A pediatric surgeon operates on kids. We operate on kids from newborn – even premature babies – all the way up to teenagers and young adults. We operate all over the body, but mostly in the abdomen and the chest. We do everything from removing lumps and bumps on the skin, to hernias, to minimally-invasive surgery, to major open surgery and everything in between.
How many hours do you sleep the night before a big surgery? Does feeling tired affect your ability to operate?
I try to get a good night’s sleep every night. I aim for getting seven to eight hours per night. That number goes down when I’m on call. Surgeons rotate call coverage overnight, so there is always a pediatric surgeon on campus at all times. During those nights, I’m up and I’m busy.
Feeling tired doesn’t really affect my ability to operate. We are well-trained to operate under all conditions. Surgeons feel good even if they’re a little tired. Plus, being in the operating room is exciting and enjoyable for surgeons so we are wide awake and ready to go during every operation.
What do surgeons eat for breakfast on the morning of a big operation?
I often don’t eat breakfast. My body is pretty used to not eating until lunchtime. That said, from time to time there are tater tots in the physician dining room – they are really good, and something that I enjoy every once in a while.
How many years did you have to go to school in order to become a pediatric surgeon?
Four years of undergraduate studies, four years of medical school, and then an additional 10 years of training after that. In total, 14 years after college. In the 10 years of training, I did a general surgery residency for seven years, a surgical critical care fellowship for one year, and then a pediatric surgery fellowship for two years.
How many operations have you done?
This is a hard question to answer. If you consider all the operations I did during my training plus the operations I’ve done here at CHOC, I’ve probably done about 4,000 operations.
How many hours was your longest operation?
Pediatric surgeons do a lot of different surgeries. Some procedures are quick, lasting a matter of minutes. Others are very complex and last for hours. The longest operation I’ve done was about seven or eight hours long. In that operation, I had to fix a congenital problem with the diaphragm, the intestine and the esophagus.
During the operation do you ever have to leave the operating room?
The vast majority of the time, we do not leave the operating room during procedures to use the restroom, eat or take any breaks. The ability to withstand long periods of time in the operating room comes with our years of surgical training. We are used to being in the operating room for many hours at a time. When we are operating, we feel very focused. We are able to tune out everything else besides the procedure at hand. At the end of an operation, that is when we will realize we feel hungry or tired. Until the surgery is over, we are in the zone.
Do you ever feel nervous or scared in the operating room?
The vast majority of the time, no – because we’ve had so many years of training, so we feel well-prepared for all situations. However, there are times when we do feel nervous or anxious. Sometimes, I think a little anxiety before an operation is actually a good thing. It keeps us sharp and focused. Our years of training allows us to control our emotions and remember to take care of the patient.
Did you always know you wanted to be a surgeon?
I always knew I wanted to be a doctor because my older brother who I really looked up to became a doctor. When I started medical school, I thought I definitely did not want to be a surgeon. That was because surgeons appeared to be not nice people on TV shows. I also thought being in the operating room would be tedious. The reality for me, was that after I started my surgical rotation as a medical student, I found that surgery was really exciting, and that surgeons were some of the most kind, dedicated, hard-working people I had ever met. Those things really motivated me to become a surgeon.
Skinnier arms and legs and exhaustion to the point of taking naps. These were the initial signs that left Jamie wondering if there was something wrong with her 5-year-old son, Jacob. Weeks later, the most alarming sign appeared: blood clots in his urine.
Jacob was taken to his local pediatrician and it was there a large lump on his lower left abdomen was discovered. Knowing it was something much more serious, Jacob’s pediatricianimmediately sent Jacob and his family to CHOC at Mission Hospital.
“Our world was changed”
When Jacob arrived, an X-Ray and a CT scan were ordered to further observe the lump on his abdomen. The results showed a tumor on his left kidney and over 30 small tumors growing on his lungs. Dr. Kenneth Kwon, an emergency medicine specialist, delivered the news that Jacob hasWilms tumor—a type of kidney cancer commonly found in young children. Jacob’s cancer wasstage 4 and had spread to his lungs.
“We were devastated,” Jamie recalls. “In just a few hours, our world was changed.“
Jacob was transported via ambulance to the Hyundai Cancer Institute at CHOC Hospital in Orange. Instead of feeling scared or worried, Jacob enjoyed watching Toy Story during the journey alongsidehis newly acquired rocket ship balloon and stuffed monkey. These small comforts during an anxious situation are one thing that helps differentiate a pediatric hospital.
“The first time coming to CHOC was extremely difficult,” Jamie says. “But the nurses and staff could tell we were struggling with the news and they did everything they could to make us feel comfortable. They also explained everything that was happening to Jacob in a way that we could understand.”
Dr. Josephine HaDuong, a CHOC pediatric oncologist, recommended chemotherapy for six weeks and then re-evaluating the growth of the tumor. Jacob came to CHOC’s Dhont Family Foundation Outpatient Infusion Center once a week to receive his initial chemotherapy. Though the process was hard and challenging, especially during a pandemic, Jacob put on a brave face every time he came in. He eventually createdbonds with his child life specialist, nurses in the clinic and Dr. Agnes Horvath, a pediatric oncologist/hematologist at CHOC.
After the initial six weeks, chemotherapy had shrunk the tumor on his kidney by almost 50%. The rest of the tumor could be removed by surgery.
“The day of surgery was extremely tough on my husband and I,” Jamie says. “Having to experience your young child go through something like this is already hard, but to add a pandemic on top was even harder. However, seeing Jacob’s resilience was what got us all through it.”
Inthespring,Dr. Peter Yu, a CHOC pediatric general and thoracic surgeon, successfully removed the rest of the tumor on Jacob’s kidney. However, Jacob was not in the clear just yet;there were still the small tumors on his lungs that needed to be tackled.
For the next 31 weeks, Jacob underwent stronger chemotherapy five days a week as well as radiation that targeted the tumors on his lungs. During that time, there were many trips to the hospital for scans, labs, appointments and a few inpatient stays. There were hard and tough days, but Jacob remembers the simple moments of receiving toys from the Cherese Mari Laulhere Child Life Department and getting his favorite snacks.
“In those months, we leaned heavily on our family, friends, faith and the expertise of our oncology team,” Jamie says. “They are the ones who helped us see the light.”
Bright, ringing moment
Towards the end of summer, Jacob received one of his last CT scans. The only items that showed were two small spots on his lungs that doctors deemed to be scar tissue.
Jacob was declared cancer-free.
A few short days later, Jacob was able to participate in a special tradition to help celebrate the news: ringing the bell.
Each patient who completes their last chemotherapy treatment at CHOCis cheered on by nurses, doctors and staff, and has an opportunity to ring a bell to signify the end of a long journey. The plaque on the bell reads:
Ring this bell, three times well.
Its toll to clearly say, my treatment is done, this course is done, and I’m on my way!
“It was an emotional moment for the whole family,” Jamie says. “We have all been waiting for this day! Jacob could not stop smiling.”
Since that moment, Jacob has now celebrated his 6th birthday. He’s excited to play sports again and hopefully start school in January.
“Even though it was an extremely tough journey, there is good that came out of it,” Jamie says. “Jacob knows he’s strong and brave, and we couldn’t be prouder of him.”
When my fiancé Ryan and I found out we were having another baby, we were excited but also a little overwhelmed. Our firstborn son Raiden was barely a year old and very strong willed. We weren’t quite ready for another, but we knew we could manage. We had no idea the journey that lay ahead of us and our new baby, but today we are so grateful that he’s healthy and happy.
During an ultrasound when I was 26 weeks, my OB/GYN found a mass on the baby’s lung. They said it was likely congenital pulmonary airway malformation (CPAM). CPAM is a mass or lesions of abnormal lung tissue that forms during pregnancy. The mass or lesions can vary in size. It is usually only in one lung and does not function as normal tissue. We did two more ultrasounds to confirm the diagnosis, and then we were referred to a maternal-fetal medicine specialist (MFM).
Our MFM confirmed that our baby, who we named Tavik, had CPAM. The cause of this condition is unknown and only 1 out of 25,000 pregnancies are affected. Research shows that this abnormality is not related to anything the mother did or didn’t do during pregnancy. Some think it may be caused by genetics, but there isn’t enough research to confirm this. CPAM was previously referred to as congenital cystic adenomatoid malformation (CCAM).
There was still a lot of time left in my pregnancy, so Tavik’s lungs had more time to grow—but so did the mass. On the ultrasounds, we could see that his heart had been pushed off to the right side. This was a lot to take in and made the next few months extremely stressful.
Babies in the womb who have CPAM are also at risk for hydrops fetalis, or hydrops. When a fetal lung mass pushes on the heart and blood vessels, the heart has trouble pumping blood. If the heart can’t keep up with the baby’s needs, fluid builds up around the lungs and in the belly, a condition called hydrops fetalis. After the baby is born, the fetal lung mass can cause problems because it can get infected (pneumonia) or take up room so that the healthy lung lobes can’t fill with air. I had ultrasounds every two weeks until Tavik’s due date.
We knew Tavik would need care after he was born, so our MFM referred us to Dr. Peter Yu, a pediatric general and thoracic surgeon at CHOC who has special training and expertise in fetal conditions.
My fiancé and I went to CHOC and met Dr. Yu, who explained everything that was going on with the baby in utero, and what would happen after he was born.
The good news was that most babies with CPAM are born with no symptoms and can go home after a few days in the hospital. Surgery to remove the mass on the lung usually comes a few months later, when the babies are bigger, and better able to handle anesthesia. If CPAMs are not removed, they can cause breathing problems or serious lung infections, and sometimes they can even become cancerous later in life.
Dr. Yu was honest with us and educated us that there are some babies who do have complications at birth due to the CPAM and can need immediate surgery after delivery. Not knowing what that outcome would be was one of the hardest things I’ve ever had to process.
Dr. Yu was so knowledgeable and made us feel more at ease about our baby’s diagnosis. We knew that Tavik was in great hands.
Tavik was born on Nov. 15, 2018 weighing 7 lbs., 10 oz. and 21 inches long. We were so lucky and beyond happy that he came out without any complications, and that he didn’t need immediate surgery. Unfortunately, later that night when the doctors came back to check in on us, they noticed he was working extra hard to breathe. They weren’t sure if this was related to his CPAM. He was admitted to the neonatal intensive care unit (NICU) at the delivery hospital and was given oxygen and put on CPAP (continuous positive airway pressure). CPAP delivers constant air pressure into a baby’s nose to help the air sacs in the lung stay open and prevent sleep apnea.
During our NICU stay, doctors performed a chest X-ray and ultrasound to get a better picture of the mass in his lung. They noticed he also had an abnormal blood vessel carrying blood to the lung mass.
Tavik spent eight days in the NICU before he was healthy enough to go home. The doctors determined that his breathing troubles at birth were not caused by the CPAM. He just had some residual fluid from the C-cection.
Two weeks later, we had an appointment with Dr. Yu so he could meet Tavik and we could make surgery plans. A few weeks after that, Tavik had a CT-scan so Dr. Yu could see exactly what was going on inside Tavik’s lung. That gave Dr. Yu a more precise roadmap for surgery.
When Tavik was three months old, he underwent surgery at CHOC Hospital. It was scary to hand over my baby for surgery, but looking back now, everything seemed to go so smoothly and quickly.
During the three-hour surgery, Dr. Yu removed the affected part of Tavik’s lung and repaired the blood vessel. While surgery was in progress, a member of Dr. Yu’s team came out to the waiting room every 30 minutes to provide an update to Ryan and me.
When surgery was over, Dr. Yu came out to let us know that he had removed half of Tavik’s left lung, sealed off the artery, and everything had gone smoothly. He showed us photos of what he had been looking at through his scope during surgery. He did this to also give us a better understanding of what had been going on inside of our son. It was really neat to see.
Dr. Yu performed the surgery thoracoscopically, using minimally invasive instruments. Only three very small incisions had to be made in Tavik’s abdomen to remove the entire mass. Tavik only has three tiny incisions on his left side. It’s mind-blowing to think that you can safely remove half a baby’s lung through three tiny incisions. Since Tavik had this surgery as a baby, the remaining portion of his lung will be able to grow and compensate for what was removed as he grows.
Tavik spent only three nights in the hospital. The first two days after surgery were hard for Tavik; he was groggy from the anesthesia, and he made some sad sounds, which was a little heartbreaking for us to hear as parents. Thanks to the awesome rooms at CHOC I was able to stay with Tavik the entire time, both day and night. During this time, I stayed with Tavik, while Ryan and Raiden stayed close to CHOC at the Ronald McDonald House. We had stayed there during our unexpected NICU stay, and they invited us back during Tavik’s surgical stay. Without them, our family wouldn’t have been able to stay together and so close to Tavik.
By the third day after surgery, Tavik was alert, smiling and getting right back to his happy self. It’s seriously amazing how fast babies heal! I was a little nervous getting ready to leave on the fourth day. The doctors constantly reassured me by telling me that he was healing wonderfully and that he was in great shape to head home. They were right. By the next day, Tavik was doing even better—he had no pain or discomfort and his incisions were already fading. You would have never known that he just had a major surgery.
A few weeks later, we had a follow-up appointment with Dr. Yu, who confirmed everything still looked great and Tavik was now CPAM-free.
Although Tavik underwent a major surgery as a baby, looking at him now, you’d never know what he had been through. You can barely see his scars, and he’s growing like any little boy should—he’s in the 80th percentile for height and weight. His prognosis is great, and we look forward to a normal life with him.
My son is such a sweet, loving, happy boy with a little bit of spice to his personality. He absolutely loves music and always wants to play in the water. He has so much fun going on walks with his older siblings Leila and Raiden.
Tavik is our little miracle baby! He has kept us on our toes since before he was born and continues to do so today. He’s always making us laugh and smile.
We are so blessed and are so grateful that he is healthy.
From the very beginning, Melissa and Kris knew their twins were fighters—they were also a surprise; the couple hadn’t been sure if they were going to be able to have more children.
“We knew these twins had a purpose and a reason. From the very beginning of their lives, they were a miracle all around.”
Melissa experienced hyperemesis gravidarum also known as HG, a rare condition characterized by extreme nausea and vomiting. Most pregnant women experience morning sickness, but less than 3% experience HG, which can lead to near-constant vomiting, dehydration, weight loss and malnutrition.
“From the second I was pregnant, I was extremely ill. The three of us shouldn’t have lived through my pregnancy, but we did,” Melissa says. “The twins are little fighters. From the womb until now, they’re just little fighters.”
Her body was so depleted that she was put on extended bedrest and hospitalized on and off throughout her pregnancy. She needed a PICC line, or peripherally inserted central catheter, for two-thirds of her pregnancy. PICC lines are sometimes needed when intravenous (IV) medications are required over a long period of time.
“The babies were getting all their nutrients from me, and I was so sick. It was really scary,” she says. “One night while on hospitalized bedrest I needed four blood transfusions. My body was shutting down. The babies were ok through everything—the blood transfusions, me getting IVs, copious amounts of potassium, medications, everything. They just kept going.”
Showing signs of gastroesophageal reflux disease (GERD)
A few days after they were born, Bowie and Finley started showing signs of gastroesophageal reflux (GER). This occurs when a small amount of acidic stomach fluid or food in the stomach goes back up into the esophagus or swallowing tube. Two-thirds of healthy infants experience gastroesophageal reflux.
When the reflux causes intolerable discomfort or complications, children may be experiencing gastroesophageal reflux disease (GERD). Nurses at the delivery hospital told the parents the babies were spitting up and throwing up more than they should be. By the time they went home a couple days after they were born, they had lost a bit more of their birth weight than they were supposed to. Melissa and Kris’ older children Scotlynd and Kingston had GER when they were younger, so they thought they knew what to expect.
Most cases of GER resolve without medication. In rare cases, treatment of GERD requires surgery.
“The older kids just got through it and was never life-threatening,” Melissa said. “With the twins, it went from ‘all babies spit up, they will be ok like their siblings’ to failure to thrive and life-threatening episodes.”
Each twin had life-threatening episodes of GERD. Melissa recalls an especially frightening night with Finley.
“After one middle of the night feeding, Finley threw up and that time, I wasn’t sure if she was ok. I went back in her nursery to check on her and she wasn’t breathing. It was the most terrifying moment. She was limp. I screamed for my husband. We tried everything to wake her up.”
Their pediatrician referred them to CHOC pediatric gastroenterologist Dr. Greg Wong. The two physicians worked together to improve GERD symptoms. Despite trying to change feeding times, amount and type of formula, and medication, the symptoms just weren’t going away.
“We wanted to stay within the CHOC network. That was important to me because our older son had been treated at CHOC, and we fell in love with the CHOC family,” Melissa says. “We know how not only wonderful and caring they are, but from a medical perspective too. We wanted the best for them and we felt CHOC was the best.”
Bowie and Finley’s path to surgery
The family hadn’t wanted to prematurely jump to surgery as an option, but in the end, it was the right decision. They were referred to Dr. Peter Yu, a pediatric general and thoracic surgeon at CHOC.
“Dr. Yu made us feel so comfortable. He really knew what he was doing,” Melissa said. “The CHOC team felt that we had exhausted all other options, and that surgery was the best option for the twins.”
Bowie and Finley underwent surgery when they were about 6 months old. Dr. Yu performed a minimally invasive procedure known as laparoscopic Nissen fundoplication to repair the twins’ GERD. At the same time, he repaired their hernias.
“They are not identical babies, but they had identical surgeries,” Melissa says.
Surgery was performed on one baby at a time. Afterwards, they were brought to recovery rooms right next to each other, so one parent could be with each twin, and they could be close by.
“Before surgery, the babies were so sickly,” Melissa said. “After surgery, they are completely different babies.”
The twins are now feeding, growing and thriving. One of many benefits of this surgery has been less laundry. Melissa and Kris used to have a full hamper of laundry every day because the twins went through clothes and sheets so often.
Celebrating holidays in the hospital
Melissa’s birthday was the day after surgery.
“It was another birthday spent in the hospital, but it put things in perspective,” she said. “The best gift I could’ve gotten was for them to be healthy and thrive again. You think about the important things, and everything else fades away.”
Helmet therapy and physical therapy
Part of the family’s efforts to control the twins’ side effects of GERD had been to keep them in one position to limit their acid reflux. Because of this, they weren’t able to do tummy time which helps prevent flat spots on the back of the head.
After surgery, Finley and Bowie wore helmets for three months that helped correct the growth and shape of their skull.
Because of GERD, the twins’ backs were strong, but their cores and trunks were weak. They are in physical therapy to strengthen their bodies and help them roll and move around using the correct muscles.
A message to other moms
Melissa’s advice for other moms taking care of babies with GERD is to just keep asking questions and remember that every baby is unique.
“There are a lot of levels of GERD, and I didn’t know how severe it could be until it happened to us,” she said. “I learned not to compare my babies to anyone else’s. Every kid is different.”
She added that this experience taught her that trials are temporary, and things will get better.
“Even in the heart of it when you can’t get through another day, and you have to take it minute by minute,” she said. “I always say it’s only temporary. It might not get better right away, but it will.
Last Mother’s Day, Melissa was on bedrest in the hospital, days away from giving birth to her twins. This year, she’s looking forward to celebrating her family being complete—and healthy.
“You have to look back and see where you’ve come from to see how wonderful it is. Last year wasn’t this way. I spent last Mother’s Day with them in the hospital preparing to give birth,” she recalls. “It’s amazing to see how far we have come in a year. We are moving forward, and we can truly enjoy them and enjoy our time as a whole family.”
The twins’ first birthday falls right after Mother’s Day. The family is planning a big celebration in their neighborhood.
“We want to include everybody that was there for them from my pregnancy through the first year of life,” Melissa says. “We want to celebrate that they made it and thank everyone for their help. Everything has been so up and down and up and down, and now were in the clear.”
My daughter Stella first came to CHOC 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 was just five months old when she underwent surgery at CHOC 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.
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.