CHOC Walk in the Park 2017: Why I Walk – Team Miranda

Seven years ago, Miranda woke up screaming in the middle of the night from unbearable head pain. She couldn’t move or recognize her parents, and then she collapsed.

Miranda’s parents rushed her, a 10-year-old at the time, to a local hospital. Physicians there initially told them to wait three days for observation.

Dr. Jason Knight, a CHOC Children’s pediatric critical care specialist and medical director of CHOC’s emergency transport services, was on call at that hospital that day, and met with Miranda’s parents, Regina and John.

An Emergency Transport to CHOC

“Dr. Knight explained what was happening better than anyone else at the hospital,” Regina remembers. “He suggested we transport her to CHOC so she could be seen by pediatric specialists. We were scared to move her, so we asked Dr. Knight if he would transport Miranda if she were his own daughter. He said yes, and we trusted him.”

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Dr. Jason Knight, critical care specialist, chair of the department of medicine, and medical director of emergency transport services at CHOC Children’s

Dr. Knight recalls, “As the physician covering the local hospital that day, it was my responsibility to assure that Miranda received the appropriate care in a timely manner. As soon as I assessed her condition and reviewed the CT scan of her brain, it was clear to me that Miranda needed to be transferred to CHOC immediately. I contacted Dr. Michael Muhonen, a pediatric neurosurgeon at CHOC, and coordinated Miranda’s transfer to CHOC.”

Scans revealed she had an arteriovenous malformation (AVM), a tangle of weakened blood vessels that had ruptured and started to bleed in her brain. Upon arrival at CHOC, Miranda immediately underwent neurosurgery with Dr. Muhonen, medical director of the neuroscience institute at CHOC.

“Miranda was critically ill upon arrival to CHOC. She reminded me of my own three daughters― innocent, beautiful and vulnerable. It was with this in mind that I approached her operation― do what it takes to keep her brain alive and functional,” recalled Dr. Muhonen.

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Dr. Michael Muhonen, medical director of the neuroscience institute and director of neurosurgery at CHOC Children’s

After a successful four-hour surgery, Miranda was placed in a medically-induced coma for several days. Her parents didn’t know if she would survive.

“When Miranda was in a coma, I told Dr. Knight that I wanted to take a photo of her so that I could show her when she woke up, but that I didn’t want to take it if she wasn’t going to make it,” recalls Regina. “For a few days, he wouldn’t let me take the photo because he wasn’t sure if Miranda was going to survive. Then one day, Dr. Knight told me it was ok to take a photo of her, and I knew that meant she was going to make it.”

John adds, “My family is intact today because of wonderful doctors like Dr. Knight, Dr. Muhonen and their teams. It’s just amazing what CHOC does. We are so blessed.”

The Long Road to Recovery

Miranda’s recovery process included child life specialists, physical therapy and rehabilitation. She spent one month at an inpatient rehabilitation facility followed by an additional three months of outpatient care learning how to walk and talk again.

The first year after surgery was critical. Miranda saw Dr. Muhonen every few months for checkups to monitor her brain, as well as a CHOC ophthalmologist to make sure her sight was progressing.

“The AVM and the clot were removed successfully, and Miranda has recovered with minimal long-term deficit,” says Dr. Muhonen. “My reward is not only seeing a disease-free brain on the post-operative MRI, it is the omnipresent smile and effervescent personality that Miranda still has, despite her near-death experience.”

Everything came back except her sight. She lost 25 percent of her vision in both eyes, but that hasn’t stopped her from dancing, her favorite activity since age 8. Miranda’s parents had to supervise her at all times for the first year after surgery to make sure she didn’t have a seizure (a possible side effect of brain surgery), which meant that her mom went to every dance practice and every pool party to ensure her daughter’s continued safe healing.

Giving Back to CHOC

A few months after Miranda’s surgery, her family was invited to participate in CHOC Walk in the Park by friends.

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Miranda and her family at their first CHOC Walk in the Park, just a few months after her emergency neurosurgery

“After what we went through, we felt closely tied to CHOC. We walked that year and fell in love with the event. We realized this was an affordable way to give back to CHOC,” recalls John. “My favorite memory was our very first CHOC Walk. Miranda walked alongside us, which was a huge accomplishment. A couple months before that, we weren’t sure if she was ever going to walk again. To see her walk on her own was the most memorable moment for me.”

The family’s first CHOC Walk was especially impactful for Miranda herself.

“I will never forget attending my first CHOC Walk one year after my surgery. I remember seeing other patients participating in the walk with their own team just like me, only they needed walkers or wheelchairs to have the capability of walking the entire distance. Seeing other patients that were struggling to do the simple task of walking, something that people take for granted, made me reflect back to being a patient at CHOC, where I once struggled with relearning how to walk during physical therapy,” recalls Miranda. “From that moment on, I promised myself I would always participate in the CHOC Walk and give back as much as I could, not only to represent the patients who couldn’t recover as fast as I did, but also for the patients that don’t make it. I am reminded every day by the scar on the back of my head of how blessed I am to have been a patient at CHOC.”

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Every year since her emergency surgery, Miranda’s family rallies dozens of friends to participate in CHOC Walk in the Park.

Every year since then, Miranda’s parents gather dozens of friends, family and co-workers to join Team Miranda, the CHOC Walk team they formed in honor of their daughter. They formed their team with the help of the Littlest Angel Guild, a philanthropic group that raises funds to support the mission of CHOC.

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Miranda and her family at the 2012 CHOC Walk in the Park

“We encourage people we meet to participate in CHOC Walk to help provide the best medical care for the children in our community. You never know if or when CHOC’s services will be needed for your children, for your friend’s children, for your neighbor’s children, or even a stranger,” says John, whose employer, Hill Brothers Chemical Company also sponsors CHOC Walk, in addition to the other philanthropic events benefiting CHOC. “We learned firsthand how much everyone at CHOC cares – the doctors, the nurses, the administrators, and staff throughout CHOC all genuinely care about the children and their families.”

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Team Miranda at the 2013 CHOC Walk in the Park

Experience at CHOC Inspires Future Career

Now a senior in high school, Miranda is preparing for graduation and heading off to college. Inspired by her experiences at CHOC, she is planning to major in psychiatry and dreams of becoming a pediatric optometrist.

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Meet Dr. Mary Jane Piroutek

CHOC Children’s wants its patients and families to get to know its specialists. Today, meet Dr. Mary Jane Piroutek, a pediatric emergency medicine specialist who has been on staff at CHOC for five years. Dr.  Piroutek graduated from the University of California, Irvine School of Medicine. She completed her pediatric residency at CHOC Children’s and a pediatric emergency medicine fellowship at Loma Linda University Medical Center. She’s also an assistant professor in the department of emergency medicine at Loma Linda University.

Dr. Mary Jane Piroutek
Dr. Mary Jane Piroutek

Q: What are your special clinical interests?

A:  I am especially interested in pediatric trauma, environmental injuries, and endocrine emergencies.

Q: What are some new programs or developments within your specialty?

A:  CHOC’s emergency department became a level II pediatric trauma center in 2015. We are the only trauma center in Orange County dedicated exclusively to kids. Or trauma team consists of physicians, nurses, pharmacists, radiology technicians, respiratory therapists, social workers, child life, and a hospital chaplain.

Q: What are your most common diagnoses?

A:  Abdominal pain (from gastroenteritis to appendicitis), seizures, traumatic injuries (lacerations, closed head injuries, fractured arms and legs), and respiratory illnesses (bronchiolitis, asthma, and pneumonia).

Q: What would you most like patients and families to know about you or your division at CHOC?

A:  At CHOC, our emergency department is staffed with fellowship-trained pediatric emergency medicine specialists. Our dual training makes us especially knowledgeable and skilled in caring for your child during their visit. CHOC Children’s is the only emergency department in Orange County that exclusively treats children. Treating children in an environment created especially for them makes what could be a scary experience into something more enjoyable.

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

A:  CHOC delivers the highest level of pediatric care while embracing and caring for the entire family.

Q: Why did you decide to become a doctor? 

A:  In high school I volunteered in a community hospital in the labor and delivery unit. I really enjoyed being part of a family’s joyous occasion. In college I volunteered in the emergency department and marveled at the fast pace, acuity and unpredictably of what the next patient’s case would bring. My academic love for science and solving problems made becoming a physician a very natural fit.

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

A:  I honestly don’t know. Once I decided that I wanted to be a doctor, I never really considered anything else. I put all of my energy and focus into medicine.

Q: What are your hobbies/interests outside of work?

A:  I like spending time with family and friends and traveling. I am also an avid Anaheim Ducks hockey fan.

Q: What have you learned from your patients? 

A:  Children are brave and have a remarkable capacity for resilience. This is evident in the child that sustains a broken leg playing soccer and is unafraid and eager to play again. Or the teenage cancer patient that is most concerned about how their family is being affected by and is dealing with their illness. My patients are humbling and help me to be a better person.

Q: What was the funniest thing a patient 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.

Related posts:

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Meet Dr. Kenneth Kwon

CHOC Children’s wants its patients and families to get to know its specialists. Today, meet Dr. Kenneth Kwon, a pediatric emergency medicine specialist. Dr. Kwon attended medical school at Columbia University. He completed an internship at UCLA, a pediatric residency at Lucile Packard Children’s Hospital at Stanford University, and an emergency medicine residency at UC Irvine. He has been on staff at CHOC for eleven years and currently serves as director of pediatric emergency services and Chief of Staff elect at CHOC Children’s at Mission Hospital.

Dr. Kenneth Kwon

Q: What are your special clinical interests?
A: Pediatric trauma and injury prevention.

Q: What are your most common diagnoses?
A: Fractures, head injuries, lacerations, febrile illnesses, and abdominal pain.

Q: What would you most like community/referring providers to know about you/your division at CHOC?
A: We are a comprehensive general emergency department and trauma center with an emphasis on pediatric and family-centered care. We have pediatric-friendly facilities including a pediatric waiting area and Child Life services, and we have the resources of a children’s hospital in our building and at our fingertips.

Q:  What inspires you most about the care being delivered here at CHOC?
A: CHOC is on the forefront regionally and nationally when it comes to patient safety and quality care, and that is not more evident than in the emergency department. I have worked in over ten emergency departments in my career, and I can safely say that the ED at CHOC at Mission is top-notch when it comes to timeliness and scope of care, facilities and staff.

Q: Why did you decide to become an emergency medicine physician?

A: During pediatric residency, I was particularly interested in high acuity care. I was deciding between neonatal/pediatric intensive care and pediatric emergency medicine. But I missed treating adults and the elderly, so I decided to pursue a second residency in emergency medicine. Now I get the best of both worlds, which is treating high acuity patients of all ages, with a particular emphasis on children.

Q: If you weren’t a physician, what would you be and why?
A: I would have become a music producer. I’ve always loved music and even dabbled as a disc jockey in college. I was never good at singing or dancing.

Q: What are your hobbies/interests outside of work?
A: Golf, family time, listening to obscure 80’s one-hit wonders, and sampling local microbrews.

Q: What was the funniest thing a patient 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.

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When Animals Attack: Preventing, Treating Pet Bites

On average, at least one patient is treated daily at the Julia and George Argyros Emergency Department at CHOC Children’s for household pet bites, and those numbers are expected to increase when warmer weather arrives, a CHOC clinical educator says.

Activities often associated with the spring and summer months such as outside play, more frequent trips to dog parks and visits to other areas with different wildlife make animal bites more common this time of year, says Sheryl Riccardi, registered nurse and clinical educator.

Though the force of a dog’s jaw and bite can be very damaging, cat bites are especially dangerous, she says. Their threat is often underestimated given felines’ smaller physical sizes, but cat bites are more prone to infection because felines’ mouths have greater quantities of bacteria.

pet bites

But no matter the animal or bite size, parents of children who are bitten should see their pediatrician or emergency department immediately after thoroughly washing the wound with soap and water, Riccardi says.

“Bites can cause cellulitis, which is an infection,” she says. “Infection causes swelling and increased pressure on the tissue, which could possibly lead to more serious tissue injury.”

While at the pediatrician’s office or ED for bite treatment, patients and families can expect clinicians to further wash the wound to prevent infection, as well as the possibility of stitches, if needed. Depending on the type of animal, antibiotics may be administered.

And if parents or clinicians have any reason to suspect the offending animal has rabies, preemptive care will be administered. Treatment entails a series of shots over the course of several days.

Snake bites should be handled in the same manner as those from cats or dogs, Riccardi says: Clean the wound, seek immediate medical attention, and administer basic first aid while awaiting help. Do not attempt to remove the venom from a wound.

Like all injuries, prevention is critical when it comes to animal bites. Be watchful for snakes while outside, paying special attention during dusk, dawn and evening hours when the nocturnal animals may be stirring.

Parents must teach children to exercise caution around all animals – even those in their family. Respect animals’ personal space and moods to prevent bites.

“Don’t let your child get in your dog’s face,” she says. “The bottom line is that dogs and cats are animals. It’s unfortunate, but they are unpredictable and can bite.”

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When Do I Take My Child to the Emergency Department?

Sometimes, deciding to take a child to the emergency department (ED) isn’t a clear-cut choice for parents.

In podcast No. 46, Amy Waunch, a trauma program manager at the Julia and George Argyros Emergency Department, helps clarify this question.

When considering an ED trip, Amy says parents should look for the ABCDs: an airway blockage; noisy high-pitched breathing; circulation problems, such as blood loss and extreme dehydration; or sudden disability, such as seizures or loss of consciousness.

Listen to the podcast to learn more about the ABCD concept, as well as other elements of an ED visit:

  • common reasons for an ED trip;
  • what ailments can wait until the pediatrician’s office opens;
  • what to expect at the ED; and
  • what to bring to the ED – and what to leave at home.