Cochlear Implants as a Journey to Hearing: Gracie’s Story

Since Kathleen had experienced a healthy pregnancy, she and her husband Mike were expecting a healthy baby girl.

“Out she popped, and everything was perfect,” Kathleen recalls. “When she failed her newborn screening test, we weren’t that concerned. We knew that babies could fail that test for a number of reasons, even if they have no hearing problems.”

baby-gracie
Baby Gracie

Two weeks later during a visit with her pediatrician, Gracie failed another hearing test. Her family was referred to Providence Speech and Hearing Center.

More testing provided a diagnosis: Gracie had severe to profound bilateral hearing loss. What hearing ability she did have would not be enough to allow her to speak and learn language.

“When I realized my daughter couldn’t even hear me tell her that I love her, I was a mess,” Kathleen recalls. “It felt like the world was falling apart in that moment.”

Gracie tried hearing aids, and although she was finally able to hear her parents say her name, the hearing aids were not enough to compensate for her hearing loss.

Since Kathleen is a special education teacher, she was already familiar with cochlear implants—surgically implanted devices that offer the hope of gaining the ability to sense sound.

“Deciding to pursue cochlear implants was a pretty easy decision,” says Mike. “We didn’t really give it a second thought. As a parent, you just want to give your kid every opportunity possible—especially the chance to hear.”

gracie-with-cochlear-implants-sign
Gracie was thrilled to get cochlear implants.

The cochlear implant artificially stimulates the inner ear area with electrical signals, which sends those signals to the auditory nerve, letting a person hear. The surgery is safest in most children around one year of age.

Meanwhile, Kathleen and Mike had been teaching sign language to Gracie and her older sister.

A few months after Gracie’s first birthday, she underwent bilateral cochlear implantation surgery at CHOC Children’s Hospital with pediatric otolaryngologist (ENT) Dr. Nguyen Pham.

gracie-cochlear-implant-surgery-day
Gracie was excited and happy the day of her cochlear implant surgery.

“When I first met Dr. Pham, I felt like I had known him forever,” Kathleen says. “He answered every single question we had and was honest with us throughout the process.”

gracie-and-parents-at-choc
Gracie’s parents were thrilled that her bilateral cochlear implant surgery went perfectly.

Kathleen knew the benefits for Gracie outweighed the potential complications that come with surgery, but as a parent, she was naturally worried about her child’s well-being.

“Every time I saw Dr. Pham I was frantic, and he was always so calming. It was nice to have that reassurance,” Kathleen says. “Dr. Pham is a miracle worker.”

Surgery went perfectly, and Gracie spent just one night in the hospital. A few weeks later it was time to officially activate her cochlear implants.

gracie-cochlear-implants-activation-day
Gracie was all smiles on activation day for her cochlear implants.

Even though Kathleen had faith the cochlear implants would work, but she was still anxious for activation day.

“Activation day was amazing and terrifying at the same time,” she recalls. “Everyone said not to worry, but I thought it might be too good to be true. I just kept thinking, ‘How could this little device be the thing that allows my baby to hear?’”

As soon as the cochlear implants were activated, Gracie’s face lit up and she pointed to her ears. Her parents let out a sigh of relief. When they took her home, they found the most joy in the small, mundane sounds around their house. Gracie could finally hear the front door open, the dog bark, and most importantly—her parents say I love you.

Before a child with cochlear implants will begin talking, they need time to get comfortable wearing their implants and undergo speech therapy. For Gracie, that time was just a few weeks. She still undergoes speech therapy twice per week, once at Providence Speech and Hearing Center and once at home.

To say Gracie is thriving is an understatement, according to Kathleen. Not only does Gracie talk and sing non-stop with her big sister Tess, but she mastered her ABC’s just shy of her second birthday. Her language skills now exceed most normal hearing children. Gracie loves going to Disneyland, and her family appreciates any opportunity to spread education about cochlear implants to inquisitive people they meet.

gracie-with-cochlear-implants-pumpkin-patch
At Disneyland and other places, Gracie’s family appreciates any opportunity to spread education about cochlear implants to inquisitive people they meet.

Gracie’s family has much to celebrate this year, but there’s something a few years down the road that Kathleen is most excited for.

“I am excited for her to go to kindergarten at a typical school. You have all these visions of your kids growing up, and for me to just drop my daughters off at one school is a big thing.”

Meet the cochlear implant team

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Stella’s Journey with Bronchopulmonary Sequestration (BPS)

By Sharlene Ramisingh, mom of CHOC Children’s patient Stella

My daughter Stella first came to CHOC Children’s when she was just a baby, but our journey really started before she was even born. At my 20-week ultrasound, my husband Havinder and I were so excited to find out the sex of our baby. We were having a girl!

That excitement quickly turned into a feeling of unease when the physician noticed an abnormal growth in the baby’s lung area. From that point on, we had to go back to the doctor’s office for monthly and eventually weekly ultrasounds to monitor the size of the mass. After additional imaging, doctors diagnosed her with bronchopulmonary sequestration (BPS). This means that abnormal tissue or a cyst formed outside her lung but wasn’t connected to her airway.

It was determined that the size of the mass wouldn’t affect delivery, and I was able to carry her to term and proceed with my birth plan. When Stella was born, there was a room full of doctors and nurses in case she wasn’t breathing. Time stood still when she came out and the room was so quiet. Everyone was waiting to hear her cry. And when she let out a tiny little sound, it felt like everyone in the room exhaled at once.

Despite the mass on her lung, she was healthy, so we got to take her home a few days after she was born. Stella’s first few months of life were filled with a series of appointments and tests. When we met Dr. Peter Yu, a pediatric general and thoracic surgeon at CHOC, he was able to give us confirmation that Stella needed surgery to remove the mass. At that point, Stella had grown bigger and stronger and was better prepared for the anesthesia required for surgery. We knew that our daughter was in good hands with Dr. Yu. He was patient, caring and we really felt like our daughter was the most important thing to him.

stella-mom-BPS-surgery
Sharlene with her daughter Stella on the morning of surgery to remove her bronchopulmonary sequestration (BPS).

Stella was just five months old when she underwent surgery at CHOC Children’s Hospital. Thankfully, surgery went perfectly, and the whole team was great. The pediatric anesthesiologist was amazing and able to deal with my daughter’s small veins.

Before Stella’s diagnosis, I had never heard of BPS. During my pregnancy and up until the surgery I was part of a private Facebook group for parents of babies with BPS. Their success stories helped me manage the stress and anxiety that I experienced during this time. I was also able to ask questions to moms who went through the surgery and who had healthy kids. My husband and I were very private about her condition during my pregnancy, and only told our parents and siblings. We were dealing with our own emotions, and we just didn’t feel up to having to explain BPS over and over again. When it did come up, we would say she a birth defect that lead to a growth in her lungs, and that it would need to be removed.

These days, Stella is doing amazing. She sprints around the house with her five-year-old brother on a daily basis, and she has a voice that will make the windows shake. She goes to swim lessons every week.

stella-after-BPS-surgery-with-dog
Stella continues to thrive after surgery to remove her bronchopulmonary sequestration (BPS).

The worrisome portion of my pregnancy and Stella’s surgery seem like such a distant memory. You would never know by looking at my daughter that she ever had any complications.

My advice to new parents facing an unexpected diagnosis is to take things one step at a time. Don’t get caught up in the negative thoughts that may happen and trust your child is in good hands with Dr. Yu and at CHOC. Always remember that this too shall pass.

Meet our surgeons

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Big Sister Gives Back to Honor CHOC Children’s

Lily’s big sister, Makenna loved her before she was even born. She was actually the one who chose Lily’s name. Their bond only grew stronger when Lily was born with a rare chromosomal abnormality requiring specialized treatment and extra help at home.

Lily and Makenna
Lily and Makenna

“Even though Lily is different than Makenna and her brother, Ethan, they just see her as their sister,” says mom, Danielle. “They’ve helped Lily learn sign language and practice pronouncing words.”

Lily’s entire family has been involved in her care from day one. Makenna, age 11, would regularly tag along to Lily’s physical and occupational therapy sessions. She was keen to learn how she could help take care of her sister. She watched closely as physical therapist Cathy Lopez taught Lily how to move her body, and occupational therapist Lauren Newhouse taught her how to eat solid food (her favorite is avocado).

Seeing the way CHOC’s rehabilitation services team cared for Lily and the progress she made in therapy inspired Makenna to give back.

Makenna’s fundraiser

When Makenna’s school hosted a fair for students to showcase causes important to them, she chose to honor CHOC. She and a few friends watched YouTube videos to learn origami and created dozens of animal and emoji-themed bookmarks. She quickly sold out of them and donated the proceeds to the rehabilitation department at CHOC.

Lily backpack

“Raising money for CHOC is the least I can do to thank them for taking such good care of my sister,” Makenna says. “Whenever we are there for an appointment, all the doctors, nurses, therapists and security guards are so nice to us.”

Organizing this fundraiser has inspired Makenna to continue her philanthropic streak.

“It was feels good to do it and it was so easy. It makes me want to do more to raise more money for CHOC,” she says.

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Lily and Makenna present a Makenna’s fundraiser proceeds to physical therapist Cathy Lopez.

Lily’s diagnosis and early days

When Danielle and her husband, David, found out they were expecting their third child, they were thrilled. A few months into Danielle’s pregnancy, a blood test showed that Lily had Turner Syndrome, a genetic condition affecting a female’s growth and fertility. That turned out to be a false positive, but a follow-up amniocentesis correctly diagnosed Lily with Mosaic Trisomy 12, a rare chromosomal abnormality about which not much is known.

Lily was born full-term via C-section at a local hospital. Immediately after birth she had trouble breathing and turned blue, and she was quickly whisked away to that hospital’s neonatal intensive care unit (NICU).

Lily needed a ventilator to help her breathe. She also required use of a CPAP, also known as continuous positive airway pressure, which helped keep her airway open. Danielle pumped her breastmilk so Lily’s care team could nourish her through a feeding tube.

Just outside the hospital, CHOC geneticist Dr. Neda Zadeh was starting to make her way home for the day when she heard about Lily’s condition.

“Dr. Zadeh was on her way out, but she turned around and came back to the hospital to run more tests and get a better idea of what was affecting her,” Danielle recalls. “Dr. Zadeh is amazing.”

In the first few days of Lily’s life, her parents weren’t sure if she would make it or not. When she was 3 days old, she was transferred to CHOC’s NICU for a higher level of care.

Lily spent the next 24 days in the NICU. When she learned how to breathe and eat on her own, she was ready to go home for the first time.

While the family spent much of their daughter’s first month in the hospital, NICU nurses made sure the family didn’t miss out on their first holiday together — Father’s Day. With her nurses’ help, Lily created a special Father’s Day craft for David using her footprints.

These days, Lily sees a mighty brigade of pediatric specialists at CHOC on a regular basis. Although not much is known about her Mosaic Trisomy 12, her care team remains fully committed to ensuring she is safe and healthy. In addition to Dr. Zadeh, Lily is under the care of neurosurgeon Dr. William Loudon, endocrinologist Dr. Timothy Flannery, and otolaryngologist Dr. Nguyen Pham. She also sees a neuro-ophthalmologist at UC Irvine.

Danielle is proud of the progress Lily has made during therapy at CHOC and seeing how that progress sparked Makenna’s giving spirit makes her proud as well.

family

“Makenna probably doesn’t realize this, but Cathy and Lauren at CHOC really cared for our entire family, not just Lily,” Danielle says. “The entire rehabilitation team at CHOC was incredibly supportive to our entire family. They were the weekly and sometimes daily reminders that we could do it. They impacted our entire family in a way that words simply cannot express. When we look back on Lily’s first years, they are in our memories and always will be!”

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Restoring a Happy Childhood: Rylee’s Epilepsy Journey

A teacher years ago bestowed an apt nickname on Rylee Christe: Smiley Rylee.

“She’s a very social, happy child,” says her mom, Sara. “She got that name from her preschool teacher. It just stuck forever. She’s always smiling.”

But despite her happy disposition, Rylee had a big roadblock: frequent disruptive seizures. And Sara wanted nothing more for her young daughter than to enjoy her childhood without this burden.

The problem

In 2013, a pediatrician diagnosed a 4-year-old Rylee with complex partial seizures. Suddenly, Rylee’s mouth would twitch and cause saliva to bubble. She’d be unresponsive to questions. While the family awaited an appointment with a specialist, the seizures quickly increased in frequency, sometimes up to 30 a day.

One day, Sara knew she couldn’t wait any longer and took Rylee to an emergency department. An electroencephalogram, or EEG, detected abnormal brain activity, confirming the pediatrician’s diagnosis of complex partial seizures. Imaging also revealed a lesion on Rylee’s brain.

An odyssey to stop the seizures began. Doctors ordered multiple tests and prescribed several types of medications. But the seizures continued. They moved to another hospital and found some temporary relief, but the seizures began again.

Finding a guide

The Christe family’s next stop was CHOC Children’s, where they saw Dr. Mary Zupanc, medical director of neurology at the CHOC Children’s Neuroscience Institute and director of CHOC’s Pediatric Comprehensive Epilepsy Program.

dr-mary-zupanc
Dr. Mary Zupanc, medical director of neurology at the CHOC Children’s Neuroscience Institute and director of CHOC’s Pediatric Comprehensive Epilepsy Program

Dr. Zupanc, who has worked with thousands of patients with epilepsy throughout her career, understood exactly how distressing an epilepsy diagnosis can be for families and how debilitating seizures can be.

“We had been through the woodwork trying to get to where we are now, to find the amazing doctor that we needed,” Sara says.

A plan at last

First, Dr. Zupanc ordered long-term video EEG monitoring of Rylee’s brain activity. Another round of imaging revealed another lesion, this time in the left frontal lobe.

Dr. Zupanc then worked to get Rylee’s seizures under control, trying two medications previous care teams hadn’t. After the seizures reduced to about one or two a night, the Christe family headed home.

Next, Dr. Zupanc set out to stop the seizures for good. It was clear though that Rylee would need more than medication. Dr. Zupanc raised the prospect of brain surgery.

“At first, I was hesitant to move forward because any mention of surgery for your child is terrifying,” Sara says. “But brain surgery? Come on.”

But Dr. Zupanc explained to the family that evidence shows more than 70 percent of patients with seizures may benefit from surgical intervention; that children respond and recover well from surgery because of the plasticity of their young brains; and that surgery should be considered sooner than later.

Taking action

The family agreed to explore the option, moving forward with subsequent testing, exams and lab work needed to determine if Rylee was indeed a surgical candidate. After reviewing the results, a team of CHOC specialists agreed that she would benefit from surgery.

rylee-epilepsy-surgery

Next for the Christes was a brain mapping session at CHOC Children’s Hospital. During the procedure, Dr. Joffre Olaya, a pediatric neurosurgeon who is specially trained in epilepsy surgery, opened Rylee’s skull and placed an electrical grid on her brain. Later, Dr. Zupanc would record Rylee’s seizures to pinpoint the seizure focus. She also stimulated the electrodes on the grid to determine the location of Rylee’s motor area and speech and language center in the brain.

Three hours of testing confirmed Dr. Zupanc’s suspicion that Rylee’s seizures were originating from the left frontal lobe. The physicians were confident if Dr. Olaya removed the lesion there, the seizures would stop.

The procedure wasn’t without risks though. Drs. Zupanc and Olaya cautioned Sara that the surgery could leave her daughter with some impairments like a facial droop, speech problems and even some paralysis.

Sara and Rylee weighed the risks with the benefits of a childhood without seizures and decided to move forward. Three days later, she underwent a successful surgery with no complications.

Back to being a kid

After four days of recovery at the hospital, Rylee and Sara headed home. The next week, Rylee returned to school on an adjusted schedule and was begging her mother to use her roller blades and ride her bicycle.

Now, about six months past her surgery, Rylee, 9, hasn’t had a single seizure. She remains on medication, but it’s likely her dosing may decrease after a few years.

Life for the Christes has changed dramatically.

“Quality of life has improved so much for the whole family,” Sara says. “I can sleep at night. It feels like I haven’t slept in five years.”

rylee-after-epilepsy-surgery

And Rylee, who will likely remain on medication for the rest of her life with close following by her physicians, is in fourth grade and back to enjoying her childhood.

“She loves to dance and sing, and she can remember the words to every song she sings,” Sara says. “She loves to swim and ride bikes, and her favorite thing in the world is mermaids.”

Learn more about the CHOC Epilepsy Program

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Living with Scoliosis: Jennifer’s Story

By Jennifer Schultz, CHOC Children’s patient

At 8 years old, I was diagnosed at the CHOC Children’s Orthopaedic Institute with idiopathic scoliosis. As a young child, I was not aware of the significance of this lifelong three-dimensional curvature. My baby blue night brace arrived two weeks later. It was a warm insulator around my spine during chilly winters, but during summers it turned into a sweltering, body-hugging, coil-wrapped anaconda. Over the years, wearing my brace was simply part of my nightly routine; the only modification was the arrival of a pink brace, a green one, and finally a gray brace, each increasing in size.

I experienced a major growth spurt – and an increase in the curvature of my spine – in middle school. Up to this point, playing tennis and the piano had been my go-to activities. Even though my doctor disclosed that tennis had no negative impact on my spinal curvature development, my family decided I should discontinue my daily practices, as well as play the piano fewer hours each week. We decided swimming would be a balanced and safe exercise. I started swim year-round with a local club, SOCAL Aquatics, to improve and strengthen my core and back muscles. I was not a big fan of the cold water, especially during the chilly winter nights, and this resulted in my wearing an embarrassing wetsuit for every practice. Quitting tennis and starting swimming were very difficult to accept, but I knew if I continued swimming, I would benefit in the end.

jennifer-swimming-scoliosis
After a growth spurt prompted an increase in the curvature of her spine, Jennifer took up swimming in place of playing tennis and piano.

Wearing a brace and swimming year-round have helped maintain my fixed curvature. A few years ago, Dr. Afshin Aminian, medical director of CHOC’s Orthopaedic Institute, directed me to the CHOC website, which contained several sets of exercises for patients with scoliosis. I started doing these stretches every day in my room for about 20 minutes. I also began SCHROTH physical therapy to improve posture and reduce progression of the curve. Doing daily breathing and walking exercises are very therapeutic and soothing to my mind and body. With enough practice and concentration, I can utilize these routines in the future should I start to feel discomfort in my back.

Two years after my growth spurt, my doctor prescribed a day brace. The shift from a night brace to a day brace proved to be even tougher on me both physically and mentally, especially since I was required to wear my brace to school. Not only was this a little humiliating, but it was very difficult to sit at a desk and maneuver around campus. The stretch marks, bruises and rashes on my back didn’t make my diagnosis any easier to accept. However, this brace was the only tool preventing my back from succumbing to a more dangerous fate: surgery. Always trying to maintain a more positive outlook has been tricky, but it has helped me minimize some of my discomfort and understand my condition could be much worse if I did not have access to a medical brace.

When I entered my freshmen year of high school, I noticed several of my friends were also wearing spinal day braces. Loose clothing became the norm for us, articles that would discreetly conceal the uneven protrusions of our braces. I empathized with my friends about some of the humiliation and discomfort of scoliosis. This was what motivated me to start a high school health club to promote healthy lifestyles and raise awareness for various health issues, including scoliosis. My vision included fundraising for orthopedic research in local hospitals and POSNA (Pediatric Orthopedic Society of North America). We sold Jamba Juice BOGO cards. Our funds helped a research project on the physiological effects on adolescent scoliosis patients. This study revealed that most teenagers with scoliosis have reduced self-esteem due to their physical appearance, and they do not share these feelings with their parents. In addition, we donated $750 to Dr. Aminian’s current research at CHOC, which is focused on utilizing ultrasound for early scoliosis detection and monitoring. This research is personal to me since I was exposed to X-rays two to three times a year to measure my spinal curvature. The ultrasound is less harmful to patients’ health, and early detection is key to prevent progression.

jennifer-scoliosis-high-school
After she started high school, Jennifer formed a health club to promote healthy lifestyles and raise awareness for various health issues, including scoliosis.

After eight long years of wearing a back brace, my spine has finally stabilized at a solid 45 degrees. My four braces currently sit inside my closet, each representing a challenge I was able to overcome. Wearing a brace was my greatest hardship. Avoiding back surgery was my greatest triumph. Persistence and dedication are key; keeping the brace on long as possible is the smartest thing to do. I learned that the opinions of my peers should be low on the priority list; my well-being is far more significant. What I realized most is that my brace ultimately made me mentally and physically stronger. Scoliosis made me understand how I could make a difference by supporting the cause and my peers.

Fundraising for scoliosis research was an unforgettable experience that allowed me to assist my friends and other patients with scoliosis. As I learned more about orthopedic research, I wanted to delve deeper into biological laboratories to understand and discover the underlying cause of scoliosis. I recently earned an opportunity to work in a local lab, where I assisted in the study of cell polarity and craniofacial development in zebrafish. Currently, the lab is using zebrafish with scoliosis to study potential mutants or mechanisms that cause idiopathic scoliosis. Although recent publications may offer reasons for the cause of congenital scoliosis in humans, the cause of idiopathic scoliosis remains a mystery in zebrafish and humans.

After acquiring hands-on experience and deeper scientific knowledge in the lab, I would like to attend a college that allows me to do undergraduate research in the fields of cell biology and genetics. My ultimate goal is to graduate with a PhD in cell biology and become a lab researcher to potentially find the cause to conditions and diseases that have similar characteristics to idiopathic scoliosis. My dream is to help unlock the code and find a cure for many childhood ailments.

Get answers to common scoliosis questions

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