Meet Dr. Laura Totaro

CHOC Children’s wants its patients and families to get to know its specialists. Today, meet Dr. Laura Totaro, a pediatric hospitalist at CHOC Children’s, as well as CHOC Children’s at Mission Hospital. After attending Loma Linda University Medical School, Dr. Totaro was part of the first pediatrics residency class through the University of California Irvine and CHOC. She has been on staff at CHOC for three years.

Dr. Laura Totaro, a pediatric hospitalist at CHOC Children’s, as well as CHOC Children’s at Mission Hospital.

Q: What are your administrative appointments?
A: I am the hospitalist representative for both the CHOC Children’s at Mission Hospital Intensive Care Committee and the CHOC Children’s Infection Prevention Committee.

Q: What are your special clinical interests?
A: I am most interested in infectious disease and autoimmune disorders.

Q: What are your most common diagnoses?
A: Seizures, asthma, bronchiolitis, pneumonia, and gastroenteritis/dehydration.

Q: What would you most like community/referring providers to know about you or your division at CHOC?
A: In an effort to better facilitate transfer of care, we now offer 24/7 hospitalist coverage at both CHOC campuses.

Q:  What inspires you most about the care being delivered here at CHOC?
A: The CHOC community provides a unique focus on healthcare for kids that goes beyond just the basics. The entire care team including the doctors, nurses and additional staff who strive to provide personalized care that not only treats a physical illness but also addresses the needs of the entire family. I am inspired by the culture of physicians and nurses that are constantly learning and trying to provide the best care they possibly can. It is such a pleasure to work in a place where everyone seems to truly enjoy their job and are trying to find ways to be even better at them.

Q: Why did you decide to become a doctor?
A: I grew up in a healthcare-focused community where I was exposed to medicine from a young age. I was inspired by the doctors around me and was fascinated by the human body. I also wanted a career that would allow me to help others here in my immediate community and abroad.

Q: If you weren’t a physician, what would you be and why?
A: I would run a travel blog and be a food critic.

Q: What are your hobbies/interests outside of work?
A: Travel, exploring new restaurants, art, and music.

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.

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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.

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!


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.

Even though Andre and his parents spent his first Christmas at CHOC due to RSV, Santa still managed to find him.
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.

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.

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

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Meet Dr. Gary Goodman

CHOC Children’s wants its patients and families to get to know its specialists. Today, meet Dr. Gary Goodman, a pediatric critical care medicine specialist and medical director of the Pediatric Intensive Care Unit at CHOC Children’s at Mission Hospital. After graduating from medical school at University of California, Irvine, he served his internship, residency and chief residency training in pediatrics at UC Davis Medical Center. Dr. Goodman completed a pediatric critical care and pulmonary medicine fellowship at CHOC.

Dr. Gary Goodman

What are your special clinical interests?

I am particularly interested in traumatic brain injury, concussions, respiratory failure and shock.

How long have you been on staff at CHOC?

I have been on staff for 30 years.

Are there any new programs within your specialty at CHOC you’d like to share?

We are now utilizing noninvasive ventilation and physiologic monitoring. We have developed improved treatment of ARDS (acute respiratory distress syndrome). We are also proud of our neuro-critical care team.

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

The division of pediatric critical care provides outstanding and personalized care for children and their families when their need is the highest. We strive to not only provide state-of-the-art medical care, but to also support the emotional needs of the patient and family. Our comprehensive, multi-disciplinary team works together to address every need and concern a patient and family might have.

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

For a pediatric specialist, there is no higher honor and privilege than working at a hospital dedicated to caring for children. I am always surrounded by and supported by other practitioners who share my passion for caring for children and who are all pediatric specialists themselves.

When did you decide you wanted to be a doctor?

I wanted to be a doctor since I was 5 years old, inspired by black and white documentaries about medicine.

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

If I wasn’t a physician, I would be an architect. I am fascinated by design and how the environment we live and work in can have such positive and even healing effects on us.

What are you hobbies and interests outside of medicine?

I enjoy listening to music (jazz and classical), cooking, photography, collecting watches and traveling.

What was the funniest interaction you had with a patient?

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?”

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Meet Dr. Jennifer Ho

CHOC Children’s wants its patients and families to get to know its specialists. Today, meet Dr. Jennifer Ho, a pediatric hospitalist. Dr. Ho attended UC Irvine School of Medicine and completed her pediatric residency at CHOC. She has been on staff for six years and is a member-at-large of the Medical Staff Executive Committee and member of the Medical Staff Performance Committee at CHOC Children’s at Mission Hospital.

Dr. Jennifer Ho

Q: What are your special clinical interests?
Care of the hospitalized pediatric patient, infectious diseases, evidence-based medicine and optimization of the electronic health record.

Q: What are some new programs or developments within your specialty?
A: I am excited that the field of pediatric hospital medicine is growing and will soon be a nationally board-certified recognized specialty.

Q: What are your most common diagnoses?
A: Asthma, bronchiolitis, dehydration and seizures.

Q: What would you most like community/referring providers to know about you/your division at CHOC?
A: We now provide 24/7 attending coverage in the hospital at both CHOC Orange and CHOC Mission to ensure the highest quality of care for Orange County children. We pride ourselves on communication and are always available to help facilitate transition of care.

Q:  What inspires you most about the care being delivered here at CHOC?
A: As a mother of two young children, it is very comforting to know that if they ever need medical care, CHOC provides the highest quality of care in a family-friendly environment.

Q: Why did you decide to become a doctor?

A: I decided to become a doctor when I was diagnosed with a heart problem in high school. I thought the human body was fascinating and I wanted to be able to help patients through their problems and get the most out of life.

Q: If you weren’t a physician, what would you be and why?
A: I would own a used bookstore with an attached coffee shop and spend my days reading old books and drinking coffee.

Q: What are your hobbies/interests outside of work?
A: Being a mommy to my two little kids, being outside, reading and playing volleyball.

Q: What was the funniest thing a patient told you?
A: From a 3-year-old girl: “I want to be a doctor like you … but only for unicorns and fairies.”

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Meet Dr. Perry Eisner

CHOC Children’s wants its patients and families to get to know its specialists. Today, meet Dr. Perry Eisner, a pediatric anesthesiologist at CHOC Children’s at Mission Hospital. Dr. Eisner attended the Ohio State University School of Medicine. He studied pediatrics at the University of California Irvine including completing rotations at CHOC. He completed his pediatrics training at Harbor-UCLA Medical Center. After becoming board-certified in pediatrics, he completed a specialized program at UCLA including a general anesthesiology residency with a fellowship in pediatric anesthesia and pediatric critical care medicine. He has been the chief of surgery at CHOC Children’s at Mission Hospital for six years, and has been on staff at CHOC for over 20 years.

Dr. Perry Eisner
Q: What are your special clinical interests?

A: My interest is in making surgery as stress-free as possible for both my pediatric patients and their families.

Q: What are your most common diagnoses?

A: My patients have a range of conditions. We have everything from trauma patients with brain injuries or children with orthopaedic injuries to kids with head and neck problems. It runs the gamut.

Q: What would you most like community/referring providers to know about you/your division at CHOC?
A: At CHOC at Mission, we have four fellowship-trained pediatric anesthesiologists and ensure that children undergoing surgery have not only the safest but also the best experience possible. There is not a hospital in the county that provides a higher level of care.

Q: What inspires you most about the care being delivered here at CHOC?
A: What inspires me the most is the dedication of the entire team that CHOC Children’s has assembled to care for pediatric surgical patients. From the surgeons and the nurses to the critical care physicians and the hospital-based physicians, it is a team that cannot be matched. We have practitioners that were trained in the finest facilities in the country and who care not only about delivering state-of-the-art care, but also care equally about reducing the stress of an illness or surgery for both our patients and their families.

Q: Why did you decide to become a doctor?
A: I became fascinated with medicine when I was in high school and worked in an emergency room in downtown Cleveland as an orderly. I have also loved interacting with children. I found that when one works with kids, you can take a horrifying and stressful situation and transform it into a minor event. That is my goal each day in the operating room.

Q: If you weren’t a physician, what would you be and why?
A: Honestly, I don’t know. It’s all I’ve ever wanted. I didn’t have a back-up plan. It’s not something I’d recommend, but it’s not something that I did. I didn’t have a plan B.

Q: What are your hobbies and interests outside of work?
A: My hobby is playing racquetball. I began playing 40 years ago and play two to three times per week.

Q: What have you learned from your patients?
A: With kids, when they’re going through something stressful, I find that you can divert their attention by doing something that they think is funny or makes them laugh. I’ve learned though that this works for adults too. It seems so natural with kids, but it works just as well with adults as kids. When there’s something stressful going on, if you can divert your attention to something light or funny, it can get you through anything.

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