals with a year of incredibly difficult work and with the unconditional support from my family, friends, and CHOC staff. There will always be things I cannot do because of what happened to me and I still go to physical therapy twice a week and have to take extra precautions in almost everything I do, but I am so happy to be back in the real world, living my new normal.

 Learn more about the Hyundai Cancer Institute at CHOC Children’s.

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Remedies for Constipation in Children

Constipation in children is an all-too-common ailment, accounting for nearly five percent of all pediatric visits each year and one out of every four pediatric gastroenterology visits. More than 90 percent of constipated children have “functional” constipation, meaning constipation without any underlying disease.

Although symptoms may vary for each patient, common signs to look for include:

  • Infrequent bowel movements (less than three per week)
  • Stool leakage
  • Withholding behavior
  • Difficult, painful or hard bowel movements
  • Abdominal pain
  • Urine accidents
  • Blood-coated stools

The most common cause of constipation in  children is withholding due to past experience with painful passage of stools, says Dr. Ashish Chogle, pediatric gastroenterologist at CHOC Children’s. Other leading factors relate to water and food intake.

constipation in children
Dr. Ashish Chogle, pediatric gastroenterologist at CHOC

Stool leakages in the underwear are often encountered in children with long standing constipation. Most children will not feel the stools passing accidently, as feeling in the rectum decreases as a result of the stretching that takes place from being constipated for a long time.

There are several things parents can try at home to alleviate the problem of constipation, he says. First, if your child is not usually a keen water drinker, increase their water intake to normal levels. CHOC recommends one full eight ounce glass of fluids per year in age every day. Increasing their fiber intake can also help relieve mild cases of constipation in children. Good sources of fiber include whole grains, whole wheat items, beans, green leafy vegetables and fruit. The minimum amount of fiber for children is equal to your child’s age plus five grams. For example, a child who is 5 years old should eat 10 grams of fiber each day (5 years + 5 = 10 grams). If the child isn’t better after trying these methods at home, consult your pediatrician. Your pediatrician may recommend a treatment plan or refer you to a pediatric gastroenterologist.

Treatment plans may include a stool softener regimen such as laxative therapy, or lifestyle changes, depending on the severity and underlying causes of the constipation. If your child has significant stool back up in the colon, the doctor might recommend a bowel clean out with Miralax.

Parents may worry that their child will become dependent on a stool softener if given for an extended duration, and thus may stop the laxatives sooner than advised by their physician.

“By stopping a laxative therapy plan too soon, the child can bounce back to being constipated,” says Dr. Chogle. “The treatment needs to last long enough that the colon fully recovers from the stretching that has occurred due to constipation. Parents don’t need to worry about their children becoming dependent, as long as they follow their physician’s treatment plan and have an understanding that it can take months for the colon to recover and function properly.”

The length of the regimen will vary depending how long the child has been constipated. There are some patients with an inherently slow colon (those with slow transit constipation). These patients will likely require laxatives long term, says Dr. Chogle.

Older children or teens with chronic constipation issues may actually be suffering from pelvic floor dysfunction, especially if they spend a long time straining on the toilet or pass only small amounts of stools each time. This could be due to an incoordination in pelvic floor muscles, also known as anal dyssynergia. Muscles tighten instead of opening up while attempting to pass a bowel movement- similar to trying to squeeze out toothpaste from a tube with the cap half open. Your child’s doctor may order a test called an anorectal manometry to determine anal pressures and pelvic floor coordination if they do not respond to other treatment options. Physical therapy, specifically anal biofeedback therapy, may be recommended for some patients.

Learn more about constipation from the gastroenterology experts at CHOC.

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    Lice Removal Tips in Time for Back to School Season

    By Katie Bui, clinical pharmacist at CHOC Children’s

    Head lice can be a pest. But don’t panic! There are many effective ways to prevent your child from getting these critters, and treat them should your child come home with lice. There’s even ways to get rid of the “super lice” that have received media attention recently for being resistant to some existing treatments.

    Prevention is the First Defense

    First things first- prevention is key. Be vigilant in monitoring your child’s head for lice before the infestation and symptoms start, usually when there are reported incidences at your child’s school or daycare. Teach them not to share hair ties, combs, hats, scarfs, and pillows at school or during sleepovers. Surprisingly, even taking selfies might increase the risk of getting head lice, since an affected child’s hair could touch another child’s healthy hair—the new way that older children and teenagers are being affected.

    Lice Removal Tips

    When treating head lice, both the eggs (also known as nits) and adult lice must be killed. To kill eggs, use nit combs and brush your child’s head from the hair shaft (the part that sticks out from the skin) for at least three days in a row. Then to kill the adult lice, there are medicines and other measures. Lice medicine can be purchased over-the-counter at your local pharmacy.

    Pediculicides (medicines that kill lice) have active ingredients such as pyrethins and permethrin lotion/shampoo. If over-the-counter medicines fail, parents should seek advice from a doctor. In some cases, prescription medicines may help, including benzyl alcohol, Ivermectin lotion and malathion lotion. These medicines are safe and effective when used as directed by the label and by your doctor or pharmacist.

    Non-medicine measures include washing and drying clothes, bed sheets, pillow cases and other linens in hot water to kill lice and eggs. Items that cannot be washed should be sealed in a plastic bag for two weeks or be dry-cleaned. Vacuuming furniture and floors can also remove nits.

    September is National Head Lice Prevention month so be sure to share these tips- but not lice- with friends and family.

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    CHOC Experts to Share Parenting, Safety Tips at Festival of Children

    Parents and families can join the team of community education experts from CHOC Children’s at Festival of Children, to be held every weekend in September at South Coast Plaza, Costa Mesa. CHOC will host an informational booth offering health tips for families and an opportunity to meet CHOC’s beloved pet therapy dogs. Every Friday in September at 11 a.m. on the Carousel Court Stage, free Mommy & Me Classes will be offered, including coffee and tea. Hear first-hand from CHOC experts on the following topics:

    Sept. 2 – Child Passenger Safety

    Sept. 9 – Water Safety

    Sept. 16 – Home Safety  

    Sept. 23 – When to Take Your Child to the ER, offered by a registered nurse and manager of the trauma program

    Festival of Children highlights all children charities serving our community for National Child Awareness Month in September. The event at South Coast Plaza will also feature other activities and crafts for children. Learn more about the Festival of Children event.

    Learn more about upcoming events at CHOC.

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    Home Safety Tips for the Whole Family

    Kids have more freedom as they get older, which teaches them independence and nurtures their curiosity, but they can often overestimate what they’re capable of doing. Most injuries for kids up to five years old occur in or around the home, so keep in mind these home safety tips for older children, to protect kids of all ages in your home.

    “Older children tend to take more risks, so we as parents must walk a fine line between bubble-wrapping our kids and protecting them,” says Amy Frias, community educator at CHOC Children’s and Safe Kids Orange County coordinator.

    • Batteries. Keep batteries and battery-operated devices out of sight and out of reach. If your child ingests a battery, seek emergency medical attention or call the National Battery Ingestion Hotline, 202-625-3333.
    • Burns. Getting kids involved in cooking your family’s meals can be a great way to encourage healthy eating habits later in life, but should be done under careful supervision. Don’t hold a small child when using the stove, and always keep sharp and hot objects out of reach.
    • Carbon monoxide. In addition to a working smoke alarm, ensure your home has a carbon monoxide detector and check its batteries regularly.
    • Choking. Even when kids are old enough to start learning how to use utensils themselves, make sure food is cut into bite-size pieces. When purchasing a toy or game, take into account the size of its pieces. Keep small items such as magnets, makeup or batteries out of reach, as they could be confused for a toy or candy. Cords and strings from window blinds should also be kept out of reach to prevent choking. Move furniture away from windows to prevent choking on cords, or falls.
    • Falls. Install window locks that prevent openings greater than four inches, yet could still be easily removed by an adult in the event of an emergency. Children under 10 years old should not be on a top bunk of a bunk bed. Use liners underneath rugs and in the bathtub to prevent falls. Secure-top heavy furniture to the wall.
    • Fire. Make a fire escape plan. Establish a place to meet in the event of a fire in your home, and remind children that getting out safely should be their first priority.
    • Medicine. Remind children that medicine is not candy. Medication should be stored out of reach and out of sight, and in a locked location. Keep in mind that medicine is usually stored in more places than just a medicine cabinet, and can usually also be found in a purse, nightstand, etc.

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    Contact Lenses: Is Your Child Ready?

    You might think your child’s glasses are adorable, but she could very well disagree. Is your child ready for contact lenses though? In honor of Children’s Eye Health and Safety Month, we chatted with Dr. Sidney Weiss, a CHOC Children’s ophthalmologist, about how parents can find out.

     With the advent of low-maintenance contact lenses that are replaced daily, children as young as 8 might be able to wear lenses, Dr. Weiss says. Children ages 12 and older are better equipped to wear and maintain contact lenses designed to last for two weeks or a month, though he still recommends one-day lenses for children this age.

    contact lenses
    Dr. Sidney Weiss

    But age isn’t the first criteria for knowing a child is ready for contacts. Most importantly, the child needs to show enthusiasm for wearing them, Dr. Weiss says.  Along with that, children must understand that contact lenses require responsibility and rigorous hygiene.

    “Children must have the cognitive ability to understand that wearing contact lenses imposes a serious responsibility to protect the health of the eye,” Dr. Weiss says.

    Hygiene is Key

    Parents must be able to judge a child’s ability to maintain good personal hygiene, which is key to ensuring safe contact use. Users must be vigilant about washing hands before inserting, removing or simply adjusting contact lenses.

    Poor hygiene and improper lens handling pose several risks to users, Dr. Weiss says.

    “Corneal infections are the prominent threat to children wearing contact lenses,” he says. “Even with proper hygiene and technique, infections can and do occur. Far less common are fungal and even more exotic sources of infections.”

    A scratch on the cornea can result during insertion or removal; if a foreign object gets between the lens and the cornea; or if a child too vigorously rubs his or her eye, Dr. Weiss says.

    “The most common signs of trouble are the presence of a red eye or the observation of a white spot on the affected cornea,” he says. “Symptoms of pain, light sensitivity, and decreased vision are common. These should alert the child and family to seek professional help.”

    Proper Materials

    In addition to frequent hand washing, contact lens wearers must use proper materials to clean and store the lenses. Never use water or saliva to clean a lens. If the child uses eye drops, only use clear drops rather than any product that appears milky. Swimming in contact lenses is discouraged, but if undertaken, lenses should be removed and thrown out afterward. Don’t share lenses with others and don’t sleep in lenses.

    In addition to good hygiene, children must have basic small motor skills to wear contacts. Though Dr. Weiss says parents can assist children in inserting the lenses, the child must be able to remove them in case of an emergency.

    Parents should supervise insertion and removal for at least several months after a child begins to wear contacts. Following hand washing, a basic insertion technique requires the child to look up, pull the lower eye lid down and forward, and place the lens onto the eye with the other hand. Removal also begins with hand washing, and essentially requires a pinching motion to pluck the lens from the eye.

    Astigmatism’s Effect

    Even with enthusiasm and good hygiene and motor skills, some children may still not be ready for contacts, especially if they have astigmatism. Astigmatism is a defect in the curve of the eye that creates a football-like shape and can be harder to fit for contacts.

    “The common spherical contact lenses available do not correct astigmatism,” Dr. Weiss says. “This circumstance may lead to disappointing vision in these children as opposed to their vision when wearing glasses, and consequent failure. Astigmatism-correcting contact lenses are more expensive and hard to fit well, and are best fit on older children and adults.”

    Astigmatism or not, proper fit is crucial for contacts. That’s why all appointments with ophthalmologists or optometrists must be kept and repeated on a timely basis, and children should not procure lenses from non-professionals, Dr. Weiss says.

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    CHOC Children’s Expands Plastic Surgery Services

    A pediatric plastic surgeon specializing in reconstructive plastic surgery has joined CHOC Children’s. Dr. Raj Vyas sees patients with a variety of complex conditions including clefts and craniofacial anomalies.

    plastic surgery
    Dr. Raj Vyas

    “Care at CHOC is delivered in such a multidisciplinary fashion, allowing for complex higher-level discussions and nuanced treatment planning in both standard and exceptional circumstances. There is also an emphasis on safety and process improvement, both critical for a state-of-the-art facility serving a complex and diverse patient population,”Dr. Vyas says.

    During his third year of medical school at UCLA David Geffen School of Medicine, the  Southern California native discovered that plastic surgery was his newfound passion.

    “I unexpectedly fell in love with plastic surgery, particularly craniofacial surgery,” Dr. Vyas explains.  “My appreciation for the depth and breath of plastic surgery grew from my experiences during this rotation in medical school. I remember seeing a child with hypertelorism undergo a facial bipartition and I was fascinated.”

    Following medical school, he completed a plastic surgery residency in Boston at the Harvard Combined Plastic Surgery Residency Program. He then completed a craniofacial surgery fellowship at New York University Medical Center, where he treated children and adults undergoing facial reconstruction for congenital anomalies or after suffering trauma and cancer. He also gained expertise in microvascular surgery and virtual surgical planning.

    Dr. Vyas is working with the team at CHOC to build a multidisciplinary program in facial reanimation. By combining craniofacial surgery with microsurgery, he hopes to restore facial form and function in children and teens with facial paralysis.

    “We have a great team at CHOC. Dr. Daniel Jaffurs has been an incredible mentor,” Dr. Vyas says. “My goal is to help make the program the best in Southern California and beyond.”

    Dr. Vyas enjoys working with virtual scanning and 3D modeling technology available at CHOC, as it helps him plan and ensure optimal safety and precision before a procedure.

    “Today, we are able to use cone beam CTs to significantly minimize radiation exposure while still obtaining high quality 3D imaging. This allows for virtual surgical planning that is both precise and extremely effective in reducing uncertainty in the OR,” Dr. Vyas explains. “In neonates with upper airway obstruction, for instance, who are scheduled to undergo mandibular distraction, we are able to customize bony osteotomies in a way that prevents injury to dental structures and nerves, while optimizing distraction vectors that improve the airway and maintain cosmetic considerations. We can also virtually anticipate the extent of facial movements and design custom splints that facilitate orthognathic (upper and lower jaw) surgery. The benefit of these types of pre-planned procedures are expanding as surgeons utilize this technology in a variety of craniofacial reconstructions.”

    When this dedicated physician is not busy helping patients at the hospital, he volunteers with Global Smile Foundation, a nonprofit organization that treats children with facial congenital deformities in underserved countries. Most recently he went to Trujillo, Peru, where he helped over 100 patients.

    “It’s so rewarding to work with children,” he says. “Their reconstructions have a long-life impact.”

    Dr.Vyas is board certified in plastic surgery and a member of the American Society of Plastic Surgeons, American Society of Craniofacial Surgery, American Cleft Palate-Craniofacial Association and International Cleft Lip and Palate Foundation, among other professional organizations.

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    Is Your Teen Sweating Too Much?

    Sweating is a natural part of puberty, a time when sweat glands become more active and the body produces more hormones. It’s also how the body cools off in response to heat, exercise or emotional distress. Given the fact that sweating is something everyone experiences, perhaps even more so during adolescence, how would you know if your teen is having problems with it?

    Teens experiencing excessive and/or unpredictable sweating may suffer from a condition called hyperhidrosis. While fairly common, the condition can be embarrassing and impact everyday activities, from holding a pen to turning a doorknob. Emotional problems, including social isolation and decreased confidence, can occur. And some teens may face painful and irritating skin problems as a result of excess sweat. These symptoms warrant a trip to the pediatrician, who can provide more information and treatment options.

    The cause of hyperhidrosis is not known, although some experts believe it may be tied to overactive sweat glands or genetics. Diagnosing the condition involves a physical exam, including a starch iodine test. Iodine is applied to the sweaty areas (armpits, hands or feet), followed by the application of starch. The combination turns blue in response to excess sweat. A paper test may also be performed. Special paper is placed on the affected area(s) and subsequently weighed to calculate the rate of sweat production. Blood tests may be done to rule out underlying medical conditions, based on the symptoms.

    There are various treatment options for hyperhidrosis:

    • Prescription strength antiperspirant creams are often the first line of treatment because they are the least invasive. When applied to the affected areas, the antiperspirant is dissolved by sweat and pulled into the pores, forming “plugs” that can stay in place for at least 24 hours.
    • Iontopheresis is a treatment that involves using a medical device to pass a mild electrical current through water (shallow pans large enough for hands or feet) and through the skin’s surface. There’s been no significant or serious side effects reported, but patients must adhere to a maintenance schedule.
    • Botox has been approved by the FDA for use in treating underarm sweating. The botox is injected into the armpit, just below the surface of the skin, to temporarily block the secretion of the chemical responsible for activating the sweat glands.
    • When no other treatments work, surgery to cut the nerve that signals excess sweating or remove the sweat glands may be considered.

    In addition to treating the physical symptoms associated with hyperhidrosis, it’s important to address the emotional impact the condition may have on your teen. Be sure to ask your child’s medical doctor about available mental health resources in your community, including possible support groups.

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    Children and Tics: What Parents Should Know

    People of all ages can experience repeated involuntary movements called tics, but they are most prevalent in children. Nearly one quarter of all children experience this genetic disorder that becomes most visible in school-aged children.

    Common motor and vocal tics include:

    • Blinking
    • Shoulder shrugs
    • Neck twitches
    • Throat clearing or sniffling
    • Coprolalia, involuntary and repetitively utters obscene words

    All tics tend to wax and wane in severity and frequency. The tics themselves can also change over time, says Dr. Mary Zupanc, chair of neurology and the director of CHOC Children’s pediatric comprehensive epilepsy program. This means that a child with simple childhood tic disorder can have repetitive eye blinking during one point in time, and during another phase, can have irregular but repetitive shoulder shrugging, and later, intermittent head twitching.

    children tics
    Dr. Mary Zupanc

    Childhood tic disorders are very common in young children. It is a “spectrum disorder,”  with some children having only intermittent, isolated tics, and having multiple motor and vocal tics. If these tics last greater than one year, the diagnosis is Tourette’s syndrome, which is simply a more severe form of childhood tic disorder.

    Preserving Self Esteem

    “Tics alone will not hurt a child, but we certainly want to preserve a child’s self-esteem, and not allow them to be embarrassed by their tics. Vocals tics can be especially problematic in the school setting,” says Dr. Zupanc. “Often times, the biggest treatment of tics is reassurance to the child and family, in addition to providing education on when it is appropriate to suppress a tic or not. Family and child counseling are often important, so that the child maintains his or her self-confidence.”

    Treatment Options

    Medication may be recommended in some severe cases. Pediatric psychologists who have training in behavioral modification can help children learn to suppress a specific tic.

    Tics often disappear around the time of adolescence in many cases of childhood tic disorders and Tourette’s syndrome, although there may be concurrent co-occurring health challenges that are more problematic, Dr. Zupanc says. Learning disabilities, attention deficit hyperactivity disorder, obsessive compulsive disorder, and oppositional defiant disorder frequently appear in tandem with either childhood tic disorder or Tourette’s syndrome.  These co-morbidities may require medications for effective treatment.

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    Tips for Minimizing Scarring After Surgery

    A child’s skin is much different than an adult’s skin, and has the potential to react to scarring much different than the way their parents’ might. In this episode of CHOC Radio, Dr. David Gibbs, a pediatric surgeon and the director of trauma services at CHOC, discusses tips for minimizing scarring after surgery, including:

    • Which children are more predisposed to scarring
    • What pediatric surgeons at CHOC do during surgery to help minimize scarring
    • What parents can do in the year after surgery to help mitigate scarring
    • Other advice for parents whose child is preparing for surgery

    CHOC Radio theme music by Pat Jacobs.

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