CHOC Patient Inspired to Become CHOC Doc

Vanessa Avina, with her father and Dr. Chang.
Vanessa Avina, center, with her father and Dr. Chang.

At 6 years old, Vanessa Avina was more interested in viewing the monitor for her echocardiography (heart ultrasound) than watching a cartoon during her doctor’s visits. Her CHOC pediatric cardiologist Dr. Anthony Chang recognized her curiosity and through the years nurtured her interest in the field of medicine. When Vanessa was 17, Dr. Chang encouraged her to participate in the hospital’s Sharon Disney Lund Medical Intelligence and Innovations Institute’s (MI3) internship program. Vanessa jumped at the chance and is now—two years later—majoring in pre-med biology at California State University, San Bernardino.

The MI3 internship program is designed to offer the brightest high school and college students in Southern California with meaningful experiences in medicine. Interns have the opportunity to shadow CHOC physicians as they conduct rounds in the hospital and see patients in the clinics. They research and present exciting topics related to the future of pediatric medicine, and attend special field trips, including this year meeting Dr. Eric Topol. A practicing cardiologist, professor of genomics and director of the Scripps Translational Science Institute in La Jolla, Dr. Topol is one of the top 10 most-cited researchers in medicine. His special interest is digital innovative technologies designed to reshape the future of medicine.

Vanessa particularly enjoyed meeting Dr. Topol and learning how he focuses on the most important development in health care today – putting the patients at the center of everything clinicians do. She’s quick to point out that her mentor, Dr. Chang, and the other CHOC physicians she has met share that viewpoint.

“It’s clear that CHOC physicians put patients and families first, and partner with them to advance treatment and care.   I experienced that as a patient and I have witnessed that time and again throughout my internship,” said Vanessa.

While Vanessa isn’t quite sure what field of medicine she wants to pursue, her experience with CHOC has solidified her interest in pediatrics. “I’ve learned so much from so many CHOC subspecialists.  They’ve truly sparked my interest in so many different specialties, from infectious diseases to oncology. They’ve especially inspired me to continue to realize my dream of practicing pediatric medicine, bringing hope to children and their families,” explained Vanessa.

A college sophomore, Vanessa knows she has a long road ahead of her, including medical school, residency and fellowship. But the 19-year-old, who will be the first in her family to graduate from college, is determined to become the kind of physician her mentor, Dr. Chang, would want her to be.

“Dr. Chang is an incredible doctor. He’s so smart and innovative. He also has an amazing bedside manner. He has been such an inspiration to me, motivating me to continue on with my dream of working at CHOC,” said Vanessa.

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Dominique’s story

With a dream of becoming a pediatrician one day, Dominique Keane-Cawrse’s professional inspiration is close to her heart.

The CHOC Children’s patient has a heart condition called tetralogy of fallot, a birth defect that includes four anomalies in the heart and requires lifelong treatment.

“I’ve wanted to be a doctor for as long as I can remember,” says Dominique, 15. “I’m sure it’s because of my condition.”

Dominique recently underwent a valve replacement at CHOC to widen a narrow pulmonary valve, a hallmark of tetralogy of fallot.

A narrow pulmonary valve is the first of the anomalies present in a patient with this condition. The valve cannot fully open, which causes the heart to work harder to pump blood. This is called pulmonary stenosis.

Second, an enlarged aortic valve is located between the left and right ventricle, rather than being attached to the left ventricle in a normal heart.

Thirdly, the patient’s right ventricle muscle is thicker than normal, a product of the heart working harder to pump blood through the narrowed pulmonary valve.

And finally, patients with tetralogy of fallot have a hole in the septum separating the two sides of the heart. This defect is called a ventricular septal defect.

All together, these four anomalies cause inadequate amounts of blood reach the lungs for oxygen and then oxygen-deficient blood circulates throughout the body.

Already, Dominique had her first heart surgery when she was just four months old, says her mother, Donna.

Because tetralogy of fallot is a lifelong condition, patients typically have procedures periodically throughout their lifetime, hence the recent second surgery at CHOC.

“She’s grown four inches in the last year,” Donna says. “Her heart couldn’t keep up and it was time for a new valve.”

As she ages, Dominique can expect future procedures, but that’s not stopping her from pursuing her dreams.

An incoming sophomore, Dominque is enrolled in a rigorous medical magnet program at JSerra High School in San Juan Capistrano that gears students for careers in medicine.

“It’s a competitive program for top students,” says Donna, adding that her daughter has a 4.4 grade point average.

But while maintaining her grades, Dominique still finds time to participate in sports. She enjoys ice skating and is an avid golfer who made her school’s varsity team as a freshman.

Dominique is also already giving back to CHOC: Recently, she lent her artistic talents to a fundraiser at Downtown Disney that benefited the hospital.

Learn more about CHOC Children’s Heart Institute

Read more stories about CHOC patients:

  • CHOC Patient Inspired to Become CHOC Doc
    At 6 years old, Vanessa Avina was more interested in viewing the monitor for her echocardiography (heart ultrasound) than watching a cartoon during her doctor’s visits. Her CHOC pediatric cardiologist ...
  • CHOC Walk in the Park: Justin’s Helpers
    As it celebrates its 25th anniversary, CHOC “Walk in the Park” has raised more than $24 million to fund education, research and adoption and utilization of the latest technologies to ...
  • A Bright Future: Ian and Micah’s Story
    Even though I’ve been hanging around CHOC for a long time now, I am continually surprised by the courage, tenacity and strength of the patients I meet. It’s especially gratifying ...

The Importance of Heart Screenings for Athletes

Parents of young athletes should talk to their pediatrician about getting pre-participation sports physicals that include heart  screenings.

After all, sudden cardiac death is 2 ½ times more likely to occur in young athletes than in non-athletes. Hypertrophic cardiomyopathy, the most common cause of sudden cardiac death in young athletes, occurs in one of every 500 people.

Young athletes are encouraged to have a physical that includes a general exam, a complete health history and family history, a 12-lead EKG screening and, for athletes with an abnormal EKG or family history, an echocardiogram. An exercise test may also be recommended.

To address the growing rate of sudden cardiac arrest in young athletes, CHOC Children’s Sports Medicine collaborates with the CHOC Children’s Heart Institute to offer the Life-Threatening Events Associated with Pediatric Sports (LEAPS) program. CHOC cardiologists work one-on-one with area schools on several fronts:

• Educate coaches and staff about heart conditions.
• Offer electrocardiogram (EKG) screenings to identify athletes at risk.
• Encourage CPR training and the installation of automatic external defibrillators (AEDs) near gyms, fields and other sports facilities.

CHOC also hosts a regular conference for Orange County school board members, high school coaches, school nurses, community pediatricians and parents who want to lower the incidence of sudden cardiac death in local teenage athletes.

To learn more, contact the CHOC Children’s Heart Institute at 714-532-7576.

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Thank You CHOC Doctors!

The nation will formally recognizesinger physicians on Doctors’ Day later this month – March 30, to be exact – but not a day has gone by in the last 50 years that I don’t think about all the wonderful doctors at CHOC Children’s who patched me up after falling from that tree.

And even all these years later, I still see one of the doctors I met during my 1964 hospital stay: Dr. Melville Singer, who is still on staff at CHOC.

Dr. Singer, 87, remembers the hospital’s opening on Oct. 5, 1964 well. A pediatrician who had been practicing in Orange County for about 10 years prior, Dr. Singer served on a committee that helped guide the hospital’s planning.

“The opening was something I was looking forward to for a long time – the need was there,” he says.

New hospital, new specialty

Dr. Singer was one of three cardiologists on staff during CHOC’s opening, a time when pediatric cardiology was still in its infancy. But changes came quickly, and they haven’t stopped since.

In the few years after the hospital’s opening, CHOC established a cardiac catheterization lab, where new techniques were introduced. Imaging processes were enhanced so that Dr. Singer no longer needed to drive to Los Angeles to get film developed. And the entire hospital continued to grow.

“It didn’t take long until we needed to expand,” he says, recalling CHOC’s original construction, which was attached to St. Joseph Hospital.

CHOC’s growth steady

Indeed, in his 50 years on staff at CHOC, Dr. Singer has watched the hospital make great physical changes, but he says the growth was well-planned, prudent and needs-based.

“As things grew and things developed, the course that the hospital leaders took to encourage future growth was appropriate and not out of bounds,” Dr. Singer says.

But no matter CHOC’s physical stature, the hospital’s significance to the community has always remained constant.

“We put all of our faith in CHOC and its system to manage the complicated patients,” he recalls. “Whenever there were patients who needed hospitalization, they were brought to CHOC. It didn’t take long to establish CHOC.”

New Orange County roots

Born and raised in the Midwest, Dr. Singer settled in Orange County after finishing his fellowship and residency at Children’s Hospital in Cincinnati. He loved the weather and the work, and stayed put.

“What’s not to like?” Dr. Singer asks.

He and his wife, Beverly, who is active in the CHOC-fundraising Lamp Lighter Guild, have four children. Three of the Singer children are in fields related to medicine, including one son who is a family physician, Dr. Singer says.

Today, Dr. Singer is a physician emeritus. He no longer treats children, but instead teaches electrocardiography and other skills to residents at CHOC. He is still involved in an adult congenital heart clinic at CHOC, where he frequently sees former patients who thank him for his help.

He can count me among them. On behalf of all CHOC patients, past and present, I thank Dr. Singer and all physicians on staff.

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Kids and Healthy Hearts



kidsandheartsRISK FACTORS
Children who don’t have heart problems as kids may develop them as adults, due to risk factors like obesity and hereditary factors, says Dr. Linda E. Muhonen, a pediatric cardiologist at CHOC Children’s. Risk factors that contribute to coronary artery disease and other cardiovascular diseases include smoking, poor diet that can lead to  dyslipidemias, high blood pressure and a lack of exercise. These often take root at an early age. “An obese child has an 80 percent chance of being an obese adult, and obesity can contribute to the onset of multiple illnesses including diabetes and hypertension,” says Dr. Muhonen.

“Parents should avoid bringing unhealthy foods into the home, such as soda or sugar-sweetened drinks,” says Dr. Muhonen. “The only drinks most kids should have are water and fat-free milk. Kids should eat three meals a day with snacks of fruits and vegetables in between. Many children skip meals, creating an environment of overeating at  the next meal; skipping meals can lead to lowering your metabolic rate. We encourage children to bring their lunch to school so they can pack something healthy like a turkey sandwich on whole wheat bread, a piece of fruit and some pretzels or string cheese.”

“I like to see families have some healthy family time before dinner, like going for a family walk or going to the park before they sit down to eat,” says Dr. Muhonen. “This gets the kids to move. One of the rules in our Lipid Clinic, where we help kids at risk for developing heart disease, is that children cannot watch TV or have screen time until they have been outside for an hour doing a physical activity. The American Heart Association recommends that children have an hour a day of moderate to vigorous physical activity. It doesn’t have to be all at one time,” she says.

Children are considered overweight if their Body Mass Index (BMI) falls in the 85-94th percentile. They are considered obese if their BMI falls in the 95th percentile or above, says Dr. Muhonen. Parents can ask their  pediatrician to help make this determination.


  • Approximate number of children ages 12-17 who are already smokers: 4.5 Million
  • Percentage of obese children who will become obese adults: 80%
  • Approximate percentage of children and adolescents (ages 6-19) who were overweight or obese in 2010: 33%

View the full feature on Kids and Healthy Hearts

Dr. Linda Muhonen


Dr. Muhonen helps patients with the full spectrum of heart conditions, with special emphasis in preventive cardiology. She also directs the Children’s Cholesterol (Lipid) Clinic at CHOC. Dr. Muhonen served her Pediatric Cardiology fellowship at the University of Iowa Hospital in Iowa City and she completed her internship and residency at Loma Linda University Medical Center. Part of her practice focuses on helping children avoid heart problems related to genetics and/or obesity later in life. She is the leading physician at CHOC’s Lipid Clinic, which treats these “at risk” children.

Dr. Muhonen’s philosophy of care: “I focus on the family as a whole when treating children with heart and obesity related problems. You can’t just focus on the child because a child is a product of genetics and their environment.”

Oral Roberts School of Medicine – Tulsa, Oklahoma

Pediatric Cardiology

More about Dr. Muhonen | More about The Heart Institute at CHOC Children’s

This article was featured in the Orange County Register on February 17, 2014 and was written by Amy Bentley.