Meet Dr. Alexandra Roche

CHOC Children’s wants its patients and families to get to know its specialists. Today, meet Dr. Alexandra Roche, a pediatrician specializing in adolescent medicine, who was recently named a diplomate of the American Board of Obesity Medicine.

Dr. Alexandra Roche
Dr. Alexandra Roche, a pediatrician who works with adolescents at CHOC Children’s.

Q: What is your education and training?
A: I received my undergraduate degree in anthropology from Barnard College, attended medical school at New York Medical College, and completed my residency in pediatrics at CHOC Children’s.

Q: What are your special clinical interests?
A: Adolescent medicine is my specialty because I love working with teens. I am fascinated by their transformation from kids into mature adults. I often work with teens who have eating disorders and on obesity medicine.

Q: How long have you been on staff at CHOC?
A: 10 years.

Q: What are some new programs or developments within your specialty?
A: Eating disorders have changed over the last 10 years that I’ve been working with adolescents. The diagnosis criteria are being defined, and we are seeing more males suffering from eating disorders. The obesity epidemic often leads to disordered eating; it can lead to rapid weight loss in unhealthy ways.

Q: What are your most common diagnoses?
A: Many patients come to me for acne, menstrual concerns, eating disorders, anxiety, questions related to sexuality.

Q: What inspires you most about the care being delivered here at CHOC?
A: We take a holistic approach to treating each patient. If someone has an ear infection, we don’t just prescribe an antibiotic; we ask ourselves, “How do I take care of the whole patient?” The reason why so many doctors are committed to practicing medicine at CHOC is the medical staff’s dedication to working their hardest to help each patient receive their best possible outcome.

Q: Why did you decide to become a doctor?
A: I wondered, “How can I effectively change someone’s life?” I wanted to help people get through the day feeling better about themselves.

Q: If you weren’t a physician, what would you be and why?
A: I would work for the National Park Service. I love being a tour guide when I have visitors in town.

Q: What are your hobbies/interests outside of work?
A: Spending time outside, being in nature, hiking.

Q: What have you learned from your patients?
A: I have learned just how resilient kids are. It doesn’t matter what they go through, they have so much strength and can persevere through anything if they have someone to show them the way.

Learn more about adolescent medicine at CHOC.

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What to Expect at the CHOC Adolescent Medicine Clinic

By Cindy Sihotang, pediatric resident at CHOC Children’s

At the CHOC Children’s Adolescent Medicine Clinic, you will encounter a dedicated team of specialists whose focus is on comprehensive care. Adolescence is a time of growth and discovery with each teen having their own unique set of needs. You can be seen here for yearly physicals, sports physicals as well as acute sick visits. There is also a special clinic for evaluation and treatment of eating disorders.

What ages can be seen at the adolescent clinic?

Adolescents can start coming to the clinic once they are 13 and can continue to be seen here until the age of 21. We understand that is very broad range of ages with different needs and concerns. Your care is tailored and age-appropriate to ensure it addresses your unique needs and concerns.

 What questions will the doctor ask me?

The doctor will likely ask you a lot of questions― that’s just because they want to get to know you! They will ask about your diet, exercise, screen time and school performance. Your doctor will also ask about dental history, hospitalizations/surgeries, medications and family history. We also bring up some other topics that might be hard for you to talk about, but are still very important: drug, alcohol, tobacco use, and sexual activity. We will ask a series of questions to assess your mental health. I We have in-house psychologists who can meet with you during that visit.

What happens during a physical? 

What is discussed between a teen and their doctor is confidential. Parents are alerted when the physician senses there are signs of danger. During yearly physicals, we do a thorough history and complete physical exam. We check for appropriate growth, screening for disorders such as obesity and anorexia nervosa by checking your height and weight. Appropriate development is screened by inquiring about school performance. We screen for anemia with hemoglobin checks. Immunizations are updated following the CDC’s schedule. We are also able to provide screenings and treatments for sexually transmitted infections We specialize in helping teens with menstrual concerns, ranging from no periods to heavy periods, or even painful cramps. We can provide important counsel regarding overall health and safety. We will work with you to come up with a plan for healthy eating and exercise, and discuss safety issues such as driving under the influence, safe sex including contraception use, domestic violence, and safety with social media.

Will my parents talk to my doctor without me?

During adolescence, teens take more ownership of their health, and take on some responsibilities that used to fall to their parents. This growth is fostered by providing confidential time for the adolescent to speak one-on-one with their doctor during each visit, without their parent present. Anything discussed during this time is confidential, meaning it stays between the patient and the provider.

What is meant by confidential time to talk with the doctor?

As a teen, you may have significant questions or concerns you’re hesitant to discuss with your  doctor while a parent is in the room. As providers, we wish to extend the most complete care possible. State laws protect confidentiality in issues relating to pregnancy prevention, testing and treating sexually transmitted diseases, and mental health. Teens are always encouraged to discuss these topics with their parents, since an open relationship builds trust and parents can provide a breadth of knowledge and experience. A teen’s confidentiality will always be respected unless there is a concern for the adolescent’s health or safety.

 

Learn more about adolescent medicine at CHOC.

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What Vaccines Does My Teen Need?

By Nina Nosavan and Rosie Korman, pediatric residents at CHOC Children’s

Vaccines are not just important for little ones. Your preteens and teens need to be vaccinated too! It’s important for parents to be aware of vaccines updated that will benefit their adolescents.

Meningococcus (MCV)

Meningitis is a severe, life-threatening illness that begins with fever, headache, and stiff neck and can rapidly progress to coma, multi-organ failure, and death. Approximately 10-15 percent of cases are fatal, and of the survivors, 20 percent can have severe disabilities including hearing loss, brain damage, amputations, kidney damage and other complications. Almost all disease is caused by the five serotypes A, B, C, W, and Y of bacteria Neisseria meningitidis. Protection against four of the five of these serotypes is provided by the meningococcus conjugate vaccine (MCV). The meningococcus conjugate vaccine is recommended for all adolescents after age 11, with a booster given at age 16. This vaccine schedule provides critical protection against this devastating disease during the college years, when meningitis commonly occurs as outbreaks in young adults living in close quarters in dormitories.

The B serotype of meningococcus is not included in the MCV. Protection against this form of meningococcus requires a separate immunization. This vaccine can be given to any adolescent 16 to 23 years of age to provide protection from serotype B during this high-risk period. The serotype B vaccination is recommended to be given in multiple doses; there are two different brands of licensed vaccinations, each with a different dosing schedule. Ask your provider which serotype B vaccine they have available at their clinic, and which dosing schedule they recommend.

vaccinesPhoto courtesy of The National Meningitis Association.

Additionally, children 10 years or older who are at increased risk for serogroup B meningococcal infections should receive the vaccine. This group includes:

  • People exposed to a serogroup B meningococcal disease outbreak
  • People with no spleens or damaged spleens
  • People diagnosed with persistent complement component deficiency

HPV Vaccine

The HPV (human papillomavirus) vaccine protects against HPV infections and HPV-associated diseases such as cervical, vaginal, vulvar, penile, oropharyngeal, and anal cancers and genital warts.  HPV is very common; nearly all sexually active adults (both men and women) will become infected with at least one of the human papillomaviruses in their lifetime. The majority of HPV infections are asymptomatic, however, over time the human papillomavirus causes cervical and other cancers. The HPV vaccine has been shown to be incredibly effective in preventing both HPV infection and the subsequent cancers HPV causes. It is most effective if given prior to the onset of sexual activity (and thus prior to HPV infection), though is still highly effective in sexually active individuals. The vaccine is recommended for patients between 9 and 26 years of age.

  • Girls and boys who initiate the vaccine series before 15 years of age should receive 2 doses at least 6 months apart.
  • Teenagers and young adults who initiate the vaccine series after 15 years of age should receive 3 doses at 0, 1 or 2, and 6 months.

Learn more about the HPV vaccine from a pediatrician’s perspective, or ask your child’s healthcare provider for more information.

Tdap Vaccine

Infants and young children receive the DTap vaccine to protect against tetanus, diphtheria and pertussis. As they get older, the protection wears off. The Tdap vaccine is a booster that helps to protect your preteen or teen from these illnesses.

  • Tetanus (lockjaw) is caused by bacteria in the soil and enters the body through cuts in the skin. It can cause lockjaw, painful muscle cramps, breathing problems, and paralysis. Up to 1 out of 5 people who get tetanus die.
  •  Diptheria is spread through coughing and sneezing. It causes destruction of tissue in the upper respiratory system that impairs a person’s ability to breathe or swallow. It can also cause heart failure and paralysis. Up to 1 out of 10 people who get diphtheria die.
  • Pertussis (whooping cough) is spread through coughing and sneezing. It can cause infants to stop breathing or children to have uncontrollable coughing fits. It can make preteens and teens very sick.

The first Tdap vaccine should be given at age 11 or 12. If your teen is 13 to 18 years old and has not received the vaccine, talk to you doctor right away. This vaccine is also recommended for pregnant women during every pregnancy, and for everyone that lives in the same household as a newborn baby. A variant of this vaccine, Td, is recommended every 10 years for adults.

Catch-up Immunizations

Is your adolescent up-to-date on all their immunizations? Did you know that if your adolescent missed some of his immunizations as a child, it is not too late to immunize? Vaccinations for many common illnesses, including polio, hepatitis A, hepatitis B, varicella (chickenpox), measles, mumps and rubella, all can be caught-up during the adolescent years. Be sure to ask your physician if your child has received all the necessary immunizations, and whether any catch-up immunizations are necessary.

PPSV23 Vaccine

Pneumococcal disease causes infections of the blood, infections of the lining of the brain and spinal cord, ear infections, and pneumonia. Infants and young children should receive the pneumococcal conjugate vaccine (PCV13) to protect against these infections.

The pneumococcal polysaccharide vaccine (PPSV23) protects against 23 types of pneumococcal bacteria and is recommended for children older than 2 years of age with certain medical conditions such as sickle cell disease, HIV infection, chronic heart or lung conditions, or cochlear implants. Teenagers and young adults who have asthma or who smoke cigarettes should also receive this vaccine.

Download your immunization guide

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What Your Teen Should Know About Ovarian Cysts

By Angela Chu, pediatric resident at CHOC Children’s

When girls hear the words ovarian cyst, they think of pain and worry about needing surgery. However, there are many different types of cysts, and some are actually part of the normal monthly cycle.

What are ovarian cysts?

A cyst is sac filled with fluid. Ovarian cysts are relatively common in adolescents and are often found incidentally. They can be either simple or complex cysts and are most frequently “physiologic,” meaning they happen normally, because of the way the body functions. In menstruating females, the ovary goes through a cycle every month to prepare an egg to be released into the uterus. During the first part of the monthly cycle, the egg is enclosed in a follicle which grows for two weeks, and then ruptures to release the prepared egg (i.e. ovulation). The follicle then evolves into something called a corpus luteum which shrinks and then disappears within two weeks, in time for a new follicle to develop. Cysts can develop when the follicle fails to rupture to release the egg or if the corpus luteum fails to shrink.

If the cyst develops separate pockets of fluid, it’s a complex cyst. Some cysts contain material other than fluid, such as skin cells or blood.

ovarian cysts
Image courtesy of Encyclopedia Britannica

Symptoms of ovarian cysts

Cysts are often found incidentally and don’t cause any symptoms. Some women may feel a sudden sharp pain in the lower abdominal region during the middle of their cycle. This corresponds to when the follicular cyst ruptures to release the egg, and is called “mittleschmerz.” The pain usually resolves fairly quickly. Larger cysts can cause pain simply due to their size, or when they rupture. In these cases, women might experience irregular periods, pelvic (lower abdominal) pain, bloating and a sense of fullness in the lower abdominal region. If the cyst is large enough, it can push on surrounding organs and cause increased urinary frequency, constipation, indigestion, or pelvic heaviness. If your daughter experiences any of these symptoms, speak to your primary care provider. Most common concerns can be managed by your primary care provider or an adolescent medicine specialist, who will determine if studies such as an ultrasound are necessary. If there is concern that a cyst may need to be removed, your provider will refer you to a gynecologist.

Complications of ovarian cysts

If the cyst becomes large and ruptures, it can lead to abdominal pain and bleeding, which can be minor or severe. There are times when the cyst can cause the ovary to twist on itself, leading to something called ovarian torsion. This can cause intermittent severe pain, nausea, vomiting, pallor and inflammation.  Ovarian torsion should be evaluated immediately.

Treatment for ovarian cysts

Cysts can be visualized and monitored with an ultrasound. Cysts that are smaller than 6 cm are usually asymptomatic and will likely only be monitored and not require intervention. Most cysts resolve on their own without treatment. Depending on the size, your doctor may recommend a repeat ultrasound in 4-6 weeks to make sure the cyst has resolved on its own. Oral contraceptive pills, also known as birth control pills, can be given to prevent new cysts from forming; however, they do not make existing cysts go away. Follicular cysts that become symptomatic or keep coming back may require surgery for removal and are an indication to start a hormone pill. Rarely, some forms of cysts identified by ultrasound will need to be surgically removed.

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Related posts:

  • Meet Dr. Alexandra Roche
    Meet Dr. Alexandra Roche, a CHOC Children’s pediatrician specializing in adolescent medicine, who was recently named a diplomate of the American Board of Obesity Medicine.
  • What to Expect at the CHOC Adolescent Medicine Clinic
    At the CHOC Children’s Adolescent Medicine Clinic, you will encounter a dedicated team of specialists whose focus is on comprehensive care.
  • What Vaccines Does My Teen Need?
    Vaccines aren’t just important for babies. Teens need to be vaccinated too! Parents should be aware of vaccines updated that will benefit their adolescents.

Is Your Teen a Safe Driver?

By Kambria Nguyen, pediatric resident at CHOC Children’s

Motor vehicle accidents are the number one cause of unintentional injuries in adolescents age 15-19. These accidents account for 36 percent of all deaths in this age group ― Six teens die every day due to motor vehicle accidents. Summer months have the highest rates of teen fatalities throughout the year, but it’s not just teen drivers who are at risk; teen passengers are also at increased risk.

There are many factors unique to teens that put them at increased risk of having an accident:

  • Teens are inexperienced drivers and may not be able to recognize dangerous situations.
  • Teens are also more likely to engage in risky behaviors such as speeding and leaving little room between themselves and the car in front of them (known as headway).
  • Teens have the lowest rates of seat belt use.
  • 40 percent of teens report texting while driving.
  • The risk of being in an accident increases with the number of teen passengers.

According to the Centers for Disease Control (CDC), nearly one-third of traffic-related deaths occurred due to an alcohol-impaired driving crash. However, drugged driving is on the rise. A recent study found that the number of people killed in crashes where drugs were present surpassed the number killed in crashes where only alcohol was detected.

In 2014, the most recent data available, 209 child passengers ages 14 and younger died in alcohol-impaired driving crashes. More than half were riding in the vehicle with the alcohol-impaired driver.

Safe Driving Tips for Teens

  • Always wear your seatbelts.
  • Follow the rules of the road.
  • Never drink and drive. Never get into a car with someone who had a drink. Make sure you have a designated driver or someone you can call if you are stuck.
  • Whether it be alcohol, marijuana or recreational drugs, impaired driving of any kind can be deadly.
  • Remember that your texts can wait. Distracted driving is dangerous.

How can you help your teen be a safe driver? Keep in mind the following tips to support your teen and their safe driving habits:

  • Before teens drive alone, supervise them driving during different times of the day and in different weather conditions.
  • Lead by example. Wear your seatbelt and do not text and drive.
  • Stress the importance of a good night’s rest as drowsy driving leads to accidents.
  • Prohibit teen passengers for the first year your teen is licensed. In California, you cannot drive between 11 p.m. and 5 a.m. or transport passengers under 20 years old, unless accompanied by a California-licensed, parent or guardian, driver 25 years or older, or a driving instructor.
  • Talk to your teen about drugs and alcohol. Discuss the dangers of impaired driving and distracted driving.
  • Sign a parent-teen driving agreement. The CDC has a template, or you can make your own.

Want important health tips sent straight to your inbox?

Sign up for our KidsHealth e-newsletter.

Related posts:

  • Meet Dr. Alexandra Roche
    Meet Dr. Alexandra Roche, a CHOC Children’s pediatrician specializing in adolescent medicine, who was recently named a diplomate of the American Board of Obesity Medicine.
  • What to Expect at the CHOC Adolescent Medicine Clinic
    At the CHOC Children’s Adolescent Medicine Clinic, you will encounter a dedicated team of specialists whose focus is on comprehensive care.
  • What Vaccines Does My Teen Need?
    Vaccines aren’t just important for babies. Teens need to be vaccinated too! Parents should be aware of vaccines updated that will benefit their adolescents.