A day in the life of a Doernbecher doc

In her spare time, Dr. Guzman loves long-distance running. Here she is at the 2015 Paris International Marathon!

In her spare time, Dr. Guzman loves long-distance running. Here she is at the 2014 Paris International Marathon!

For the last 12 years, Dr. Judy Guzman has cared for OHSU Doernbecher patients with infectious diseases. She loves working with kids because of their optimism, and it’s safe to say our patients and families feel the same way about her. Affectionately known as “The Guz” among some patient families, Dr. Guzman is also involved in several projects aimed at decreasing hospitalized children’s risk of developing infections.

This Doctors Day, we sat down with Dr. Guzman to learn what an average Wednesday looks like for her.

***

6:00 a.m.: Wake up for a morning run around my neighborhood (although the recent Daylight Saving change has admittedly made me skip a few runs…)

7:00 to 8:00 a.m.: Get my kids ready for school. They’re old enough to make their own breakfasts at this point, so I’m just a supervisor now!

8:00 a.m.: Wave kids off to school. We’re lucky to live only three blocks from our school, so they can walk – rain or shine! Once they’re on their way, I drive up to Doernbecher.

Dr. Guzman and her amazing clinic team meeting with a sweet Doernbecher patient

Dr. Guzman and her amazing clinic team meeting with a sweet Doernbecher patient

9:00 a.m. to 12:30 p.m.: Wednesday morning clinic. I have the best clinic team ever!

12:30 p.m.: Lunch. Every Wednesday I have the kale Caesar salad from the Natural Food Store next to the OHSU gift shop. It’s my favorite!

1:00 p.m. to 5:30 p.m.: Various tasks, including patient care, research meetings and conference calls. Of course, there’s always some paperwork to do!

5:30 p.m.: Head home! I spend the rest of the evening making dinner, helping my kids with their homework – general household frenzy stuff!

 

Dr. Guzman with her family

Dr. Guzman with her family

 

Judy Guzman, D.O.
Associate Professor of Pediatrics, Division of Infectious Diseases
OHSU Doernbecher Children’s Hospital

 

 

Know a Doernbecher doctor you’d like to thank? Leave a comment below or email socialmedia@ohsu.edu, and we’ll be sure to pass along your note! 

Hemangiomas: What parents need to know

As their infant grows and matures, many parents will experience and express concern about birthmarks. Up to 20 percent of Caucasian babies will have vascular birthmarks. The most common type is the infantile hemangioma, also known as “strawberry hemangioma.”

Hemangiomas are benign vascular proliferations that tend to appear in the infant’s first week of life as a faint red stain or patch. Over the next several weeks to months, the hemangioma undergoes a rapid proliferation or growth phase. When the child is approximately 6-9 months, the hemangioma’s growth halts and is followed by a very slow involution or “shrinking” phase.

Approximately 10 percent of hemangiomas involute, or “disappear” by 1 year, 50 percent by 5 years and 90 percent by 9 years. Many will never completely disappear and can leave behind some residual changes in the skin and tissues. These are most troubling when located on one’s face or neck.

While we don’t know what causes hemangiomas, we do know that there are some risk factors for getting hemangiomas, including :

  • Caucasian race
  • Female gender
  • Prematurity
  • Low birth weight
  • Multiple gestation
  • Prenatal hypoxia (pre-eclampsia, placental abnormalities)
  • Advanced maternal age


What to know if your infant has a hemangioma
The rapid growth in hemangiomas occurs during the first 3-4 months of life in most babies; close observation is often suggested during this time to determine which lesions require treatment (e.g., those causing functional impairment or those with impending complications like ulceration, obstruction of the eye or breathing passages). Early treatment (as young as 4 weeks of age) is most effective in halting the growth of these birthmarks.

Learn more about birthmarks and get in touch with our Hemangioma and Vascular Birthmarks Clinic here.

Carol J. MacArthur, M.D.
Professor, Pediatric Otolaryngology – ENT
OHSU Doernbecher Children’s Hospital

 

 

 

The Talk: Let your kid’s questions be the guide

This article was written by Megan Haverman and originally appeared in the Portland Monthly 2016 Kids’ Health Annual magazine.

It’s inevitable. Maybe a curious 4-year-old inquires after the state of an obviously pregnant woman in the grocery aisle. Maybe a kid happens upon a racy scene on TV, or hears something from friends that requires explanation. This is the moment at which many parents balk: the beginning of the discussion of the bird and the bees.

Barbara Long, M.D., M.P.H., who’s worked as an adolescent doctor for more than 20 years, says these questions are often more benign than parents believe. “Sex is not a freak-out thing, but it tends to be perceived that way,” she says. “We worry about it! But if we’re matter-of-fact and use the right kind of language, it doesn’t have to be.”

The trick, according to Dr. Long, is to answer only what’s being asked; add more detail later, or upon further interrogation. “A baby comes from the mom” can easily expand into, “Mom pushes out the baby at the hospital.” Often, that might be enough. By giving the simplest answer, parents can maintain a developmentally appropriate conversation over time.

By 9 or 10 answers become more nuanced: “Mom has an egg and dad has sperm, and they get together and make a baby.” If a child asks how, then it’s time to break things down into penises and vaginas. While Dr. Long recommends using the correct words for each body part, she says it’s more important for parents to feel comfortable.

Parents can initiate conversation outside of the kitchen table to keep the discussion light: Dr. Long suggests using television, which often implies sexual activity, as a jumping-off point to talk about dating relationships, birth control or safe sex in the context of other people.

“I want to break down the myth that kids don’t want to talk to their parents about sex,” she says. “They want to talk, they don’t want to be talked at – there’s a big difference.” Parents can make it a two-way street by asking what their child thinks is happening, or how they feel about it.

A holistic approach to the conversation also helps kids to be in a better position when they’re teenagers. “We really just want our kids to make good decisions,” Dr. Long explains. “At 13 to 15, you’ve already done your work. They’re making decisions that are a reflection of their upbringing. That’s why the ongoing discussion is important.”

 

You’re not alone!

  • An online search for “talking to kids about sex” should lead to both helpful and personal tales.
  • Planned Parenthood offers tips for talking to children at any age about sexuality, plus a parents’ guide to Puberty 101.
  • A part of the National Campaign to Prevent Teen and Unplanned Pregnancy and aimed at older adolescents and young adults, Bedsider.org features a Guy’s Guide to birth control and a section on sexual myth-busting.

All tied up with latching

Nothing compares to the excitement of being a new parent. The bond between a mother and her baby starts to form soon after birth, and it happens in many ways. Mothers have to assist their newborns in basic functions, including sleeping and eating. So when breastfeeding does not go as smoothly as had been expected, it can cause significant frustration in new parents.

When discussing this issue, something that frequently comes up is whether or not a child could have a shortened tongue frenulum, also known as a “tongue tie.”

What is tongue tie?
We all have a frenulum underneath our tongue. As we develop in the uterus, our tongue starts out fused to the floor of our mouth. As we grow, the tongue is freed, except in the midline, where a small band of tissue remains – we call this the frenulum. The size of this band and the degree to which it restricts tongue movement can vary widely.  Studies show that up to 10 percent of the population can have this condition; however, it doesn’t always cause symptoms.

What problems can it cause?
Tongue tie has been associated with breastfeeding problems, including sore nipples, poor latch and poor weight gain. A quick procedure called a frenulotomy can be performed, and at least in some cases, can be helpful to improve breastfeeding. The procedure is not without risks, although they are fairly rare; these can include bleeding, infection, injury to surrounding saliva glands and recurrence of the tie due to scarring. It also doesn’t always work to fix all issues with breastfeeding.

Because this issue has not been researched as thoroughly as we would like, the degree to which your baby may improve with the procedure can be hard to determine.  Your Otolaryngologist will work with you to weigh the risks and benefits for your particular situation in deciding whether or not to proceed.

When does tongue tie need to be treated?
The procedure is reasonable to consider when there is significant pain with nursing that doesn’t improve with time, experience and improved latching technique. Additionally, poor weight gain in a child with a tight frenulum may prompt consideration of the procedure. A consultation with a lactation consultant can be invaluable in sorting out these issues.

Tongue tie can also be associated with speech problems.  These do not usually surface until later in childhood, often between 4-6 years of age, and affect only a minority of patients that are born with a tongue tie. For this reason, clipping the tongue in a baby solely to prevent future speech problems is not generally recommended.

Lourdes Quintanilla-Dieck, M.D.
Assistant Professor, Pediatric Otolaryngology – ENT
OHSU Doernbecher Children’s Hospital

 

 

Ericka King, M.D.
Assistant Professor, Pediatric Otolaryngology – ENT
OHSU Doernbecher Children’s Hospital

 

 

 

After baby: Supporting new moms when days are full of tears

This piece originally appeared on the KinderCare blog. It’s shared here with their permission. 

Most parents will name the day their baby arrived in the world as one of their very best days of their lives.

But what if mom doesn’t feel overwhelmed with joy? What if she finds herself crying a few times a day? What if she just can’t find the energy to get out of bed? And what if all of this makes her feel she’s failing as a mother?

“The fact is that most women have some worry and occasional weepiness after they have a baby,” says Dr. Nicole Harrington Cirino, who heads the Women’s Mental Health and Wellness division at the OHSU Center for Women’s Health.

There are very real reasons for the moodiness – beyond first-days-with-a-newborn exhaustion. Immediately after child birth, levels of hormones like estrogen and progesterone (which are 20 to 30 times greater than normal during pregnancy) drop precipitously. These dramatic shifts can have a profound impact on the chemical-messenger systems of the brain, which in turn can alter a new mother’s emotions, concentration, attention and response to stress. Fatigue, exhaustion, oversensitivity, loneliness and crying: These all can be typical responses to these hormonal changes.

The tricky part for a new mom who suddenly finds herself in tears is figuring out whether her reactions are normal, or if she may be exhibiting more serious symptoms associated with postpartum depression, anxiety, or other mood disorders. Doctors call these profound changes perinatal mood and anxiety disorders (or PMAD), and they are not uncommon. One in seven women will experience postpartum depression, or PPD, after their pregnancy.

Here’s how to take care of yourself, and support new mothers, daughters, and friends when they need it – and encourage them to reach out for support if necessary.

Prepare for the possibility

Women who have a history of depression or anxiety are more susceptible to postpartum depression or other mood disorder. Other risk factors include a strong family history of mental illness, an unstable relationship with the father of the baby, economic hardship, an unplanned or high-risk pregnancy, or twins or triplets. But even women without these risk factors may experience PMAD.

If you think you may be susceptible, get your support team in place. In those early months with a new baby, getting (close to) enough sleep, eating nutritious meals and taking (some) time to care for yourself can be powerful tools to guard against depression and mood disorders. Talk to your partner, parents, friends and in-laws about what help you might need – cooking meals, doing laundry, watching the baby while you shower – and what support they can give. Don’t be afraid to get specific!

Take note of your feelings

There is a difference, Cirino says, between “baby blues,” which peaks days 3 to 5 days after childbirth and resolves within one or two weeks, and more serious conditions. The baby blues is a milder form of depression.

“These women are still able to experience joy, and their mood recovers after hours or a day,” Cirino says. “But if a woman’s symptoms persist or worsen for more than two weeks or are severe enough to really interfere with her relationship with her baby, her partner or her ability to provide care for herself, then she may need more professional support.”

It can be difficult, in those sleep-deprived days, to keep track your feelings, so enlist your partner’s help, or jot down your feelings in your phone or on a calendar.

Talk about the changes you’re experiencing

Don’t sit alone with your thoughts. Cirino recommends talking about it with a trusted friend, partner, obstetrician or primary care doctor. Speaking up, she says, can often be the hardest part.

“Some women who experience this often are successful women who are trying to do everything well and can’t admit they may be struggling and need help,” she says. “They may have no history of mental illness and do not understand it, so they blame themselves and what they think are weaknesses as a mom.”

Fortunately, we’ve become a lot more comfortable talking about PPD, partly thanks to celebrity moms like Hayden Panettiere who experienced overwhelming postpartum depression. “It’s really painful and it’s really scary and women need a lot of support,” Panettiere told “People” magazine.

Remember that depression is only one possibility

Not all symptoms show up as depression. According to Cirino, many women have heightened anxiety after pregnancy and birth. This can manifest in physical symptoms of anxiety like heart racing, shortness of breath, tremors, feelings of choking, and insomnia. Other women have obsessive thoughts about cleanliness, safety, their infant being harmed or other worries that they just can’t get out of their head. If you’re not feeling right after giving birth, but it doesn’t seem like “depression,” don’t hesitate to reach out to your doctor or other health care professional you trust.

How to help a new mom in your life who is struggling 

“Be supportive and listen without judging. Make sure moms get sleep and breaks from childcare to eat, exercise, socialize and have time to care for themselves,” says Cirino.

“Partners can also play the vital role of helping moms arrange mental health appointments and follow through on treatment plans, since sometimes it is hard to initiate and follow through on tasks when you are depressed or anxious.” Most importantly, “Reassure them of how much they are loved and help them be in contact with others who care for them and love them.”

 

The Director of Women’s Mental Health and Wellness at OHSU, Dr. Nicole Cirino was trained as a reproductive psychiatrist and has specialized in working with mental health issues experienced exclusively by women across their reproductive life cycle. Dr. Cirino has worked extensively with women and their families who experience perinatal mood and anxiety symptoms for the past 10 years.

 

Volunteer spotlight: Meet Gloria

The OHSU Doernbecher lobby is a busy place. It’s where visitors and employees go to fuel up on coffee, where colleagues convene, where students study and, often, where families and friends meet to talk, to hope, to cry, to get a moment of peace.

If you’ve been in our lobby in the last 11 years, you might already know volunteer Gloria Libby. She sits, focused, at the piano, where she plays music for the benefit of all who pass through our hospital. Unless you happen to spot Gloria’s white cane, you’d never know she’s unable to see sheet music or even the piano keys (though she does have the ability to detect light and shadows). When she was just 2 weeks old, a cerebral hemorrhage left Gloria blind.

 

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We sat down with Gloria to ask her a few questions about the healing power of music at Doernbecher.

How long have you been playing the piano?
Well, my mother says I started when I was 5, but I don’t remember playing until I was 6 or 7 years old. I went to residential schools for the blind all 12 years of my education. That’s where I took piano lessons!

What kind of music do you enjoy?
I’m classically trained, so I like to simplify and play some classics. I play a lot of hymns and I like to play oldies – songs for baby boomers and before. I also love listening to Celtic music.

Why did you choose to volunteer at Doernbecher?
[I was already connected to OHSU in a way because] my husband had a job in employee health at OHSU. Initially I reached out because I wanted to volunteer to rock babies in the NICU. I ended up playing the piano at Doernbecher instead and have been doing so for about 11 years now – it’s a special way to reach out to people. I also play at church and at the retirement home where I live.

What’s your favorite part about volunteering at Doernbecher?
I love the people here. I kind of like to hide behind the piano a bit, but I can still be social!  I especially like it when parents bring children to me to say hello. And, of course, I love visits from the animal-assisted therapy teams, including Sallie and Beau!

How do you think music helps calm and heal Doernbecher’s passersby?
I was a certified Music Therapist, and what I’m doing at Doernbecher just feels right. I think there’s a lot of unease at any hospital. There’s trauma going on; there’s life and death going on. Students, too, are learning to face these issues and I think music really helps.

***

Thank you for sharing your time and your music with us, Gloria!

A message from the Oregon Poison Center

In light of the recent arsenic and cadmium exposures in Southeast Portland, the Oregon Poison Center has the following message: The Oregon Department of Environmental Quality (DEQ) and the Oregon Health Authority (OHA) are working around the clock to respond to these exposures.

We are urging concerned citizens to keep abreast with the latest information from the DEQ and the OHA:
Click here to view the DEQ metal emissions website
Click here to view the OHA metal emissions website

The Oregon Poison Center is part of a multiagency collaboration to respond to these exposures. Our toxicology experts provide medical advice to health care providers and the public. Our hotline number is 1-800-222-1222.

Finally, we urge the public to follow our social media channels for the latest information from health authorities:
Follow the Poison Center of Oregon, Alaska and Guam on Facebook
Follow the Oregon Poison Center (@ORpoisoncenter) on Twitter

Additional coverage
“‘Should I get tested for arsenic or cadmium?’ – a doctor responds” via the Portland Mercury
 “Air at SE Portland schools to be tested Friday after toxins detected” via KGW
“Cadmium, arsenic in SE Portland air found 4 months ago” via KOIN

Questions? Please leave a comment below and we’ll do our best to get you an answer.

Give birth to hope by donating cord blood

Every minute a hero is born with the potential to save a life. The Oregon Cord Blood Program works to save the lives of thousands of critically ill patients with blood diseases like leukemia and lymphoma who are in urgent need of a life-saving transplant. Umbilical cord blood, which is typically discarded, is rich with the blood-forming cells that can give blood cancer patients hope for a cure. Donating your baby’s cord blood to a public cord blood bank can help patients get the transplants they need.

Earlier this year, a cord blood transplant saved 4-year-old Michael Wilson’s life after he was diagnosed with Krabbe, a potentially fatal degenerative disease. Krabbe, also known as globoid cell leukodystrophy, is a rare genetic disorder caused by the deficiency of a specific enzyme. Most patients with Krabbe disease present with symptoms within the first six months of life, and approximately 10 percent present later in life (including adulthood). Patients with juvenile onset disease like Michael typically present with weakness, loss of skills and vision loss. Late infantile and juvenile patients regress at an unpredictable rate, but all become severely incapacitated and usually die two to seven years after diagnosis.

Cord Blood volunteer team“It’s amazing that something once considered medical waste [umbilical cord blood] can now be used to save lives,” said Eneida Nemecek, M.D., M.S., M.B.A., project leader of the Oregon Cord Blood Program and director of the OHSU Doernbecher Pediatric Blood and Marrow Transplantation Program. “Unrelated umbilical cord blood donation may be the only chance for cure for patients who have exhausted all available treatment options and for whom no matched family members or adult unrelated donors are found for transplantation.”

What’s the difference between Cord Blood Donation and Private Storage?

When you donate your baby’s umbilical cord for public use:

  • It’s available to any patient in need of a transplant; it’s not reserved for your family members.
  • It’s free for donors. The Oregon Cord Blood Program covers the cost of collecting, processing and storing cord blood units. The donor’s name is kept confidential, and the recipient family’s privacy is protected. Names are not shared with any patient or with the transplant center.
  • It’s collected under strict quality standards to make sure the cord blood unit is usable for transplant. If standards aren’t met, the cord blood unit may be used for research to improve the transplant process for future patients, or the unit will be discarded.

Private Storage:

  • If you store the cord blood in a family (private) cord blood bank, it is reserved for your own family members. Family cord blood banks are available throughout the country for anyone. You are charged a fee for the collection and an annual fee to store the umbilical cord blood.
  • Cord blood is not a biological insurance plan for your child’s future. For some diseases, the patient’s own cells can be used for transplant. However, many diseases treated with transplant may already be present in the baby’s cord blood. For these diseases, a transplant using cells donated from a relative or an unrelated donor is the best choice.

Is there any risk when donating Cord blood?

  • Cord blood donation is completely safe for you and your baby. No blood is taken from your baby. It’s only taken from the umbilical cord itself after your baby is born. Your labor and delivery plan will not be affected. And when you donate your baby’s cord blood to a public cord blood bank, there are no collection or storage costs. Your baby’s cord blood will be listed on Be The Match Registry®, where it’s available for anyone in need of a transplant.

OHSU partners with BloodWorks Northwest to screen and bank collected cord blood units. The Oregon Cord Blood Program is facilitated by coordinator Madeleine Tuson-Turner and a group of nine amazing volunteers to provide this life-saving treatment to those in need.

Interested in becoming a volunteer with the Cord Blood Donation Program? Find out how you can volunteer.

Have questions or interested in donating cord blood? Contact Madeleine Tuson-Turner at the Oregon Cord Blood Program to get started.
About the author: Sean Robertson volunteers as a researcher at OHSU with the Cord Blood Donation Program, the Pediatric Oncology Associate Research Internship program (P.O.L.A.R.I.S.), and as a communications volunteer with the Office of Research and Academic Volunteer Services.

 

What you need to know about Zika virus

Medical and public interest has focused on Zika virus and its effects on the unborn babies of pregnant women. Zika virus is spread by mosquitoes; this virus has been detected in countries in Central America, South America, the Caribbean and Mexico.

Zika virus usually causes mild disease (fever, rash, pink eye, joint pains) and goes away without the person needing much medical attention.

However, there may be a relationship between pregnant women having Zika virus infection, and their babies having a birth defect known as microcephaly (a head size that is much smaller than expected), which may cause significant brain damage and may be life-threatening. The Centers for Disease Control and Prevention (CDC) has strongly advised that pregnant women do not travel or live in areas with Zika virus. If a woman has traveled or resided in a country with Zika virus during her current pregnancy, she is advised to discuss with her doctor how this may affect her baby.

Zika virus has been seen in the continental United States in travelers returning to the U.S. from regions with Zika virus. In addition, the mosquito that can spread the virus does exist here in the U.S. There is the possibility that Zika virus may be spread to non-travelers if they are bitten by mosquitoes who previously bit a Zika-infected person in the U.S.

To prevent Zika virus infection in all persons (including pregnant women), people should focus on preventing and avoiding mosquito bites – this involves wearing long-sleeved shirts and pants, using plenty of approved insect repellent and avoiding being outdoors, particularly at dusk and dawn.

For more information on Zika virus, including possible effects on unborn children, please view the dedicated CDC webpage, the CDC’s Questions & Answers: Zika virus infection (Zika) and pregnancy and the CDC’s Travel Health Notices.

Dawn Nolt, M.D., M.P.H.
Clinical Associate Professor
Division of Pediatric Infectious Diseases
OHSU Doernbecher Children’s Hospital


OHSU in the news:
Our experts weigh in on the Zika virus
Traveling to Mexico? OHSU shares warning over birth-defect-linked Zika virus (January 25 via Portland Business Journal)
Birth defect-causing Zika virus likely headed to U.S. (January 25 via KOIN 6)
Travel advisory for pregnant women and Zika virus expands (January 23 via Bend Bulletin)

 

2015 in review: It’s all about the patients

Social media is great for connecting families, patients, employees, donors and community members with one another and with the hospital as a whole. We love sharing Doernbecher stories and news to help foster a sense of community and provide a space where folks can support one another, get advice from experts and learn how they can give back.

Below you’ll find this year’s most-read blog posts. Happy reading!

 

1. Meet Hope, Doernbecher’s hospital facility dog 
Our chief canine officer, Hope, was a hit from the moment she stepped her paws inside Doernbecher. This post explains more about her training, her personality and how she’s bringing hope to our halls.

2. Eleven things your ‘well child’ wants you to know
Pediatric resident Dr. Antwon Chavis shares how his brother’s autism defined him as a “well child” and shares 11 tips for parents and families with special needs children.

3. Isaiah’s Doernbecher story
Isaiah’s mom, Melissa, shares what it was like discovering her son had a brain tumor and offers tips for parents (stay away from Google!) who are going through similar challenges.

4. Once upon a time: Mae Lin’s Doernbecher story
You’ve probably heard Mae Lin on the radio! She was born when her mom, Dr. Dawn Nolt, was only 28 weeks pregnant. Dr. Nolt walks us through what it was like being both a mother and a doctor in the hospital where her daughter was treated and shares her pint-sized hero’s NICU story. Click here to listen to Mae Lin’s radio spot!

5. Five things you might not know about cancer survivorship
Dr. Susanne Duvall
and Dr. Caroline Grantz shared five helpful tips for patients and families who have completed active treatment for cancer. A great resource for family members and friends who want to know how to support survivors and caregivers, too!

6. Six strategies to improve your baby’s sleep skills
Part of an ongoing series, sleep expert Dr. Elizabeth Super shares six common-sense approaches for breezier ZZZs.

7. Behind the scenes: Doernbecher Freestyle XII
For the first time, we went behind the scenes of the Doernbecher Freestyle program, where our patients are teamed up with Nike designers and developers to create custom shoes and apparel. The Nike team weighed in on why the program is so important and impactful for them – and why it’s the highlight of their year.

8. Our lemonade experience: the Charles family’s story
Doernbecher Freestyle patient-designer John Charles was diagnosed with Crohn’s Disease last year. His parents, Tony and Mary Charles, explain how his diagnosis impacted their family and why they’re so committed to building awareness for others dealing with Crohn’s. Fun fact: John Charles can swallow seven pills at once!

9. A ‘purrfect’ pair: Meet Doernbecher volunteers Huck and Carol
Big cat, big smiles. You’ve likely seen Huck Finn and his human, Carol, wheeling around the halls of Doernbecher. Huck, a Maine Coon cat with a “checkered past,” has an enormous impact on our patients and families.

10. The vaccine every teenager needs
Dr. Jennifer Edman explains why the HPV vaccine is important for all teenagers (yep, girls and boys!) and when they should get vaccinated to prevent infection from the most common strains of HPV.

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