Doernbecher physician competes in Ironman triathlons to benefit pediatric dentistry program

Jeffrey Koh, M.D., head of anesthesiology, OHSU Doernbecher

I was fortunate to compete in my seventh Ironman distance triathlon last November in Tempe, Ariz. As has been the case for all my Ironman races, I have paired my personal athletic journey with fundraising for one of Doernbecher’s very important programs. The past three years I have raised money for the Doernbecher Pediatric Dentistry Program, which provides much-needed dental care to the children of Oregon.

Oral hygiene in children remains a huge public health problem in our country, and the program at OHSU Doernbecher is working hard to help through direct care, research and education of the next generation of pediatric dentists.

Every year, I am reminded of the dedication required to prepare yourself for the 140.6 total miles traveled in an Ironman swim, bike and run. This effort pales in comparison to the strength and determination shown by our staff, patients and parents here at DCH.

While I have many personal reasons for putting myself through this every year, the fundraising I am able to accomplish truly completes the experience for me. I am grateful to be healthy enough to compete in these amazing events, to have the support of family and friends, and to work in an amazing place like Doernbecher where I am inspired daily by those around me. To those who think an Ironman is out of reach, I will simply say life is too short to wonder if you can do something, the real fun is trying!

Jeffrey Koh, M.D.
Professor and Chief, Division of Pediatric Anesthesia
OHSU Doernbecher Children’s Hospital

A beautifully illustrated concept

For surgeons trying to explain a new concept, surgical technique, or anatomical insight, a picture may truly be worth a thousand words. That is why I am always excited to work with my colleague Andy Rekito, an award-winning medical illustrator and artist, and assistant professor of neurosurgery at OHSU.

Whether I am representing Doernbecher’s neurosurgical work to the public, teaching neurosurgical young faculty and residents safe and proven techniques, or presenting an important new finding to colleagues around the country, one of Andy’s carefully designed and meticulously crafted illustrations are often what drive my message home and what my audience will ultimately remember.

A great example is surgery to treat a birth defect that occurs at the junction between the skull base and the top of the spine, called Chiari malformation. Doernbecher was one of the earliest hospitals in the United States to adopt and then systematically analyze a new, less invasive form of surgery for Chiari malformation.

Like traditional methods, this operation relieves pressure on the junction between the brain and spinal cord, restoring brain function. The unique aspect of the new technique is to preserve the skull lining that contains cerebrospinal fluid and protects the brain itself. This approach avoids some complications, reduces time in the hospital and even saves health care resources.

Recently, my colleagues and I published a major analysis of the outcomes of Chiari decompression surgery using the new technique compared with the traditional method. In addition to sharing the outstanding results of the new operation, I also wanted to give other neurosurgeons around the country important information about how to accomplish the surgery. That is where Andy Rekito’s illustrations came in.

In fact, not only were his anatomical and surgical illustrations effective in conveying the key concepts, they were also spectacular artwork that helped earn our paper the cover of a world-leading journal, Neurosurgery.

OHSU/Doernbecher neurological surgery is constantly striving to make care better, and to share our advances with others in the field to benefit all children. Outstanding colleagues like Andy make that possible.

Nathan Selden, M.D., Ph.D.
Mario and Edie Campagna Chair of Pediatric Neurosurgery
Director, OHSU Neurological Surgery Residency Program
OHSU Doernbecher Children’s Hospital

 

 

Share a room with your baby, not a bed

Although sharing a bed with your infant can be common, sound research recommends against it. The American Academy of Pediatrics (AAP) recommends infants and their parents share a room, but not a bed.

The AAP updated their policy statement on “Sudden Infant Death (SIDS) and Other Sleep-Related Infant Deaths” in 2011 with specific recommendations that infants sleep on their own sleeping surface.

Having an infant sleep in a crib or bassinet decreases the risk of SIDS by as much as 50 percent. Room sharing without bed sharing allows for parents to be close enough to easily feed, comfort and monitor their baby.

Although parents feel they can easily monitor their children while asleep and bed sharing, studies have shown an increased risk of infant overheating, airway obstruction, head covering and exposure to tobacco smoke that can increase the risk of SIDS.

An adult bed is simply not designed for an infant, even with the best of parent intentions.

Babies younger than 3 months who were born premature and/or with low birth weight are at the highest risk from bed sharing due to low muscle strength and immature motor skills.

Parents need to be informed that bed sharing is dangerous. Sharing a room with your child facilitates bonding, feeding and comforting during the night without any risk to the infant.

Ask your pediatrician if you have further questions about infant sleep safety, or visit the American Academy of Pediatrics website.

Elizabeth Super, M.D.
Assistant Professor of Pediatrics
Pediatric Sleep Disorders Medicine Program
OHSU Doernbecher Children’s Hospital

5,000 books for 5,000 smiles

Andrew Herinckx

Imagine a child with a serious medical condition. Imagine that child and his family waiting for surgery. Preparing to undergo a medical procedure. Passing the time during recovery. Now imagine that child and family reading. Calming their minds. Trading their current reality for something magical. This is the power of a book.

Hi, my name is Andrew Herinckx, and I am a Boy Scout with Troop 618 in Beaverton, Ore. As part of a service project to earn my Eagle Scout rank, I worked to collect books to help children and families pass the time while in the hospital, or while recovering from a health crisis. My goal was to collect 5,000 books.

Boy Scout Troop 618, Beaverton, Ore., collects 4,000 books for Doernbecher.

My book drive included developing a theme – “5,000 Books for 5,000 Smiles” – posters and fliers to promote the book drive. I conducted the book drive in November at two local churches, a school and by doing neighborhood canvasing of more than 3,000 homes in the Beaverton area. I organized more than 60 volunteers to help over three weekends to leaflet neighborhoods, collect books and deliver them to OHSU Doernbecher Children’s Hospital and the Ronald McDonald House.

Boy Scout Troop 618 at OHSU Doernbecher.

In the end, we collected more than 12,000 children’s, youth and adult books.

Approximately 4,000 of the books were not usable/appropriate, but that left more than 8,000 that were in good condition to donate to the beneficiary organizations. I estimate that roughly 4,000 were given to OHSU Doernbecher and 4,000 to the Ronald McDonald House. Both organizations were thrilled to receive the book donations and were grateful for how the service project would help many families.

I appreciate the community support and am grateful to OHSU Doernbecher Children’s Hospital for allowing me to conduct this service project to help earn my Eagle Scout rank.

Andrew Herinckx
Troop 618
Beaverton, Ore.

Pack a nutritious school lunch that’s fun to eat!

Q. What can I pack in my son’s school lunch that is nutritious and fun to eat?

A. Sandwiches made on whole-grain bread with a lean protein like turkey ham or chicken are easy to make, affordable and convenient  to take to school.

Some children like lettuce or sliced cucumber on sandwiches, but many are picky about vegetables. Try offering small vegetables like baby carrots, cherry tomatoes and sugar snap peas to dip in a small amount of low-fat dressing.

If you’re unsure about portion size, choosemyplate.gov is a helpful resource. Enter your child’s age and get a guide on serving sizes.

One way you can save time while packing lunches is with a “Shop and Chop” day: When you get home from grocery shopping, clean chop and prepare vegetables in separate containers so packing lunches all week is a breeze.

Jennifer Kim, R.D.
Healthy Lifestyles Clinic
OHSU Doernbecher Children’s Hospital

When mental illness pushes kids out of control, Doernbecher psychiatrists help restore peace

Kate and Kira Smith

Twin sisters Kate and Kira Smith often talk in an excited duet, finishing each other’s sentences to share an idea or observation. Playful and affectionate, they readily hug and say, “I love you.” They are best friends.

Four years ago the twins were fighting constantly, sometimes cruelly, destroying each other’s treasured possessions. Competition and comparison ruled their relationship. Each felt an uncontrollable compulsion to do exactly what the other was doing. One would not sit down until her twin did. They worried obsessively about who was consuming fewer calories or exercising more. They were dangerously thin.

Kate and Kira felt out of control. “You can’t think about anything else,” said Kate. “You realize it’s totally irrational, but still, you can’t stop thinking about it.”

The twins’ parents, Rebecca and Preston, were desperate to find help for their daughters. But some of the mental health practitioners they spoke with didn’t seem to understand the complexity of twin relationships. Others were quick to offer a diagnosis of “eating disorder,” rather than looking deeper into the root causes of the twins’ behavior.

Life changed when Rebecca was referred to Ajit Jetmalani, M.D. at OHSU Doernbecher Children’s Hospital. Jetmalani leads Doernbecher’s Division of Child and Adolescent Psychiatry. He and his team of mental health specialists recognize that mental and physical health are inextricably linked.

With respect and compassion for each individual, Jetmalani builds patient relationships based upon honesty and trust. For Kate and Kira, these were the keys to finding their way back to a healthy relationship. “Everyone deserves a good doctor like that,” said Kira.

Jetmalani recognized Kate and Kira’s intelligence and intellectual curiosity and treated them accordingly. He diagnosed the twins with an obsessive-compulsive disorder (OCD), explained to them how it affects the brain, and shared his experiences treating other teens with OCD. He patiently but firmly challenged the girls to take small steps toward new behavior, starting with the simple act of sitting down at different times when they arrived at their weekly appointment.

Most importantly, he taught Kate and Kira that OCD was their enemy, not each other. The concept of a battle they had to win resonated with both girls, whose interests include medieval weaponry and female warrior heroines (Kate), and the Victorian era and women’s rights (Kira).

Over time, moments of calm turned into days of calm. The constant fighting stopped. The girls felt happy for the first time in years. Today, Kira and Kate say that they – not OCD – are in control.

The girls had the opportunity to express their gratitude – and their creativity – as participants in this year’s Doernbecher Freestyle program, a collaboration with Nike in which Doernbecher patients design Nike shoes to benefit the hospital. Kate’s shoe is decorated with a coat of arms and the words, “You are stronger than you think you are.” Kira’s features a playing card motif, a reference to Alice in Wonderland and its themes of madness and a key that unlocks a small door.

Parents Rebecca and Preston are deeply thankful for OHSU’s program. “My children were on the side of a cliff, stranded on a little ledge,” said Rebecca. “Dr. Jetmalani picked them up and put them on firm ground.”

Jan O’Dell
OHSU Doernbecher Children’s Hospital Foundation

From a physician-parent’s perspective

Maddy gets an EEG.

Everyone always says that pediatricians become better physicians once they have children of their own. When I found out I was pregnant with my first child, I started to envision each patient as my own child, and it changed me, for better or for worse. I cried more, I smiled more, and I just cared more. I was able to look at situations from the perspective of a parent, and I could not imagine what it must feel like to watch your child, the most important person in your life, endure the unavoidable discomforts of being a hospitalized patient.

Imagine my relief when I was blessed with a healthy, beautiful, full-term baby girl. The first couple of days were a surreal blend of joy, stress, love and an overwhelming sense of responsibility. After the first night at home, I really felt like we had overcome a major hurdle and that things would surely get easier from there. I told myself that if we were all going to survive, I needed to stop using my medical brain and start just being a mom.

That’s why on day of life 3, when my daughter started having what seemed like abnormal movements of her left arm, I told myself that most people probably would not have even noticed. I told myself to stop being a paranoid physician-parent who knows too much, and to just relax. Turns out I knew just enough.

What started off as focal upper-extremity movements progressed to left-sided seizures lasting up to 3 minutes at a time. All I could think was “please God, no, not seizures. Anything but seizures.” What happened in the hours thereafter is a bit of a blur. My mind ran through what we all refer to as a “differential,” and no matter how I approached it, the conclusion was the same: seizures = badness.

On the way to the hospital, I remember walking through what would happen, step by step, with my husband. I knew exactly what labs would be drawn, what procedures would be done, and what treatments would be initiated. I was literally as prepared for what was to come as anyone could be. But still, when it all actually happened to my precious baby girl, I felt like I had been punched in the stomach by Mohammed Ali.

I cannot even begin to describe what the following days were like. Words like terrifying, excruciating, mind-numbing and exhausting don’t even come close to describing it; there are literally no words. During that week, I experienced life as the parent of a sick child. It was the worst week of my life, and I’ll be damned if I’m going to let my daughter and my family experience something like that without learning something from it. This is what I learned:

Just make the time.

Maddy goes home!

The most important part of our day while in the hospital was meeting with the medical team each morning. Learning updates, getting questions answered and having a daily plan made it feel like each day we were getting closer to my daughter being healthy again. From experience, I know that morning rounds often feel cumbersome and even annoying if “too much” time is spent in a patient’s room. But do we really have so much to do that taking an extra 5 or 10 minutes to answer a worried parent’s questions will significantly alter the course of our day? No, not really. That extra 10 minutes the team devoted to my daughter meant the world; it was the difference between feeling like we were part of the team versus feeling like we were a checkbox. Every single day we should work to ensure that our patients and their families know that we value their health and comfort more than we value our own time.

Every single poke sucks. Period.

Sure, lab draws and procedures are a necessary “evil” of medicine. And as we all know, peripheral IVs are lost regularly, and it often takes multiple attempts to draw labs on a pediatric patient. But what we don’t realize, as the ordering physician, is how painful it is for a parent or loved one to watch those multiple attempts. And furthermore, how much trust a parent must have in the medical team to allow those attempts to occur. The fact that the majority of parents give us permission to continually poke their child without fully understanding why we need to do so is nothing short of amazing. The level of trust patients and their families have in us is truly humbling. Every lab, every procedure and every intervention we make should be thought about; if not, we’re abusing the trust we’re given and we’re not doing our job.

Everyone has a breaking point.

Maddy’s baptism.

As physicians we’ve all had the experience of caring for a patient, complex or not, and been amazed by the level of composure maintained by the patient’s loved ones. We’ve also all experienced caring for a patient whose loved ones at one point or another lost that composure. Loss of composure during a hospital admission is expected. What is difficult to anticipate, however, is when that composure will be lost and what event will tip a parent “over the edge.”

During my daughter’s admission I was able to handle LPs, multiple IV attempts and EEGs with what I think was impressive composure. But when she got antibiotic-induced diarrhea, I literally had a complete meltdown. For whatever reason, I just couldn’t handle the thought of her having to deal with just “one more thing.” Since then, when I go in to tell a family that we’ve had an unexpected complication, if I am berated and the blame falls to me, I try to take it in stride with grace and humility. I try to remind myself that it is not an attack on my character or my ability as a physician, but rather a parent’s way of coping with what is likely one of the most traumatic experiences of their child’s life.

Being a pediatrician, the person responsible for the well-being of a child, scares me. And we should be scared. We should be scared enough to think hard about each lab we order. We should be scared enough to find the energy to go home and read the latest research to ensure that our diagnosis is correct and that our plan for treatment is the absolute best available. And we should be scared enough to let ourselves feel the emotions that accompany such responsibility. Those emotions keep us from becoming robots that are simply trying to survive the grueling life that is the reality for practicing physicians. Each and every day, I remind myself of what it was like being on the “other” side, and each and every day, no matter how exhausted I am, I am thankful.

Sara Rourke, M.D.
Third-Year Resident in Pediatrics
OHSU Doernbecher Children’s Hospital

 

Bringing comfort to families in the Doernbecher Neonatal Care Center

Having a baby in the Neonatal Intensive Care Unit (NICU) can feel like you are on a roller coaster. It can be both joyous and stressful, happy and scary.

That’s why the March of Dimes NICU Family Support Program in the Doernbecher Neonatal Care Center (DNCC) is focused on bringing information and comfort to families during their NICU stay.

The NICU Family Support Program provides support and a variety of activities for families, including group craft activities, group meals, sibling activities, photography, special events, including NICU baby showers, holiday parties and much more. The program also welcome donations of certain craft items, including yarn, scrapbooking materials, meals and more.

The program is looking for volunteers, including NICU graduate families. While a baby is in the NICU, many families appreciate the support they get from a parent “who has been there.”

If you are interested in learning about volunteer or donation opportunities, or if you are a graduate of the DNCC and want to reconnect, please contact: jhorner@marchofdimes.com. All NICU Family Support volunteers must complete the required screening and training requirements.

Jennifer Horner
March of Dimes
NICU Family Support Specialist
OHSU Doernbecher Children’s Hospital

 

Newborn screenings: what to expect in hospital right after birth

For those of you who are expecting new babies, congratulations! In addition to getting to know your newborn and learning to care for her, there are many things that happen in the hospital after a baby is born that you should be aware of.

It may seem like a lot of poking and prodding around your perfect new baby, but each test is done for a very specific and important reason. All are designed to make sure your baby is healthy and has the best start in life.

You can talk to your baby’s future health care provider about these topics to learn more.

Vitamin K

All babies are born with a low vitamin K level, which is an important factor in helping a baby’s blood clot. That’s why we give all newborns a vitamin K injection shortly after delivery. The vitamin K shot helps prevent a type of bleeding called vitamin-K deficient bleeding (hemorrhagic disease of the newborn). This rare but serious condition can range from bruising of the skin to bleeding inside the baby’s brain. Unfortunately, there’s no way to tell who will be affected and vitamin K is not found in breastmilk or infant formula (Pediatrics).

Bilirubin

It’s normal for almost all babies to look a little yellow, or jaundiced, after birth. A blood or skin test  measures the baby’s amount of jaundice (bilirubin) after birth. Infants with very high levels of bilirubin are at risk for neurologic problems. This test can detect severe jaundice early, so that it can be treated right away, often with simple light therapy (Healthline).

Erythromycin

Newborn’s eyes are treated with erythromycin ointment, an antibiotic to prevent the development of bacterial conjunctivitis (eye infection). This preventive treatment is safe, easy and effective in preventing sight-threatening eye infections (Healthfamilies.org, American Academy of Pediatrics).

Hepatitis B

Vaccination of all newborns with hepatitis B vaccine, regardless of mom’s hepatitis B status, is recommended. The earlier a baby receives the first hepatitis B vaccine, the better protected she is in cases of unknown maternal infection or accidental exposure (Aboutaids.org, U.S. Dept. of Health and Human Services).

Newborn screen

Here in Oregon, babies receive the first newborn screen in the first day of life and the second one around two weeks of age. A few drops of blood from a heel prick are sent to the state public health lab. You and your baby’s provider will be contacted if anything abnormal is found (Oregon.gov, Oregon Health Authority).

Hearing screen

Hearing loss is the most common congenital condition in the United States. We screen all newborns in the hospital soon after birth to identify infants with hearing loss as early as possible. Early identification has been shown to improve outcomes (Healthchildren.org, American Academy of Pediatrics).

Heart disease screen

A pulse oximetry probe, which looks like a piece of tape, is placed on an infant’s hand or foot to measure the amount of oxygen in the blood. This test is not painful and can detect certain types of congenital heart disease in infants. Without screening, some newborns with heart defects might be missed because the symptoms may not be evident before they go home (Centers for Disease Control and Prevention).

Lauren Harris, M.D.
Second-Year Resident in Pediatrics
OHSU Doernbecher Children’s Hospital

Carrie Phillipi, M.D., Ph.D.
Associate Professor of Pediatrics
OHSU Doernbecher Children’s Hospital
Director, Mother-Baby Unit
OHSU Hospital

 

Leadership matters

Jodi Coombs, M.B.A., B.S.N., R.N.

We are always bringing new talent to OHSU Doernbecher Children’s Hospital. Usually that means we are looking for a surgeon who can bring new expertise or pediatric specialists who have innovative research programs or who bring new programs to our children’s hospital. I’m particularly excited about two talented people that we’ve brought to the Doernbecher leadership team.

Last winter, Jodi Coombs, M.B.A., B.S.N., R.N., came to Doernbecher from Boston Children’s Hospital to be the Vice President for Women & Children’s Services. Jodi has been a leader in some of the best academic children’s hospitals in the United States.

In addition to Boston, she has worked at Vanderbilt and Stanford (Lucille Packard Children’s). Jodi’s nursing background informs her practice as an administrator, and she has been a great partner in advancing care at Doernbecher this past year.

Ken Azarow, M.D., F.A.C.S., F.A.A.P.

A few weeks ago, Ken Azarow, M.D., F.A.C.S., F.A.A.P., joined the Doernbecher leadership team as our Surgeon-in-Chief. Ken comes to OHSU Doernbecher from the University of Nebraska, where he was a Professor of Surgery, and he had a long career as a pediatric surgeon in the United States Army before moving to Nebraska. In addition to being a superb surgeon, his extensive leadership training and experience will serve us well. We are indeed fortunate to have recruited Ken.

Among our other tasks, Jodi, Ken and I will be working hard to ensure that our Doernbecher surgical services are second to none. Ken will also be working on a daily basis with our anesthesia and nursing leadership in the Doernbecher operating rooms to monitor and enhance the quality of our services.

We have a lot of work to do. Just a few of our tasks include:

  • Building new operating rooms, one of which will include an intraoperative magnetic resonance imaging (iMRI). The iMRI will ensure that our children with brain tumors and epilepsy are getting the very best cutting-edge care.
  • Planning for how to bring new technologies to other surgical programs, including upgraded operating rooms for our cardiac surgery program and minimally invasive surgical programs to many of our surgical subspecialties.
  • Helping advance our ability to provide outpatient surgical services – children are best off when home with their families. How do we best support families in providing more of the care at home.
  • Recruiting the next generation of Doernbecher surgeons.

Doernbecher is a great place. With these great partners in leadership, I’m very bullish on the future of Doernbecher. Everything we do is on behalf of the kids and families that we serve.

H. Stacy Nicholson, M.D., M.P.H.
Professor and Credit Unions for Kids Chair
OHSU Department of Pediatrics
Physician-in-Chief
OHSU Doernbecher Children’s Hospital

Doernbecher Children's Hospital

Doernbecher Children’s Hospital

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