A letter from one ‘well child’ to another

A few weeks ago, pediatric resident Dr. Antwon Chavis wrote a blog post called “11 things your ‘well child’ wants you to know.” This week, he’s back with a letter for all the other ‘well children’ out there. 

Well Child Photo for TW

Hey there,

My name is Antwon. I heard you’re the sibling to a child with special needs, like I am. I wanted to write you a letter explaining why I think you’re amazing, and how lucky I think you are. I know your life seems harder than a lot of people that you know, but to be honest, you’ll be better off because of it.

I know you deal with more than kids your age should. Your parents spend a lot of time caring for your sibling and taking care of regular doctors appointments, hospital stays and phone calls. You see the love and patience they have when taking care of him or her. They never stop trying to get what your sibling needs, and they lose sleep so you and your sibling are well cared for. You’re going to learn so much from them! Believe it or not, your parents are teaching you how to be a good person and an amazing parent.

I know that this is hard to take into consideration, as you struggle with jealousy and worry for your sibling. You struggle with anger because you can’t go to every school or social activity you’d like. You struggle with embarrassment as your friends don’t always understand, and then guilt because you felt embarrassed. Or worse, guilt that you are healthy while one of your best friends is not. You know what? I get it! You totally have the right to feel like this sometimes. And its normal, and I’ve felt the same way. But it gets so much better as your and your sibling get older.

Do you know what’s awesome? Your sibling loves you in a way that most adults will never understand. They look at you and know how important they are to you, that you lose sleep crying for them, that you struggle with envy and guilt but that, regardless, you play with them like no one else can. You are their friend and protector. Even if they, like my brother, can’t speak, you both can carry out entire conversations that no one else understands. I bet you guys even have inside jokes. Friend, let me tell you – that is extremely cool!

Your parents see what you do for your sibling, and they are so very proud of you. And they don’t always know how to say it. They notice when you stop what you are doing to smile at them, to give them a hug or a kiss, or a hello. They see how softly you speak to them. They see how gently you play with them. They watch you go out of your way to include them in the things you do. They even know about that time you got in a fight with the kid next door to protect them. And they are so thankful for you. You are so helpful to your parents, even if you don’t know it. It takes a special person to do your job, and no one on earth could do it like you do.

Lastly, friend, promise me that you will remember something. In a very unique and indescribable way, you know love, you know heartache, and you know what is truly important. These lessons aren’t easy to learn, and they will eventually define who you are. They’ll cause you to mature much faster than your friends. They’ll cause a stranger to pull your parents aside and tell them how impressive you are. They’ll give you a weird sense of humor and ability to find joy in almost anything. You are an awesome person and even at your young age, you have changed the lives of others for the better. All because you are the sibling of a child with special needs. Enjoy your journey, friend!

With love and admiration,

Antwon

Antwon Chavis, M.D.
Resident in Pediatrics
OHSU Doernbecher Children’s Hospital

Dr. Chavis has a wide array of interests, including working with teenagers, children with mental health concerns and children/adolescents with behavioral or developmental issues. He enjoys working with older children and their families because he gets the opportunity to educate the patient directly, as well as the family that cares for them.

Lizzy’s Doernbecher story

When 10-year-old Doernbecher Freestyle patient-designer Lizzy Olivan came down with a fever last summer, her mom Beatriz knew something wasn’t right. We sat down to learn more about Lizzy (now 11) and her battle against Acute Lymphoblastic Leukemia (ALL).

***

Can you tell us more about Lizzy’s diagnosis?

Last August, she came down with a fever. I gave her some Tylenol and kept a close eye on her. After four days, I took her to the pediatrician, who thought she was likely fighting some sort of virus. It wasn’t normal for Lizzy to have a fever without a cough or other cold symptoms; I figured her little body was trying to fight something, but just didn’t know what.

Two or three days after that, I took her back to the doctor – she still had a fever and was pretty lethargic, just not acting like herself. Normally, she’s pretty dark by the end of the summer, but she looked pale – gray, almost.

Our doctor took and sent out a full bloodwork panel, and she called us that same evening to let us know it looked like Lizzy might have leukemia. Our doctor sent Lizzy to our hospital in The Dalles (Mid-Columbia Medical Center) right away, and from there she was transferred to Doernbecher.

She started treatment about two days after we arrived at Doernbecher, once they had determined what kind of leukemia it was. We were there for eight days, and then we got to go home to start the regular chemotherapy treatments.

What was Lizzy’s diagnosis like for you as a mother? Lizzy dance

Having worked in a dialysis center, I understood a lot of the medical terms when Liz was diagnosed. It made it much easier to understand everything going on and how things worked.

That said, it all happened really fast. Other than having her tonsils removed when she was 6, Lizzy has always been really healthy and active, so I didn’t expect it to be anything this serious. A few weeks before she was diagnosed, we were in Seaside, where she was competing in a national dance competition. She had complained about some abdominal pain, but we thought it must just be muscle soreness from her swimming and dancing. She’s a busy girl!

We’ve heard Lizzy’s physicians adore her! What was her time at Doernbecher like?

Lizzy really appreciates and likes her doctors. At a recent appointment, we heard that Dr. Lindemulder is a fantastic baker. Lizzy asked her about that, and Dr. Lindemulder promised to bring some cupcakes to her next IV treatment.

During her latent intensification period, which was every other week, we were at Doernbecher spending four to five days inpatient while she got a high dose of chemo. On one of those trips, she was bored – it was getting close to Christmas, and she wanted to be home. Our doctors asked if there was anything they could do for her, and Lizzy asked if anyone could get her a slushy. Dr. Garland went out to 7-Eleven and brought her a slushy. It was definitely a moment she (and I) will never forget!

Where is Lizzy at with her treatment today?

She’s been in maintenance since May. For her, that means she’s taking oral chemotherapy here at home in The Dalles and receiving IV chemotherapy once a month in the outpatient clinic at Doernbecher. That’s what it will look like for the next two years.

Lizzy turned 11 in June, and she just started middle school this fall. She’s playing flute in the band, and she’s back to dancing. She also teaches the little ones to dance tap and jazz. On top of that, she was just elected treasurer for her sixth-grade class and she’s a junior cheerleader. I tell her she needs to slow down!

Our family has become involved in raising awareness about ALL and other cancers that affect both kids and adults. We were involved in the Be The Match Walk+Run at Doernbecher and participated in Relay for Life as well.

What would you tell other parents and families who are going through what your family faced with Lizzy’s ALL diagnosis?

It takes time, and it will get better with time. These doctors know what they’re doing. They will do anything and everything in their power to help your child. Ask them any questions you may have – they will get you an answer. They’re amazing, they know what they’re doing and they will take care of your child.

I want to thank Doernbecher and the whole staff – everyone who has become a part of our lives. We’re very, very grateful for them.

***

Meet Lizzy and the rest of this year’s incredible Doernbecher Freestyle patient-designers here – we hope we’ll see you at this year’s collection reveal and auction on October 23!

How to talk to your kids about tragedy

How can parents and guardians best help kids understand and process tragedy? What does a “normal” reaction look like?

Below, OHSU Doernbecher Children’s Hospital Child Psychiatrist Ajit Jetmalani, M.D., provides guidance for families in the days and weeks following a high-profile disaster or tragedy.

  • Parents should be aware of their own reactions to these tragedies and attempt to refrain from alarming their children through verbal or non-verbal cues. Children often become concerned about their own safety or the safety of their families upon hearing of tragedies. Children often take their parents’ lead as to how to react.
  • Every child’s reaction is unique to his or her personality, developmental stage and experiences. Create a sense of openness to discussion but avoid pressuring children to talk.
  • It is important to make sure children understand that the events that took place are rare occurrences and that children remain quite safe and secure.
  • Parents should monitor their kids’ TV watching and make sure they are not overly exposed to tragedies such as these. News reports are too fast for kids to absorb. In addition, children process this type of information much differently than adults and think of the personal impacts more often than adults do.
  • It’s OK to proactively talk to your kids about these events, as they will likely hear about them later. Be sure to provide limited detail and highlight the rarity of such occurrences.
  • Experts also think that children who are preschool age and younger do not need to be provided with details of these events unless they ask.
  • Encourage kids to talk about how they are feeling and respond to those concerns.
  • Remember that loving and supportive relationships can protect against anxiety. Reinforce those relationships and remind kids how families help protect children.
  • Look for signs that a child is struggling to cope with their emotions: for young children; increased fear of separation, regression of skills (bed wetting, not wanting to dress themselves), hyperactivity or anger. For older children; increased isolation, irritability and seeming withdrawn or disinterested in school and friends. If you see these issues, talk to your child and seek assistance if necessary.
  • Parents strive to make the world as safe as possible for their children. When things like this happen, it feels like the shield is broken. We can’t control natural disasters and horrible violence, but we can control how we express love and compassion on a daily basis. We can continue to set clear expectations and provide instruction about how to be generally safe in society. Reminding children and adolescents about safety precautions they can take day to day can support an eventual return of a sense of safety in your family’s life.

Additional Resources
Dr. Jetmalani also recommends the following National Child Traumatic Stress Network resources for parents and caregivers:
Psychological First Aid Field Operations Guide
Tips for Parents on Media Coverage
Age-Related Reactions to a Traumatic Event

This post originally appeared on the OHSU News and Events site

Five things you might not know about cancer survivorship

Cancer-Survivorship-graphic-Doernbecher

1. Worry doesn’t go away when cancer does.
While completing the final chemotherapy and/or radiation appointment is a huge milestone in the family’s journey, just because active treatment is over does not mean that the family is “out of the woods.” Active treatment can provide an easy focus for the family’s worry, and once that has completed, the family must transition to a new “waiting game.” We often hear that transitioning away from frequent hospital and clinic visits and decreasing interactions with the medical team can be scary, because “no one is checking” (on the treatment progress) as frequently.

It’s normal in this time period to continue to experience a variety of emotions, such as fear about cancer coming back, anxiety and/or anger. Families can benefit from continued support and check-ins from loved ones during this time. Distractions (e.g., mini vacations, going to the gym, having a babysitter for date night) can help families cope with the waiting.

2. It can take a while to transition to a new normal.
Patients and families have been focused on medical efforts for a prolonged time; it can take a while to switch gears. The medical team often becomes a part of the family, and no longer seeing them as often means the family isn’t getting the encouragement and social support they were used to. It can be difficult for the entire family to transition back into work and school settings because these settings tend to be faster-paced and less focused on each individual, which can feel like a huge change from the personalized interactions with medical staff.

Additionally, the child and family are now faced with making decisions regarding who and how to tell people about the child’s medical history. Finally, if there are new limitations or long-term physical or mental changes as a side effect to treatment, adjusting to these new aspects in the family’s regular daily life can take time and effort. It can be easy to assume that now that “cancer is gone,” everything will return to normal. For many childhood cancer survivors, normal looks different after treatment. Checking in regarding ways to help (e.g., installing accessibility ramps) can help families feel less overwhelmed by any new needs their child has.

3. Caregivers: Take care of yourself, too.
It can be easy to neglect your own needs when a loved one is battling cancer or transitioning to survivorship. When you feel like your loved one is in a crisis it’s common and often necessary to prioritize the patient’s needs. However, treatment is often a marathon, not a sprint, and it’s important to keep everyone balanced and healthy.

Just like they ask you to remember on the airplane, parents and caregivers are encouraged to put on their “oxygen mask” first before assisting others with the idea that if you are not taking care of yourself, you won’t be able to help others. This is true for many of life’s events and phases: If you aren’t taking care of yourself (e.g., eating right, sleeping well, getting social support) you will not have much energy to support others. Additionally, as patients are coming out of the most active phases of treatment, it’s common for caregivers to feel guilty if they begin to go back to regular self-care routines. It’s important to recall that whatever helps caregivers feel happy, healthy, and balanced will also translate into better care for patients.

4. There are many ways to cope.
A good rule of thumb is: “If it’s not getting in the way, it’s OK.” The process of transitioning from being an active patient to reintegrating back into the community and your previous roles can be challenging. It’s good for people to start getting back to basic tasks of daily living, like going to work and/or school, completing daily tasks, eating well, sleeping well and engaging with others socially.

As a support person (e.g., friend, coworker, neighbor, family member), check in with patients about how you can best support them. Visiting, talking, having a book club, going on outings, or just sitting and watching TV together can help with social isolation. Some people appreciate having a good listener to talk to about their feelings and experiences, while others prefer not to talk about the cancer-related experiences and instead talk about lighter everyday topics. Both preferences are OK. It’s pretty typical not to want to talk about cancer or not to go right back to previous activities, hobbies or friend groups; this does not necessarily mean that the child and family are not adjusting or coping well. However, it’s also common for transitioning back into daily roles and expectations to be very challenging – in this case, it can be helpful to talk with a counselor or psychologist.

5. What not to do
Don’t
stop asking about how the family is doing; they may need your support now more than ever.

Don’t assume that the experience is over or the hardest part is behind them. For example, don’t say: “You must be so glad that’s over!” Instead, try, “How can I help as you guys move forward?”

Don’t assume everything will go back to the way it was before; sometimes long-term physical and mental effects from treatment are permanent or emerge slowly over time. Don’t say, “I knew everything would be OK; you are so strong.” Do try, “You guys are so strong and I’m still here for you in whatever ways you need.”

Finally, while the above tips can be useful, every family has their own experience of cancer treatment and survivorship. Let the family tell you what they need, and honor their wishes and requests. Don’t let concerns about saying or doing the wrong thing cause you to withdraw from the family. Apologize for missteps and keep showing up for the family – loved ones are vital throughout the family’s journey, including in their transition to survivorship.

 

Learn more
For more information regarding childhood cancer survivorship, please visit the following:
Our Childhood Cancer Survivorship Program
The National Children’s Cancer Society (NCCS)
Children’s Cause Cancer Advocacy Survivor Resources
Critical Mass

 

Susanne W. Duvall, Ph.D.
Assistant Professor, Department of Psychology
The Institute on Development and Disability and the Child Development & Rehabilitation Center
OHSU Doernbecher Children’s Hospital

Caroline J. Grantz, Ph.D.
Postdoctoral Researcher, Department of Psychology
The Institute on Development and Disability and the Child Development & Rehabilitation Center
OHSU Doernbecher Children’s Hospital

 

Six strategies to improve your baby’s sleep skills

KC FB Profile logoThe Dr. Super Sleep Series is written in collaboration with KinderCare. KinderCare believes that early childhood education creates brighter futures. They are the largest provider of early childhood education in the nation and they are passionate about creating a world of learning, joy and adventure for more than 169,000 children every day. For more parenting resources, crafts, learning activities and family fun, visit their blog

It’s 2 a.m. and little Quinn is wide awake and calling (okay, wailing) for you – again.

If your child is healthy and over six months of age, then she is developmentally ready to learn self-soothing skills. Hooray! If you and your child are not getting enough sleep, then it might be time to learn some sleep skills that will help the whole family get more rest. Dr. Elizabeth Super, a pediatrician and children’s sleep specialist with the Pediatric Sleep Medicine program here at Doernbecher Children’s Hospital, shares six common-sense approaches for breezier ZZZs.

1. Consistency is key. Soothing at intervals? Crying it out? Co-sleeping? Any of these approaches can work well, but the secret to helping your child learn sleep skills is to pick an approach that you and your partner can deliver calmly and consistently.
Having trouble? Get realistic about what your family can do consistently and then give it a week (or two). How quickly your child adopts new sleep habits depends on his sleep temperament and his developmental stage. Two weeks gives him plenty of practice understanding what to expect at bedtime.

2. Start at bedtime. “When trying to change sleep habits, we think about bedtime first,” Dr. Super says, as it’s easier for parents to stick to a consistent approach in the early evening – and harder to find the patience at 3 a.m. Begin by setting a regular bedtime between 7 and 8 p.m., Dr. Super advises.
Having trouble? Try moving bedtime 20 minutes earlier than your normal routine. A child who isn’t overtired will have more reserves to spend on learning new sleep skills.

3. Find a great routine. Maybe your child responds well to a bath, massage, singing, or the scent of lavender. Whatever it is, build a ritual that feels relaxing for both of you. Dim lights will also help your baby understand that when it’s dark out, it’s time for sleeping.
Having trouble? Try simplifying. The classic “brush teeth, book, bed” routine is simple and clearly communicates that it’s time for bed.

4. Put her down drowsy but awake. “If you don’t want to be there in the middle of the night with your child, you don’t want to be there when she falls asleep at bedtime,” Dr. Super says. Put your child down in her crib drowsy but awake. Keep in mind that some babies will have more difficulty putting themselves to sleep than others, and some transitions – like vacations, illness, or a move – will cause disruptions in sleep routines.
Having trouble? Try changing your approach. If your baby is older than six months and you’ve always soothed her to sleep, try making your soothing routine very brief or simply putting her down and saying “Good night, I love you, it’s time to go to sleep.” She will probably protest in the short term, but it will give her the chance to practice putting herself to sleep independently.

5. Introduce a lovie. You don’t need to wait for your child to imprint on a favorite teddy bear; you can pick his transitional object for him. Once your child is over 1 year old, rolling over, and raising his head, it’s safe for him to sleep with a special blanket or a small stuffed animal – just watch out for button eyes or other small bits that can be choking hazards. Including that beloved bunny or blankie in the regular bedtime routine can help your child associate comfort and sleep with it.
Having Trouble? Try an article of your clothing. Some babies respond well to familiar smells, so try putting him to sleep with a scarf or T-shirt that smells like mama. If your baby loves his binky, try scattering extra pacifiers around his crib so that he can always reach one when he wakes up at night.

6. Plan for night wakeups. Middle-of-the-night wakeups can be a challenge. Check to make sure that your child is not wet, ill or cold, and then give a calm, brief, reassurance (nothing fun and no feeding) and leave your child to settle back to sleep. Once they know that nothing too exciting is going to happen in the middle of the night, some babies have an easier time getting back to sleep on their own.
Having trouble? Try letting him fuss. If you’ve already done a brief intervention, let him fuss for a length of time that works for your family. If he still can’t put himself back to bed, then soothe him to sleep. After all, good rest is important for everyone, and you can practice building self-soothing skills again tomorrow – beginning at bedtime.

Other posts in the Dr. Super sleep series:
What is your baby’s ‘sleep temperament?’
Monsters under the bed: banishing bedtime fears
Battle bad dreams, night terrors and things that go bump in the dark
The real scoop on teething and sleep

 

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

What is your baby’s ‘sleep temperament?’

The Dr. Super Sleep Series is written in collaboration with KinderCare. KinderCare believes that early childhood education creates brighter futures. They are the largest provider of early childhood education in the nation and they are passionate about creating a world of learning, joy and adventure for more than 169,000 children every day. For more parenting resources, crafts, learning activities and family fun, visit their blog

From the moment he or she is born, a baby’s innate personality shines through in so many ways: how he eats (with zeal! selectively…), what makes her smile or how he plays. And yes, tired parents, how your baby snoozes (or doesn’t) is also due, in part, to the sleep personality that she was born with, also called her “sleep temperament.”

Doctors and sleep researchers have identified two types of sleep temperaments in infants as young as six months: self-soothers and signalers (babies who tend to call out during the night). Most babies fall somewhere in between the two temperaments.

We tend to assign values to these temperaments (for example, the notion that self-soothers are “great sleepers” while signalers are “not good sleepers”), but there really isn’t a hierarchy, says Dr. Elizabeth Super, pediatrician and children’s sleep specialist with the Pediatric Sleep Medicine program at OHSU Doernbecher Children’s Hospital. “Babies aren’t good or bad sleepers,” she says, “they’re just different.”

Curious about which temperament your baby has?

Self-soothers

All babies naturally wake up five to seven times per night – this cycle continues into adulthood, although it’s often imperceptible to adults. Babies with self-soothing sleep temperaments are more easily able to drift off to sleep when bedtime begins, as well as get back to sleep on their own when they wake. These sleepy-heads may also snooze for longer periods of time, or start sleeping through the night sooner than other babies.

Is your baby a self-soother? You may hear her wake up (perhaps babbling to herself) and then settle back to sleep. She might use a pacifier, suck her thumb, cuddle up with a favorite blankie or hum to herself as part of her soothing routine.

Signalers

It takes these wide-eyed (and sometimes lusty-lunged) little ones longer to learn self-soothing skills that come more quickly to others. These babies may have more difficulty falling and staying asleep, and when they wake up during the night, they may cry or call out.

Is your baby a signaler? If your healthy baby has regular nighttime wake-ups, or if his cries stop and he lights up when he sees you enter the room, then you may have a signaler. Learning a new sleep routine, or settling back into his normal routine after an illness, vacation, illness or developmental milestone may take more time as he discovers and develops self-soothing skills.

Whatever her innate sleep temperament, you child’s sleep skills are a learned behavior. The self-soothers of the bunch may’ve caught on more quickly, but don’t worry, your signaler will get there in his own time.

“Developmentally, all children, whatever their sleep temperament, will learn to adapt and fall asleep independently as they grow,” Dr. Super says. Remember that sleep challenges will come and go and even the calmest of self-soothers may have difficult phases of sleep development. Whatever your child’s sleep temperament, supporting great sleep habits will help her build sleep skills that she needs to get good rest.

Other posts in the Dr. Super sleep series:
Six strategies to improve your baby’s sleep skills
Monsters under the bed: banishing bedtime fears
Battle bad dreams, night terrors and things that go bump in the dark
The real scoop on teething and sleep

 

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

 

Healthy eyes: Six vision tips for kids and parents

Vision screeningWhen should kids receive their first vision screening? 

The first screening is actually done when a baby is born as part of their newborn check up. Additional vision and eye health assessments are done with each subsequent primary care evaluation throughout childhood. When a child is old enough to provide information about their eyesight at pediatric appointments, about age 3 to 5, a visual acuity assessment should be performed. Oregon passed a law last year mandating that all children receive a vision screening before they start preschool, kindergarten or first grade.

The beginning of the school year is a good opportunity to identify vision problems. What should parents look for?

Pay close attention to see if your kids are having trouble seeing anything at all – Can you see something your child cannot? Are they rubbing their eyes or having trouble while using an iPad or computer? If you have any concerns, you should have their vision examined, either at the pediatrician’s office or by an optometrist or ophthalmologist.

What does a provider need to know about a child’s vision?

If you’ve noticed any of the following, be sure to let your child’s provider know:

  • Your child’s eyes are not aligned or are red or irritated
  • Your child squints to read certain things
  • Your child appears to have more difficulty seeing compared with other children or yourself

The biggest concern is that alignment issues might be caught too late, causing permanent vision loss. Kids may not know that they have vision problems, making it even more important for parents to keep an eye out for them.

How can parents protect their kids’ eyes while playing sports?

Kids who are who are performing in athletic endeavors should use eye protection, especially with small ball sports – tennis, baseball, golf, etc. If a ball hits your child’s eye, it can rupture the globe.

What about eye safety and screen time?

I tell my patients to use the 20/20/20 rule when doing focused activities that involve screen time on iPads or computers: Take a break every 20 minutes and look beyond 20 feet away for 20 seconds. This helps the eyes to recover after prolonged near focusing effort.

What resources are available to parents to have their children’s eyes checked if they can’t afford an eye exam? 

Casey Eye Institute Elks Children’s Eye Clinic offers free vision screenings in partnership with the Oregon Elks Association and libraries around the state through their See to Read program (click here to view a schedule). Other charitable or civic organizations like the Elks and Lions Clubs offer free vision screenings. If a family doesn’t have insurance and has eye concerns, start with your pediatrician’s office or a school screening. Some nurses may also screen for vision problems.

Daniel Karr, M.D.
Professor of Ophthalmology and Pediatrics
Casey Eye Institute
Oregon Health & Science University

Dietary treatments for epilepsy: Which diet is the right fit for your child?

Jane Riebold, M.S., R.D. ’15, is a newly-minted alumna of the Graduate Programs in Human Nutrition in the OHSU School of Medicine. Jane will be attending the prestigious Boston Children’s Hospital Pediatric Clinical Nutrition Fellowship to complete further training in nutritional treatments for childhood disease. Below, she shares a brief guide to the different types of dietary therapy for epilepsy.

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There are about 750,000 children in the United States who are living with epilepsy, a brain disorder that causes seizures. While antiepileptic drugs exist, dietary treatments for epilepsy can effectively reduce seizure frequency and severity for some children. Dietary treatment may also give some children good seizure control with a reduced dosage or number of antiepileptic drugs. Dietary therapies for epilepsy are very high in fat and low in carbohydrate, and should only be followed under the supervision of a pediatric neurologist and dietitian. The low-glycemic index diet, the modified Atkins diet and the classic ketogenic diet are three different therapeutic diets that a pediatric neurologist and dietitian may discuss as options for your child.

The low-glycemic index diet is the least restrictive type of dietary therapy for epilepsy. Successful low-glycemic index diet therapy requires parents to be able to track the amount of carbohydrate (and what kinds of foods) their child eats each day. Parents must limit the grams of carbohydrate contained in their child’s food to about 40-60 grams per day, or as instructed by the dietitian. Foods with a low glycemic index (≤50) are preferred. Glycemic index measures the amount that a certain food raises a person’s blood sugar when compared to pure glucose, which has a glycemic index of 100. For example, a small apple has a glycemic index of 40 and contains about 15 grams of carbohydrate.

The modified Atkins diet is more restrictive than the low-glycemic index diet because fewer grams of carbohydrate are allowed per day. During modified Atkins therapy, parents will limit the grams of carbohydrate contained in their child’s food to about 10-20 grams per day as instructed by the dietitian. Any type of food containing carbohydrate is allowed if the grams of carbohydrate in the food fit within the daily allowance, and fats and protein are again encouraged. Modified Atkins is less restrictive than the classic ketogenic diet because parents must be able to track the amount of carbohydrate that their child eats each day but do not need to track their child’s intake of fat or protein.

The classic ketogenic diet is the strictest form of dietary therapy for epilepsy. The ketogenic diet is prescribed as a ratio of the grams of fat a child eats in a day compared to the total grams of protein and carbohydrate that a child eats in a day. The classic ketogenic diet typically provides 3-4 grams of fat for every 1 gram of protein and carbohydrate combined (for comparison, a modified Atkins diet could also be described as an approximate 1:1 ratio). While following the classic ketogenic diet, 87-90 percent of the energy that a child consumes from food each day is derived from fat. The classic ketogenic diet requires parents to track the amount of protein and fat, along with carbohydrate, that their child consumes each day. Accuracy is so important that all foods must be weighed on a gram scale before they are eaten so that the amount of fat, protein, and carbohydrate they contain can be correctly calculated. This can be very challenging and time consuming for parents, particularly if their child is a picky eater. A dietitian works closely with every child on this diet to provide recipes, educate the family, and ensure that all of the child’s nutritional needs are being met.

To learn more about dietary therapies for epilepsy, contact the Doernbecher Children’s Hospital Pediatric Epilepsy Center or visit the Charlie Foundation website.

***

The ketogenic diet team at Doernbecher Children’s Hospital currently includes Carter Wray, M.D., assistant professor of pediatrics, OHSU School of Medicine; Andrea Frank, MSN, CPNP, instructor of pediatrics, OHSU School of Medicine; Audrey Easttum, RD, LD; and Megan Fuetterer, RDN, LDN, CPT.

A Q&A with Pediatric Hem/Onc nurse Lily

Lily and another wonderful Hem/Onc nurse, Patsy!

Lily, left and another wonderful Hem/Onc nurse, Patsy!

Happy Pediatric Hematology/Oncology Nurses Day! We appreciate our incredible nurses every day of the year, but wanted to show some extra love for the RNs who care for our Hem/Onc patients.

We snagged a few minutes with Registered Nurse Lily Doebler to ask why she chose this career, what inspires her and more!

What made you decide you wanted to be a Hem/Onc nurse?

After I finished my undergraduate degree, I had no idea what I wanted to do. I knew I loved kids, so I started volunteering here at Doernbecher in 2006 or 2007 as a “float” volunteer. I found that I loved volunteering on 10S with the Hem/Onc patients – I fell in love with the kids and their families. I love working with families in the long term, getting to know them and building relationships. That’s what I like best about Hem/Onc nursing.

What’s your favorite part about your job? The most challenging?

My favorite part is the kids! They constantly inspire me, crack me up and keep me on my toes. They are truly the  toughest people on the planet and my heroes. The toughest part is witnessing their suffering – treatment is hard.

A patient shaved Lily's head at a St. Balrick's Foundation event earlier this year.  Photo by Marie Sullivan

A patient shaved Lily’s head at a St. Balrick’s Foundation event earlier this year. Photo courtesy of Marie Sullivan

What do you wish people knew about Hem/Onc nursing? 

It’s not all doom and gloom! We have a playroom, and kids play. We do a good job, and a LOT of our kids get better. Another thing I wish more people knew is that childhood cancer research is so underfunded.

What words of encouragement would you like to share with Doernbecher families?

Kids are amazing and resilient and tough. And you’ve got us here with you always!

What advice would you give aspiring nurses?

Nurses have to love what they do to be great at it. Find the type of nursing that speaks to you and that you love with all of your heart, then do that.

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Got a Doernbecher nurse you’d like us to thank? Leave a message in the comments below or email us at socialmedia@ohsu.edu. We’ll be sure to pass along your message! 

Beyond the shoes – Jordan Geller’s Doernbecher Freestyle quest

No one knows sneakers quite like Jordan Geller does. He holds the Guinness World Record for the largest collection of sneakers owned and is passionate about sharing his collection with others in the sneaker community by way of his “Shoezeum” and by sharing photos and videos on his social channels. Below, Jordan shares his quest to collect 13 highly sought-after Doernbecher Freestyle shoes and makes an exciting announcement about his next project, an auction that will help us help kids!

As soon as Nike and OHSU Doernbecher Children’s Hospital announced the release of the “What the Doernbecher” Dunk Highs, I knew I needed to have a pair. These shoes are made up of 13 previous Doernbecher Freestyle models, and all proceeds from the auction went directly to the Doernbecher Children’s Hospital Foundation. The challenge with obtaining a pair was that only 11 pairs were going to be released – and only one pair in each size.

After a series of fortunate events, I ended up with the size 11 pair, which cost $11,100.00. I felt like the whole thing was meant to be and that I needed to do something with this opportunity.

When the shoes arrived a few weeks later, I was elated. I could hardly contain myself as I filmed the unboxing video. I even knocked the camera during filming because I was so excited (watch the video, below)!

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As I was unboxing the shoes, an idea started to form. That was when my quest began. I decided to find and purchase each of the 13 models whose design elements were used in the What the Doernbechers, filming and sharing a YouTube video review on each pair and their patient-designer’s story along the way.

You can view all 12 videos I’ve made on my YouTube channel. These are links to the twelve videos that I have done. The thirteenth pair (designed by patient-designer Alice Heinz in 2007) is on its way!

In addition to collecting all of these shoes and making videos to raise awareness for Doernbecher Children’s Hospital, I decided to go through my closet and storage unit and pull out a bunch of my shoes to auction off on eBay and donate the money to Doernbecher.

On September 1, I will be listing 53 pairs of my shoes and donating 100 percent of the proceeds to the Doernbecher Children’s Hospital Foundation. All of my shoes will include a Doernbecher wristband and pamphlet (pictured here). The next day, I’ll be listing 70 pairs of Nick Hogan’s shoes. Nick is donating 50 percent of the proceeds to the Doernbecher Children’s Hospital Foundation. (Please note: his shoes will not include wristbands or pamphlets.) You can check out some of the shoes that I pulled out of my storage unit for the auctions here, and you can view some of Nick’s kicks that will be auctioned off here.

Here’s a link to my eBay store: ebay.com/ShoeZeum. Happy bidding!

The auctions will go live on September 1 and 2 and will run for 10 days each. Thank you, Doernbecher, for the opportunity. This is so much fun!

Love, Jordan

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Save the date for the Doernbecher Freestyle 2015 collection reveal and auction on October 23 at the Portland Art Museum!

Doernbecher Best in the Country U.S. News & World Report

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