Please make giving a resolution in 2012

As we are making our New Year's resolutions, let’s add one more thing to our lists – make life better for children. If you have been out and about this holiday season, you may have seen the new Children’s billboards featuring patient Annabella Spears spreading the message of peace, joy, and giving! 2011 has been a challenging but triumphant year for Annabella. As the Spears family celebrates a new year, they have only a scar across their daughter’s tummy to remind them of the events of the past year.

First-time parents, Alexa and Shad, brought newborn Annabella to their Dallas home in Oct. 2010, but after seven weeks, they noticed that her skin looked yellow. A trip to the pediatrician landed Annabella at Children’s, where she underwent extensive testing and was diagnosed with biliary atresia, a rare disease of the liver and bile ducts.

Without a transplant, Annabella’s liver would fail. She was listed for a new liver in March 2011. “I didn’t want to ask, but I kept wondering if we would lose her, because I had no idea really what ‘transplant’ meant, and it sounded really scary,” Alexa said. “I just kept thinking that we couldn’t lose our little girl.”

All her parents could do was wait for a liver that would be a match for Annabella. She regularly visited the Solid Organ Transplant clinic at Children’s and was closely monitored.

Dr. Dev Desai, division director of pediatric transplantation at Children’s and associate professor of surgery at UT Southwestern Medical Center, would be the surgeon implanting the liver when the time came. “Annabella’s liver failed rapidly, and because of the quickness of her disease, she went to the top of the waiting list,” Dr. Desai said.

At 6:30 a.m. on June 16, Alexa and Shad received the call they had been waiting on for three months. They couldn’t believe the day had finally come. Dr. Desai flew in a jet to procure the organ, returning to Children’s where 8-month-old Annabella
was in the operating room being prepped.

After a successful surgery, Annabella recovered perfectly. “It’s pretty amazing — her skin has gotten pinker, and the whites of her eyes are white again, instead of yellow,” Alexa said. “She has energy plus, and she is rolling over, lying on her belly and having a great time. It’s remarkable.”

You can help make stories like Annabella’s possible by joining Children’s in our daily mission to make life better for children. Please consider making a gift today, and make a difference in the life of a child.

Holiday Snaps

Ingredients:
1 cup brown sugar, packed
3/4 cup vegetable shortening
1 egg - replace with 1 Tbsp applesauce if allergic to egg
1/4 cup molasses
1 1/2 cup all purpose flour - replace with 1 1/2 cup oat flour, barley flour, or gluten free baking mix
1 cup old fashioned oats (not instant)
2 tsp baking soda
2 tsp ground ginger
1 tsp ground cinnamon
1/4 tsp salt
Sugar for rolling cookies

Directions:
1) Preheat oven to 350°F.
2) Combine sugar and shortening, beat until creamy.
3) Stir in egg and molasses.
4) Combine flour,oats, baking soda, ginger, cinnamon and salt.
5) Add dry ingredients to creamed mixture and mix well and chill for 1 hour.
6) Roll dough into 1 inch balls and roll in sugar. Place on greased cookie sheet 2 inches apart.
7) Bake 8 to 10 minutes until lightly browned. Let cool for 5 minutes before removing from cookie sheet to cooling racks.

Makes 4 dozen

Food Allergy Friendly Chocolate Cake

Ingredients:
2 cups oat flour
1 cups sugar
6 Tbsps Cocoa Powder
1 tsp baking soda
1/4 tsp salt
1/4 tsp cinnamon
1 cup rice milk
1/3 cup canola or cooking oil
1 tsp vinegar
3/4 tsp vanilla

Directions:
1) Heat oven to 350°F.
2) Grease and flour (using oat flour) 9 X 9-inch square pan.
3) In a small mixing bowl combine dry ingredients. In separate bowl mix wet ingredients together.
4)Slowly add wet ingredients to dry and beat until smooth.
5) Pour into prepared pan. Bake 35-40 minutes or until a toothpick inserted in center comes out clean.
6) Cool; cut into squares.
7) Optional: Sprinkle powdered sugar over the top.

Serves 8

Sweet Potato Apple Casserole

Our third of five food-allergy friendly recipes is tasty as a side dish or dessert. And it's nutritious!

Recipe courtesy of Whole Foods Market

Ingredients:
1 1/2 pounds whole sweet potatoes
3 granny smith apples, peeled, cored & sliced
Juice of 2 oranges
Zest from one orange
1/2 tsp ground cinnamon
1/4 tsp allspice
1/4 tsp nutmeg
2 Tbsps butter - replace with milk free margarine if allergic to milk
2 Tbsps brown sugar
1/2 cup chopped nuts - replace with crushed corn flakes if allergic
to nuts

Directions:
1) In a medium sauce pan cook unpeeled whole sweet potatoes in boiling water for about 20 minutes until fork tender. Drain. Or bake potatoes at 400°F for 45 to 60 minutes until soft to touch.
2) While cooking potatoes, heat apples and orange juice in a skillet with spices and orange zest. Cover and cook for 3-5 minutes until apples soften.
3) Peel sweet potatoes and slice. Layer sweet potatoes in microwave safe casserole dish with apple slices. Sprinkle with mixture of brown sugar, butter, and nuts (or substitutes).
4) Microwave on high for 4 to 5 minutes.

Serves 8

Herbed Prime Rib Roast

The second, in a series of five, allergy-free holiday recipes is Herbed Prime Rib Roast. Enjoy!

Recipe courtesy of Whole Foods Market

Ingredients:
4 cloves garlic
3 Tbsps chopped fresh rosemary
3 Tbsps chopped fresh thyme
2 Tbsps expeller-pressed canola oil
2 tsp coarse sea salt
1 1/2 tsp freshly ground black pepper
1 3-rib bone-in standing rib roast (about 5 pounds),
trimmed of excess, but not all, fat
1 1/2 cups low-sodium beef broth

Directions:
1) Preheat oven to 475°F. In a food processor, pulse garlic until chopped.
2) Add rosemary, thyme, oil, salt and pepper and pulse until you have a chunky paste.
3) Rub the roast all over with the paste and place bone-side down in a roasting pan.
4) Roast in the middle of the oven for 20 minutes.
5) Reduce oven temperature to 375°F and continue roasting about 1 hour longer.
6) Use a meat thermometer inserted into the center of the roast (not touching bone) to check the temperature in several spots and continue roasting meat, checking temperature every 5 or 10 minutes, until about 10 degrees shy of
your preferred level of doneness. The meat will continue cooking while it rests after being removed from the oven and the temperature will rise another 5 or 10 degrees. Target temperatures are 130 to 135°F for medium rare and 135 to
145°F for medium.
7) Transfer roast to a cutting board, bone-side down, and let stand 25 minutes before carving. Meanwhile, carefully spoon off and discard fat from dark juices in roasting pan.
8) Use oven mitts to place pan over medium-high heat and add broth. Simmer, scraping up browned bits from the bottom of pan, until reduced to 1 cup, about 10 minutes.
9) Carve the roast by running a long, sharp knife between the rib bones and meat to separate them.
10) Slice meat into portions, arrange on a platter with the bones (there’s meat left on the bones and some people may want one) and spoon hot pan juices over the top.

Serves 6 to 8

Holiday Berry Sauce

Even if your kids don’t have food allergies, it’s likely that you’ll be cooking for one of your kids’ cousins or friends who is allergic to one of the top eight food allergy triggers (milk, eggs, peanuts, tree nuts, fish, shellfish, soy and wheat). This week before Christmas, we’re sharing directions for an entire food-allergy-friendly holiday meal. One recipe every weekday. That way, if you have to make any last minute substitutes, you’ll be able to.

 
Recipe courtesy of Whole Foods Market

Ingredients:
6 cups fresh cranberries, rinsed and drained
1/2 cup orange juice, more if needed
1 (16 ounce) package frozen blueberries
1 (12 ounce) package frozen raspberries
Zest of 1 orange
1 1/2 cups agave nectar or honey
1 cup sugar, or to taste

Directions:
1) Place cranberries in a large saucepan.
2) Add orange juice and cook over medium heat for 7 to 10 minutes or until cranberries start to pop.
3) Add blueberries, raspberries, orange zest, nectar and sugar. You may need to add a little more orange juice at this time if mixture is not slightly wet.
4) Cook an additional 10 minutes, mashing cranberries if desired with a potato masher. Let mixture cool before serving.

Serves 12 as a side condiment

Buy safe toys this holiday season

With the holidays approaching, it’s so easy to buy that special child in your life the coolest toy you can find. Like a 280-piece dump truck model kit you know your 3-year-old nephew will just love. But if you don’t check the toy’s intended age range, one or all of those 280 pieces might end up in his mouth instead, and put him at risk of injury or even death.

I might have bought that dump truck when my wife and I went shopping for our nephew this weekend, had it not been for a toy safety demonstration I recently sat in on here at Children’s.

Jesus Alderete, a coordinator with our Injury Prevention Program, recently shared with media how to keep the holidays accident-free by choosing safe and age-appropriate toys for youngsters. He said if a toy or its parts can fit through a toilet paper roll, it poses a choking risk for kids 4 and younger. Other tips included:

Check the toy’s intended age range listed on the packaging, and follow the manufacturer’s guidelines.

• Keep toys meant for older kids away from infants and younger kids.


• Buy dolls or stuffed animals with eyes that are sewn on, rather than plastic. Plastic eyes tend to fall off and are a choking hazard for younger children.


• For older kids, be sure to buy a helmet that they can wear with their new bike or other riding toys.

The information is a great reminder considering that since 2000, an average of 20 children a year have died in the U.S. after being injured or involved in accidents with toys, according to Safe Kids USA, a non-profit organization that works to prevent unintentional childhood injuries.

Thanks to Jesus’s guidance, my nephew won’t be getting that dump truck model for a few years. Instead, we went with an age-appropriate sea turtle night light.

You can read more about toy safety and the recommendations of our Injury Prevention Program here.

How not to install your car seat

My wife and I are expecting our first child, a daughter, any day now.

What I’ve learned about being an expectant father in my wife’s last trimester is to contribute where I can and try not to interfere the rest of the time.

However, I have inherited a few responsibilities. Probably the most important is installing the car seat. I’m not incredibly handy, so the initial thought was a little daunting.

After all, I’d written about the masses of incorrectly installed car seats. Of all the soon-to-be fathers out there, I certainly knew how important it was to make sure that the base was in tight and the carrier was locked in place.

But what I didn’t know was that the secureness of the car seat was only the beginning of car seat safety.

I learned that when my wife and I brought our cars to Children’s for a car seat safety check up. I had done my best to install the bases the weekend before and, to my surprise, they passed the specs for tightness and security. Our gracious inspector and an Injury Prevention program coordinator at Children’s, Jesus Alderete, told us so.

We did find out, however, that there was a lot more to making car seat safe than just its installation. For example:

1) Our car seat was behind the driver’s seat. Research has shown that the back seat is the safest location to put a car seat. However, there are many factors to consider when choosing the safest seating position. The most important factors are for the car seat to be placed where it fits the best, where it can be installed by the caregiver in the easiest way and in a position where the caregiver can easily harness the child the right way every time the child rides in the vehicle. For our car and most cars, the safest position was the middle of the back seat. Behind the driver’s seat was actually the least safe spot for the car seat in our car.

2) We planned to put up additional stuff besides the seat. We planned to put up a mirror on the car’s back seat so we could see her face in the rearview mirror and also planned to use a window shade that pulled down from a bar. We also had put down a seat protector so the car seat base wouldn’t damage our seats. What we learned is that these types of aftermarket products are not federally regulated. Using them with a car seat when the car seat manufacturer has not crash tested them could null and void our car seat’s warranty. If parents do decide to use these products they should look for products that are made and approved for use by the car seat’s manufacturer. When choosing these products look for items made from soft lightweight materials with rounded edges. In addition, look for items that are secured with straps or anchors rather than those that simply Velcro on.

3) We left the canopy extended in the car. The manufacturer’s instructions should be consulted to see if they allow the canopy to be extended while the vehicle is in motion. Every car seat is different so be sure to always read the car seat’s manual. Our car seat manufacturer advised against leaving the canopy extended in the car.

4) The back seatbelts were unbuckled. Due to the potential for strangulation by the seat belt, when a car seat is installed using LATCH, the vehicle seat belt in that seating position (i.e. If the car seat is in the middle, the seat belt that would regularly be used to buckle in the person sitting in the middle seat) should be buckled and the retractor switched to locking mode to insure that a child cannot place it around their neck. A certified car seat technician can assist you in doing so.

Don't worry, though. If I can get it installed correctly, I promise you can. And if you have trouble, most local fire and police stations have sessions to help correctly install car seats.

Speaking to my son about the Penn State scandal

Betsy MacKay is the vice president of public affairs at Children's. During her more than 13 years here, she has also raised her son, Wills, who is now 12.

I usually have a hard time getting Wills to talk very much at breakfast. He wants to eat, watch SportsCenter and head to school. Sound familiar?

Well, yesterday was different. Wills sauntered in, sat down over his hot pancakes and asked “Mom, what is going at Penn St. and what happened in that locker room thing?” Alrighty then – why did his Dad have to be out of town???

Because I have spent the last 13 years working around amazing experts on topics like this at Children’s, I didn’t run. Instead, I was able to engage my precious little boy on a very dicey topic. Here is what we talked about:

Sometimes grown men do really awful things to young boys. When Wills asked what kinds of things, I bit the bullet and described the assault in complete detail as the SportsCenter coverage raged on in the background with the sound muted. Wills squirmed on the barstool and got a sheepish grin but looked me in the eye the whole time. It felt right and good to be talking to him this way.

We then revisited the idea that he is never to let anyone touch him in his privates or even talk to him about any sexual topic that makes him uncomfortable. Thankfully, we have a wonderful pediatrician who has talked to him this way since he was a toddler.

We chatted about how boys that love sports like he does will spend a lot of time in locker room showers. I made sure he knew that was normal and fine and that what happened at Penn State is extremely rare. I told him he should not be afraid because coaches are generally wonderful, giving people who are reliable mentors. However, I added that the world has plenty of bad actors too and he must always trust his instincts about what is right behavior and wrong behavior.

I then emphasized that he should always feel totally secure and comfortable telling his dad and me if anything of this nature ever came close to happening to him because we would protect him at all costs.

That was really the end of it. He then skipped off to grab his backpack and ran outside to catch his carpool ride. Oh, he kissed me goodbye, too – my treat for the day!!

When I got to work, I had the wonderful opportunity (and so do you) of being able to call Dr. Pete Stavinoha, an incredible child psychologist here at Children’s, to get his insights. He validated my concerns over this Penn State hoopla and its impact on our kids. (Listen to Dr. Stavinoha interviewed about the Penn State scandal on KLIF here - he comes on at around the one-minute mark.)

He also reminded me of a very good point that I forgot to make with Wills. Dr. Pete said we must stress to kids that they should not ever be afraid to report an incident like this if they witness it or if it should ever happen to them. This is a crime and the police must know about it. Real men speak up and tell the truth. This is where Joe Paterno failed, and we are all hurt by it, even as we hurt for him. I am going to follow-up with Wills on that point.

Anthony's first camp experience

Kathleen Herman had been praying her son, Anthony, would get to go to camp this summer. Anthony was born with a heart condition that causes narrowing of the heart valve, and he has undergone countless tests and procedures at Children's. His heart condition has continued to worsen, and at times, Kathleen and her husband, Ray, weren't sure their son would make it another day.

So, when Anthony was able to board the bus and head to Camp John Marc for a week of fun in the sun, they were beyond grateful. Read one of the entries from Kathleen on Anthony's caringBridge page:

Tuesday, June 28, 2011

Ok. So now I've cried.

First-time parents always get an update call from Camp Moss during the first couple of days of camp. I knew to expect it. But I didn't expect the familiar voice I heard on the other end of the line yesterday when I received our call.

The call was from Dr. J. She was the attending cardiologist during the first week of Anthony's hospitalization for endocarditis, the worst and most frightening days of his illness. As the attending, she had been the bearer of all the bad news we received during those first few days. We had not seen her since then and we had no idea she was even at camp. I was thrilled to talk to her again, especially under such different circumstances.

She told me she had begged to be the one to call "the Hermans" because she had made us cry so many times in the hospital. She wanted to be the one to share some good news with us for a change! And she did.

Dr. J was with Anthony Sunday night during his cabin's bedtime story--the Camp Moss staff has a tradition of telling bedtime stories to the younger campers, crowning a storytelling "winner" at the end of the week--and then again at arts and crafts yesterday morning. She said Anthony is really enjoying himself and that "it is so good to see him like this, not curled up in a hospital bed."

Of course, hearing the news that Anthony continues to do well at camp is wonderful, but hearing that news from someone who had seen him at his worst made it all the more profound. I was so happy and touched by our conversation that I began to cry when I shared the details of it with Ray.

Oops. Tears.

Please don't tell Dr. J.

She'd be upset to know she made me cry again.

Getting messy for a cause

Jude Cobler’s life is sanitized for his own protection. Not much can be messy and that’s hard for a kid. But a couple of days ago, Jude got to be just the opposite of neat.

Jude, a patient at Children’s, underwent a bone marrow transplant in December 2010 and still has to be careful about his exposure to infection, but the other day he got to dip his hand in paint and squish it on a bright and shiny new car. The finger painting outing was part of a presentation for pediatric cancer research by Dallas-Fort Worth-area Hyundai dealers.

The dealers brought a white Santa Fe SUV to the hospital and encouraged patients to plant their hand prints on the car. The idea was to celebrate the children’s lives and to have them share their stories with children and families across the country that are participating in similar events for the carmaker’s Hope on Wheels program, which has raised funds for childhood cancer research initiatives for the past 13 years. The hand prints also were put on paper and will be made into decals for display by Hyundai dealers across America next year.

Grant for research

The hand prints were part of a ceremony by the area Hyundai dealers to award a $40,000 grant to the University of Texas Southwestern Medical Center for Dr. Raven Cooksey. Dr. Cooksey is a fellow at UT Southwestern in pediatric hematology-oncology. She practices at Children’s in the Center for Cancer and Blood Disorders. Children’s is where UT Southwestern doctors learn advanced pediatric medicine. The grant money is part of $2.7 million that the Hope on Wheels Tour will donate this year to back pediatric cancer research nationally.

Dr. Cooksey’s research is on metabolic syndrome in young survivors of brain tumors who were treated with radiation. Metabolic syndrome is the name for a group of health risk factors that can lead to type 2 diabetes and heart disease. Dr. Cooksey is studying whether radiation may lead to metabolic syndrome.

But for Jude, the day was all about telling his story and spreading some bright green paint around. And if you remember at all what it’s like being a 6 year old, you know how important that is.

Bringing Home Allie Was Too Much for Momo

Editor’s note: This week is American Veterinary Medical Association’s National Dog Bite Prevention Week. Children’s is also focusing this month on injury prevention. To highlight both efforts, Melanie Medina weighs in with her family’s experience with dog bites, and shares tips from the veterinary behavioral therapist she worked with to treat her dog’s aggression.
The instant it happened, I knew we had to get rid of him. I loved this dog more than life itself. He was like my child — until I had a child and he tried to bite her.
That’s when it hit me: Momo is a dog. He is going to do what his DNA tells him to do, no matter how much I loved him and how much I tried to change him.
Growing aggression
It happened more than three years ago, but it still hurts to think about the day we surrendered Momo, our pug. My daughter was only about 10 days old. I had laid my daughter on the couch and was standing over her, about to swaddle her into a little burrito. Momo was standing there, right under my feet, with his eyes on Allie.


Momo lunged under my arm, up onto the couch and tried to bite Allie. He had the toe seam of her pajama pants in his mouth.
I screamed for my husband. We unsnapped my daughter’s pajamas and realized she was OK. If he had reached just a millimeter or two further, I’m confident he would have taken off her toe, or maybe her foot. Within 30 minutes, we were on the phone with DFW Pug Rescue, talking to the manager about surrendering Momo. My husband had the horrible task of driving Momo up to a vet’s office, where he left him for a Pug Rescue representative to pick him up.
Behavior therapy for dogs
But we had to do it. We’d had Momo for seven years, and his aggression slowly built up until it was out of control. A year before our daughter was born, we hired a behavioral therapist who specializes in aggression in dogs. Her opinion was that in most cases, a family’s new baby and old baby (the dog) can develop a loving relationship right from the start — unless the dog has serious pre-existing issues.
We hired her to help us sort out Momo’s issues, and his aggression definitely improved. But bringing a new baby into the home was too much for him. (The therapist we hired, Lecreca Taliaferro, DVM, has guidance on how your family can get your human baby and canine baby to bond.)
Pug wins graham cracker
Fast forward three years later. With Momo living happily ever after (I hope) in a new family’s home, I thought we were past worrying about dog bites.

But just a few weeks ago, Allie, who, thankfully, has both of her feet, was munching on a graham cracker. Our other pug, Spanky Mae, swiped it out of Allie’s hand. Allie swiped it back, but Spanky Mae wasn’t having it. Spanky jumped toward Allie to get it back, and in the process, bit Allie’s face. Spanky’s teeth barely grazed Allie’s skin, but it scared us, especially Allie.
My husband and I considered calling DFW Pug Rescue again but decided to keep Spanky Mae. After all, she didn’t have a history of biting or being the least bit aggressive. She just wanted that darn graham cracker.
Instead, we used the experience as a teaching moment for Allie. We told her, “When you’re fighting with a dog over food, the dog always wins. Mommy and Daddy can always get you another graham cracker.”
Nationally and locally dog bites on the rise
If my personal story hasn’t left an impression, maybe some statistics will. Here at Children’s, our Trauma department has seen a rise in patients being treated for dog bites. In 2001, we saw 15 kids for dog bites. By December 2010, that number rose to 36.
Our statistics mirror national ones. Since 2008, the number of Americans hospitalized for dog bites increased from 5,100 in 1993 to 9,500 in 2008, according to a government study. Children younger than 5 and adults older than 65 are most likely to be hospitalized for dog bites, to the tune of $18,200 on average for treatment.
Thankfully, my family didn’t fall into those statistics.
Shopping for cats?
DFW Pug Rescue later told us that Momo was adopted by a family who also owned a boxer. Momo tried to be aggressive in his new family’s home, but the boxer, who probably had a good 30 pounds on Momo, asserted his dominance. I think that’s what Momo needed.
And today, Allie insists that she wants a kitty cat, not a puppy dog. We’ll see about that.

The doctors Corrigan

As a third-year pediatric resident at Children’s Medical Center Dallas, Dr. Nicole Corrigan can still be expected to have lots of medical questions. And while she can ask her colleagues for the answers, she can also call her mom.

That’s because Nicole’s mother is Dr. Suzanne Corrigan, who was a pediatric resident at Children’s 30 years ago and is a clinical associate professor of Pediatrics at the University of Texas Southwestern Medical Center.

Nicole and her sister Danielle, who’s a second-year pediatric resident at Children’s Mercy in Kansas City, “call about day-to-day life that comes up in the practice of medicine that no one prepares you for,” Suzanne said.

Together, Nicole and Suzanne Corrigan are believed to be the only mother-daughter physician duo that has undergone pediatric residency training at Children’s.

Times have changed
Times have changed a lot in 30 years of pediatric residency training. For one, the hours of training are significantly shorter now and mandated by law. In Suzanne’s day, pediatric residents worked every third night or every other night, sometimes 100-120 hours per week. Today, Nicole legally can work no more than 80 hours a week.

Nicole also has more support staff to assist during shifts. During Suzanne’s days as a resident, they had to do their own blood draws and microscope work.

Additionally, there also weren’t nearly as many women in medicine 30 years ago. “There were 10 woman out of 200 in my class at UTSW and only four women in residency my year,” Suzanne said.

“It’s also very different for them than it was for us in terms of sheer volume of patients but also the severity of illness that Children’s physicians see,” Suzanne said.

Suzanne knew all this when Nicole was accepted as a pediatric resident at Children’s but also knew that her daughter would receive excellent training. “I told Nicole she was going to work really hard but would get the best training anywhere.”

Suzanne added: “I can’t say enough good things about the preparation we received and that they’re getting now — giving them the skills they need to critically think, analyze and put solutions together.”

Advice on medicine as a career
Suzanne’s advice for residents and medical students is simple: “If you’re going into medicine to make money, that the wrong way to go. You need to want to take care of children who are really ill. It’s a full-time job and you need to give completely of yourself when you are on the job. You also need a partner or someone who can be there for support,” she said. “You need to be able to put your cares aside. When you’re here, the patients, they’re your priority. You need to be able to compartmentalize.”

“The other big part of medicine is working with the parents and fighting for what’s right for the kids in the community. If you’re not working to do that, then you shouldn’t be in medicine.”

Nicole’s path
Nicole will be continuing her career at Children’s. She completes her residency in June and has accepted the position of third attending physician as a general pediatrician in Children’s Emergency Department.

Nicole said she “feels lucky to have such great training and exposure to superb role model pediatricians, especially her mother and feels blessed to have found her calling in pediatrics.” She added: “In what other professions are families so grateful for your care that you create a special bond with them, I feel lucky to be their doctor.”

Autism by the numbers

April is National Autism Awareness Month so stories about autism spectrum disorder (ASD) are appearing in the news. The CDC estimates that an average of 1 in 110 children is affected by autism. I know a child with autism and you probably do too. Autism is really a broad range, or spectrum, of pervasive developmental delays (PDD) and the cause is still unknown, although research suggests it is a genetic condition. What is known is that the number of children affected is growing.

Because the numbers are increasing, I asked Dr. Patricia Evans, a Children’s Medical Center Dallas child neurologist and autism expert, what’s behind that fact. Here’s what she had to say.



Dr. Evans also said that increasing cases of autism also may be occurring because there is less stigma associated with seeking help for these children, and doctors are more willing to apply the diagnosis to help a patient.

Signs to watch for in your child
How can parents tell if their child has an ASD? Dr. Evans said symptoms may include:
· Does not interact well with others, including parents
· Does not communicate well with others
· Demonstrates repetitive behaviors
· Is preoccupied, usually with lights, moving objects or parts of objects
· Does not like noise
· Has rituals
· Requires routines

These behaviors may resemble other conditions or medical problems so always consult your physician. For younger children, your family doctor should be conducting assessments at well-baby visits. If your child is older, talk to your school about getting an assessment conducted. Children's offers a comprehensive range of services for children with ASD.

And she's still here, folks

Nancy Zeiger made it clear when she began volunteering at Children’s four and a half years ago that she would quit once she had grandchildren.

In the fall of 2008, she became the grandmother of twin grandsons. In March 2011, she welcomed another grandson. And in April 2011, you can still find Zeiger volunteering at Children’s.

“I feel like there is still a need for me here,” said Zeiger. “You don’t have to be here long to realize there are so many patients here who have nobody. Some literally may not have a visitor stop by their room for an entire day. And parents need help, too.”

Zeiger fulfills those needs in a variety of ways. The majority of her volunteering time is spent sitting with patients in the neonatal intensive care unit, but she also works as an office support volunteer. Even her part-time job benefits Children’s.

Children’s contracts with Zeiger’s employer, Access Language Center, to provide interpreters for patients. Zeiger is a certified interpreter, which enables her to interpret for deaf patients or their parents.

“Nancy’s versatility makes her a great volunteer,” said volunteer coordinator Barbara Green. “What makes her so unique is that it just seems at the right time, she is in the right place to provide that extra help in whatever way you need it.”

At this point, Zeiger has made no new plans about becoming a full-time grandmother.

“I tell people I can’t do anything on Wednesday, because Wednesday is my Children’s day,” said Zeiger. “Grandkids and work can be my other days.”

Marathons may be for kids, too

It sounds crazy, but children may be able to run marathons as early on as first or second grade.

Several weeks ago, The New York Times ran this blog on their website. The author, Gretchen Reynolds, reported on two different studies: one about running injuries in children and the other about how early children can run the hallowed 26.2 miles involved in marathons.

The first study indicated that as many as 12 million children ran for exercise in 2007 and that the number is increasing. Along with the increase in child runners, though, there has been an increase of running injuries in children. But those injuries aren’t typical overuse injuries like stress fractures or tendonitis. Instead, the commonly reported injuries seemed to be caused by a lack of coordination and falling, things like twisted ankles, scraped wrists and bruised knees.

The second study analyzed data on the 310 children between the ages of 7 and 17 who ran and finished the Twin Cities Marathon in Minnesota between 1982 and 2007. What it revealed was that only 4 of the 310 (a whopping 1.3 percent) ever visited the race’s medical tent and that none of them required anything beyond a brief test. The author of the study concluded that running long distances like marathons isn’t inherently unsafe for certain children as long as they have proper supervision and training.

That sounded a little wacky to me. I was always told that children aren’t supposed to lift weights before puberty (although thoughts on that have changed in the past several years, too). I assumed the same principal applied to distance running.

Moreover, my vet told me not to run my golden retriever before she was 18 months old. I figured human bones would be much more sensitive and fragile than dog bones.

So, in my confusion, I sent an email with those thoughts to the pediatric sports medicine expert at Children’s, Dr. Shane Miller. This was his response:

Foster,
The reason your vet recommends not running with a golden retriever at that age is because as a breed goldens are at increased risk for hip dysplasia. The theory is that around 18-24 months of age, the growth plates in the dog's hips are closing and are at less risk of damage (which is why they can do X rays at 2 years of age to eval for hip dysplasia). A golden retriever is very obedient and will continue to run through pain to keep up with its master, but will limit itself if playing with other dogs. Growth plates in kids close in the teens (boys usually later by about 2 years than girls).
The answer really should be individualized to the athlete. For example, it is generally accepted that an 8-10 year old could do a 5k race, but I ran my first 10k (6.2 miles) race at age 6 without any difficulty. It really should be more dependent on the athlete, their maturity, etc. This also assumes a gradual increase in training intensity and duration. A rule of thumb is one should not increase by more than 10% per week.
As with all kids that age, we have to be cautious with heat illness and dehydration as their surface area to volume ratio is less than adults, and they are not as good at thermoregulation. Falls, sprains, strains, overuse injuries, heat illness, and dehydration are all potential injuries in running at all ages.
Running can be safe for kids when supervised and the emphasis is on having fun. Just like with your golden retriever, allowing the kid to set the pace will give them the best chance of staying free of injuries and should not cause any long-term damage to growth plates or otherwise.
One recommendation for younger kids that want to do a "marathon" is to have them complete 26.2 miles over multiple sessions. At the end, they can have the pride of saying they completed a "marathon" with the added benefits of learning the importance of physical fitness. One example is marathonKids (www.marathonkids.org).

CT scans and children: tips for parents

You may have seen coverage recently on CNN Health about the increased number of CT, or computed tomography, scans being ordered by doctors for children.

The number of these scans has risen five-fold over a 14-year period, according to the research.

Radiation levels accumulate over time, so it’s important for parents to think about the risks and benefits of medical imaging. Our experts at Children’s Medical Center in Dallas offer these tips for safer CT scans for your children.

Most importantly, choose pediatric radiology services over adult ones if possible. Children's has staff that specializes in pediatric radiology. They are specifically trained to limit radiation. Children's also uses equipment that's made and calibrated for kids.

• Talk to your pediatrician about the best way to diagnose your child's condition. A CT scan is not always the best choice. Sometimes no imaging at all provides the best medical benefit.


• Ask your physician if it's possible to use a technique that doesn't cause radiation exposure, such as an MRI or ultrasound.


• Try to avoid having your child undergo repeat or duplicate imaging scans. This means keeping close tabs on your child's medical record and the number of scans he or she has had.

We also have tips for X-rays to help parents ask the right questions about these procedures and more information on radiation exposure.

Speaking to families about organ donation, Part 2

Grayson Burgess works for the organ procurement organization Southwest Transplant Alliance (STA) as one of two in-house coordinators at Children’s and Parkland Memorial Hospital. He is responsible for offering the option of organ donation to families of potential donors and has been specially trained by STA to handle those conversations in a way that best supports families while also increasing the likelihood of consent. I recently spoke to Grayson to get a better understanding of what that involves. This is the second of two parts of that discussion.

Q: I’ve heard about an organ crisis. What does that mean?
A: It means that the need for organ transplants vastly supersedes available organs. That has always been the case, and it continues to be the case today.

Q: What do you say to families to explain the benefit of organ donation?
A: One of the things we tell them is that donation doesn’t just benefit recipients. It also benefits families who choose to donate because they’ll know that their child was able to help someone else live. The way we look at it is that we’re not taking something from the family but instead giving them an opportunity to make a very positive difference in someone else’s life. I also talk to them about how rare of an opportunity it is for them to even have the option to donate.

Q: Why is it so important that there is a formal process for deciding who ends up receiving the organs?
A: It’s important to have a formal process to ensure that everyone is on an equal playing ground. The national rules and regulations for organ allocation are not just applicable for Southwest Transplant Alliance or organ donations at Children’s, they’re applicable for everyone in the United States. And that ensures that all potential transplant patients have an equal opportunity to get an organ.

Q: Then are people not allowed to decide who receives their organs?
A: There is a process where a family can elect to give one of its loved one’s organs to a family member or friend. If there is someone they know personally, we can attempt to place that organ with the designated person before we put the organ on the national list of available organs. That is an acceptable process nationwide called directed donation.

Q: How often does it work out like that?
A: Very, very rarely. The majority of organ transplants come from national waiting lists.

Q: What is the process like for patients waiting on an organ from a national waiting list?
A: That would depend upon that patient’s condition, the organ needed, and the patient’s transplant center. Everyone’s situation, of course, is unique. The constants are that each person’s physicians do a great deal of evaluation before placing a patient on the list, and the wait can be a long one. For some patients, unfortunately, the wait is too long. While 75 people in the U.S. receive life-saving organ transplants each day, approximately 18 people die every day before the organs they need become available. That is why it’s tremendously important to register on the Donate Life Texas registry at http://www.donatelifetexas.org/ and to make sure your family is aware of your decision.

Speaking to families about organ donation, Part 1

Grayson Burgess works for the organ procurement organization Southwest Transplant Alliance (STA) as one of two in-house coordinators at Children’s and Parkland Memorial Hospital. He is responsible for offering the option of organ donation to families of potential donors and has been specially trained by STA to handle those conversations in a way that best supports families while also increasing the likelihood of consent. I recently spoke to Grayson to get a better understanding of what that involves. This is the first of two parts of that discussion.

Q: How does the process of speaking to families begin?
A: A call to STA is required on all patient deaths and all imminent patient deaths. At Children’s, it’s generally the nursing staff, physicians or nurse practitioners who make the call to us. The organ donor protocol begins with a referral of a patient that meets clinical standards for donation, which means the patient is on a ventilator with a neurological injury and missing two or more brain stem reflexes and is absent sedation or hypothermia. We follow these cases as patients are tested for brain death or families have decided to withdraw treatment.

Q: When should STA get the call?
A: It’s important for us to get the early call when a patient meets clinical triggers – before the patient is actually brain dead and before the family begins to discuss withdrawal of treatment. This early involvement is important so we can come on site, take a look at the patient’s chart and assess that patient for donor suitability. That, of course, takes time. And it is very difficult for us to try to assess the patient and talk to the family about organ donation at the same time. We also don’t want to discuss donation with a family unless we are relatively sure that donation is an option for them. Not every patient that we get called about is a candidate for donation. So the time for chart review is critical.

Q: What qualifies a patient as a candidate?
A: Each case is an individual call. There are many variables, and most of those are fairly technical. So, it’s impossible to explain concisely. But the important thing is that we do have staff that are trained and equipped to determine suitability.

Q: How often are people candidates?
A: Rarely. Because potential organ donors must be ventilated, it is only in rare cases that patients meet eligibility. Only then do we discuss the topic of organ donation with families.

Q: How do you broach the topic of organ donation with families?
A: The circumstances of every situation are unique. So, we go about it in different ways. At all hospitals, but at Children’s especially, we work with Social Work, chaplains, Child Life, and with all of the ancillary services as well as the clinical staff to try to determine when the best time would be for our staff to talk with the families. We make sure the needs of each family are met and we talk with them about the person they’ve lost, and who that person was. And we ultimately explain their options and answer all of their questions.

Q: Are there other people in the room besides you and the family?
A: Most of the time we’re accompanied by hospital staff, and they are always welcome to be there. At Children’s particularly, it’s policy that we have a huddle to talk to everyone involved in the care of the patient – to the attending physician, the bedside nurses, the charge nurse, the practitioner, any fellows or residents and any ancillary staff. We want to make sure we touch base with everyone involved in the patient’s care before we talk to the family.

Q: It seems like the conversation with the family would be incredibly difficult. How do you do it?
A: We work with each family individually, depending on where they are in their circumstances. Our staff is specially trained to be able to have those very detailed and meaningful conversations, which is a big part of the reason why we ask that only designated requesters discuss the organ donation option with families.

Q: How often are families receptive to the idea?
A: Exact consent rates vary from year to year, but it’s fair to say that the majority of families that are asked to donate say ‘yes.’ When STA staff is called early and makes the approach, consent is generally obtained 70-80 percent of the time.

Making a statement

Football really isn’t Kelsey Oudshoorn’s game; volleyball is. But the other day, the 15 year old was waiting, football in hand, to meet Roger Staubach and Troy Aikman at Children’s. The two Dallas Cowboys icons shook her hand and autographed her ball, which she bought especially for the occasion.

Kelsey, a patient in the Center for Cancer and Blood Disorders, got to meet the Hall of Fame quarterbacks at a special photo shoot for the children who will participate in the 23rd annual Beyond the Rainbow Luncheon and Fashion Show hosted by the Children’s Cancer Fund.

Proceeds benefit Children’s
Proceeds from the April 15 luncheon and fashion show benefit pediatric cancer research. The fundraiser is expected to net $270,000 for Children’s and UT Southwestern Medical Center. The photos taken with Aikman and Staubach at Children’s will be used as part of a book of art created by children with cancer.

Staubach and Aikman are honorary co-chairs of the annual luncheon and come to Children’s each year for a photo opportunity with the children who will appear in the fashion show.

The fashion show features childhood cancer survivors and those still in treatment, and remembers those who have lost their fight with the disease. Kelsey finished chemotherapy for alveolar rhabdomyosarcoma on Valentine’s Day at Children’s at Legacy in Plano. Her type of cancer is an especially aggressive form of the soft tissue sarcomas that can occur in children.



Red shows her personality
It’s fitting that Kelsey finished her chemo on a day that’s symbolized by red. For the photo shoot with Roger and Troy, Kelsey wore a bright red fedora decorated with a white fabric rose. She accessorized the hat with a long white scarf emblazoned with flowers, a flowered top, and bright red high-top sneakers.

Kelsey says she picked her hat “because it’s bold, and we were asked to dress like our personality.” Red’s not her favorite color, purple is, “but I like the statement.” With a sense of self and of style like that, Kelsey is bound to wow them at the fashion show.

Our experience with bulimia

Editor's note: This is part two of a two-part series offering an inside look into bulimia. This part was written by the father and stepmother of the author of "A thirty-something's battle with bulimia." The family's names have been changed.

The thing I remember most about that time was Jessica’s anger. Long before I realized she was bulimic, her rage was remarkable.

Keep in mind that there are so many very wonderful aspects to Jessica’s personality and character. Perhaps the most obvious one as a child was her sense of justice. Jessica was always quite small and, even though she was always taught to be kind, I never was more proud of her than the time I discovered she had punched a huge boy at her elementary school because he was bullying a friend of hers.

She has always been very determined, and self-motivated. And she is a wonderful writer, all of which is to say that, where bulimia is concerned, bad things do indeed happen to good people.

When Jessica was 8, her mom and I divorced. I know the divorce was a traumatic event in her life but at the time, I didn’t see any obvious manifestations of it. Again, all I can recall about this period of time is that she had a bad temper.

When Jessica was 14, she came to live with her stepmom, Sheryl, and me. Sheryl had become pregnant. When Jessica moved in, she seemed to be excited about the idea of having a little sister. But a comment she made later about her being sorry to upset our "little family" — meaning me, Sheryl and the new baby – made me think she felt alienated. It could have just been her striking out, looking for something hurtful to say, but the comment was made, nonetheless. I know now that bulimia is about control and I feel certain that her living arrangements were a part of her life that frustrated Jessica and that she felt helpless to do anything about.

She seemed to be happy at her new school. She found friends and became a cheerleader. She always made good grades, and we would remark to one another about how much self-discipline she had about her schoolwork. We never had to ask her if she’d done her schoolwork, she just did it – right after dinner, secluded in her upstairs bedroom.

During this time, Sheryl told me that Jessica was becoming angrier and angrier. I guess I didn’t believe it was anything more than teenage angst, until I saw firsthand some of her angry episodes. When Sheryl suggested getting her some counseling, I finally sat down and talked to Jessica. She told me she hated everyone and could not stand to have anyone touch her. She said she knew she needed help and that "it can’t go on like this."

The psychiatrist we took her to prescribed an antidepressant. Unfortunately, Jessica wouldn’t take it on a regular basis. The therapist said this was typical for teenagers. He told us that she was depressed and that in teenagers, one of the major symptoms of depression is anger.

Eventually Jessica graduated from high school. We had apparently weathered the storm and thought things were pretty good.

Jessica was very bright and had no problem getting accepted to a college seven hours away from where we lived. Like most kids, she thought she wanted to get as far away from home as possible. In school, she was, of course, about as far away from Dallas as she could get and still be in a state-supported university.

She seemed to do well at college. Phone calls and visits home revealed nothing out of the ordinary. She joined a sorority, got a job and made excellent grades. Then, during her sophomore year, things started to fall apart. She called me in tears one time and told me that everything was disintegrating. I don’t remember the details of the conversation, but it seemed obvious to me that she was screaming out for help. I told her to pack her bags and come home so we could get her the intense help she needed.

Jessica sat out for a semester. She got the care she needed on an in-patient basis with continuing counseling after she was discharged. During this time I accompanied her to a visit with her counselor. At the time, Jessica’s physical build was normal, if not a bit on the thin side. I was astonished to hear that she thought she was too fat and needed to lose some weight. The counselor told me that that was an indication of her distorted sense of herself.

In retrospect, we should have gotten Jessica help sooner for her anger. I also trace a lot of the problems back to the divorce. Regardless of how resilient they appear on the outside, I think all children need professional guidance to get them through such a traumatic experience.

Today, Jessica is married to a loving husband. They have children. Her problems with bulimia seem to be far behind, but I suspect she still, to some small degree, silently fights the battle.

A thirty-something’s battle with bulimia

Editor’s note: In this two-part series, a Dallas family gives an inside look into the world of a bulimic. First, the daughter, now in her thirties, talks about the things in her life that led up to her eating disorder. Tomorrow, her father will share his perspective on how he learned about his daughter’s bulimia and how he helped her through it.

If you suspect your child is having trouble with an eating disorder or seems distressed or depressed, please talk to your pediatrician about your concerns.

There’s no way I can describe bulimia in a way that will make anyone understand. Anyone other than a fellow bulimic.

I know, intellectually, how disgusting it is to think of sticking your finger down your throat and making yourself throw up. But to me, there is something comforting in the act of doing so. It makes me feel like I’m taking care of myself. See what I mean? If you’re not bulimic, this is not going to make sense to you. But I will try to explain it.

How I became a bulimic

Something happened when my parents got divorced. I will never understand how a divorce like the one my parents went through translates into me becoming bulimic, but I believe that was the start of something screwy in my life.

Their divorce was amicable. It happened when I was 8. The moving trucks came to our house just a few days after I finished second grade. I remember sitting on the brick fence around our house, under a mimosa tree, watching moving guys loading furniture into moving vans.

I’m not saying that my bulimia is my parents’ fault. It’s no one’s fault but my own. They never made me eat entire boxes of Frosted Mini Wheats and then forced me to throw up. But somehow, I just didn’t handle their divorce and their subsequent dating and remarrying well. The bulimia didn’t even kick in until I was in college.

Building self-hatred

Maybe it was the moving around. I moved back and forth between my parents three times before I finally went off to college. I lived with Parent A and the alcoholic step-parent for a year or so. I lived with Parent B and my new wonderful other step-parent for a year. Then back with Parent A for four years. Then back with Parent B for three years.

During this time, an impossible amount of rage was building inside. I had good, close friends, but I hated everyone else. Especially myself. By my senior year, I often envisioned myself as two people. One version would lie on the ground so the other version could kick me and beat me up for being so ugly and such a horrible person.

My freshman year in college was fun and horrifying at the same time. I went to a university seven hours away from home. I went through rush and joined a sorority, where I felt so out of place. These girls were confident and beautiful and classy. I was small and ugly and had no social graces whatsoever. They formed immediate friendships with each other. I made a few friends but was petrified to show my true self to anyone. Up to this point in my life, I loathed every part of who I was, so it was hard to try to reach out and let other people get to know me.

Losing control

I remember the first time I made myself throw up. Or tried to. At first, it’s really hard to do. My stomach didn’t know what to do the first time I tried it, so I just gagged a bunch but didn’t throw up. Just like anything in life, practice makes perfect.

It was the summer between my freshman and sophomore years at college. I was living at a camp in the Hill Country of Texas. I was a camp counselor. I had 12 or so 8- to 9-year-old girls in my cabin. It was a sports camp where campers could choose from a dozen or so sports that they wanted to participate in. I was the cheerleading and gymnastics coach. Over a two-week period, I taught one simple, short cheer. I was so depressed, I wasn’t motivated to get out of bed and teach cheers.

While I was at camp, my mother was in a car accident. My grandfather, who I loved very much, died. As I was leaving the camp to go to my grandfather’s funeral, I got in a terrible car accident. During my grandfather’s funeral, when family members and friends brought all kinds of food, I gorged on everything I could get my hands on. This was the way I dealt with the stress of death and car accidents and deep self-loathing.

What it feels like to throw-up

When I returned to camp, the binging continued. On disgusting, rubbery chicken breasts and peanut butter and jelly sandwiches and graham crackers and chocolates. After a week or two of doing this, I realized I was out of control and had to stop eating this way. But I couldn’t seem to make myself stop. So instead, I went into a restroom during a break in my day and I tried to make myself throw up.

I wasn’t successful at first, but after three or four episodes, I started to get good at it.

When my sophomore year started, the binging and purging continued. I would eat to ease the stress and then throw-up to relieve the pressure and swelling in my stomach from all the food. The feeling I would get after throwing up was sheer relief.

If you are a runner, you’ve probably experienced this feeling. You know when you finish a really great run where you’ve worked your body out hard and you have an endorphin rush? That’s the same feeling I’d get after eating and throwing up.

The beginning of the end

Several weeks in to my sophomore year of college, I realized that I needed help. I felt isolated and friendless at college. I hated myself more than words could say, and I was so fat, I couldn’t bear to look at myself. (Looking back, I was probably not more than 10 or so pounds past a normal weight for my height).

I called my parents and told them what was going on. I withdrew from school and moved home (with Parent B and wonderful step-parent). I got into inpatient therapy. I got a job for the rest of the semester. When the new semester started, I transferred to a different university that was much closer to home.
At my new university, I found a psychologist who ran group therapy sessions with other students who had eating disorders. I began taking an antidepressant. I began a long series of one-on-one counseling sessions with a therapist.

The therapy and medication helped, but nothing eased my self-hatred more than binging and throwing up. I continued to binge and purge throughout college and my early twenties, despite therapy and medication.

One therapist suggested that I put a sticker on a calendar for every day that I didn’t make myself throw up. I’d get through a week or two or three and rack up all these stickers. I used those little metallic star stickers that come in green, red, silver and gold. The same ones elementary school teachers use to slap on test papers when a student got a good grade. My coworkers would see the stickers in my Day Runner and ask what they were for. I’d tell them the truth about my bulimia. I felt like keeping my eating disorder a secret made it dark and made me feel isolated.

Telling other people about it ended up being helpful to me. The success made me realize that I could, possibly, break my cycle. When I didn’t earn a star sticker, I saw it as a road bump—not a complete unraveling of all the good work I had done previously.

The acts of reaching out to my parents for help, group therapy, individual therapy, putting stickers in a calendar and being open with people was the magic combination for me. I don’t know how other women (and men) make it through.

A never-ending battle

But the work’s not finished. I remember the last time I made myself throw up. I was in my early thirties and during a time when I was feeling out of control. I only did it once or twice before it hit me just how badly I didn’t want to get back in that cycle again. I stopped myself before it got too far.

I think bulimia will always be with me. I will always obsess about how many calories I’m eating each day and how much I’m working out. I despise hearing family members (especially those who know about my bulimia) talk about their low-carb diets and tummy tucks and such. I try not to make a big deal out of it, but my heart starts racing when the subject comes up.

I am blessed, though. I have a supportive husband who knows about the bulimia. I have children now, and I do everything I can to make sure they have consistency and stability in their lives. I realize that any traumatic experiences they go through as children will likely manifest itself in a way that may not come to light until they are much older. I do the best I can to make sure they know they are loved and know that they can always come to me when they are upset or depressed. I just want them to be happy with themselves.

Children's in the News

Children's is regularly featured in the news for a variety of reasons, and we had a few stories come out this week that we wanted to share.

Transplant patient on Today Show tomorrow
Lyndon Baty has been a patient at Children's since he was 3. The 15-year-old from Knox City, Texas, spent nearly all of last summer here after his body showed signs of rejecting the kidney transplant he received here in 2003.
The Nephrology staff at Children's was able to stabilize Lyndon's condition, but his immune system was so compromised that he couldn't go to school this year. This was especially troubling for Lyndon because - as his mom, Sheri, says - "he loves the spotlight."
"Lyndon loves being around his friends," Sheri said. "He has really missed that. The illness and dealing with rejection has been really difficult, but I think what has been most difficult on him is missing out on the social interaction."
But that all changed at the beginning of this semester when Lyndon's school district was able to arrange for Lyndon to remotely attend school through a robot - as shown in the video at the bottom of this Huffington Post article.
"He still can't go to school with his friends physically, but this little robot has provided such an amazing outlet for him," Sheri said. "Since then, his appetite has been better. He's been more upbeat. It's been amazing to see the difference."
News outlets across the country have picked up on Lyndon's story, and he will even be featured on The Today Show on NBC at 8 a.m. tomorrow morning. Watch his interview if you get the chance!

Stroke study making national headlines
Nearly 2,000 news outlets have recently featured new critical stroke initiatives that were launched at Children's to diagnose and treat strokes in children.
Pediatric stroke is a little-known condition that occurs as often as leukemia and brain tumors but often is not recognized by parents or physicians, despite the serious short- and long-term health consequences. As part of this effort, Children’s plans to start one of four research sites in North America participating in this groundbreaking research.
“Pediatric stroke research is in its infancy,” said Dr. Michael Dowling, medical director of Children’s Pediatric Stroke Program. “We’ve simply got to find out why children suffer strokes.”
You can read more about the initiative in this Boston Globe online article.

CCBD patient inspiring others
Fourteen-year-old Payton Agnew loves to make jewelry and wants to be a doctor when she grows up. Last June, Payton underwent a bone marrow transplant at Children’s to treat T-cell lymphoma and is currently in the intensive care unit battling her disease.
Learn how Payton has inspired her entire elementary school to join in her effort to fight cancer in this WFAA news clip that ran this week.

Plano boy gives little brother life-saving transplant

Editor’s Note: When Jude Cobler, 6, of Plano, was diagnosed with acute lymphocytic leukemia in August 2010, the diagnosis was difficult for his family to accept. It was harder still when traditional therapies failed. In October 2010, the Cobler family learned that Jude would need a bone marrow transplant.

This procedure would rid Jude of his own unhealthy blood cells and replace them with healthy blood-forming cells from a donor. But finding a donor can be difficult, because the recipient and donor’s tissue types must match. There is a 25% chance that a sibling will match.

Thankfully, this was the case for Jude. His older brother, Joshua, 12, was a match. On December 23, 2010, Joshua donated his bone marrow to Jude. Here, Joshua describes what it was like donating marrow to his little brother.

The donation
The bone marrow procedure was today. I lay in the soft hospital bed wearing a hospital gown completely relaxed. If I were not under the influence of the calming medicine, there is no way I would’ve been able to sit still. They rolled me down to the transplant room.

The actual procedure began after I was unconscious from general anesthesia. The doctor made two small incisions on the skin over the hip bone and inserted a special hollow needle/syringe into these incisions. The needle is inserted through these incisions at various angles and draw out the bone marrow. The marrow itself looks exactly the same as blood. Gauze and stretchy tape were then placed over the wound.

The aftermath
I felt exactly three seconds pass before a nurse woke me up in the recovery area. I was in the worst pain I’ve ever felt. (Then again, I’ve never truly been in pain before). After what felt like two minutes, but was probably much longer, she told me I met the requirements to go home. They took me upstairs by wheelchair to Jude’s room. He enthusiastically screamed my name and asked if I was all right. I limped over to the couch where I lied down and groaned. The pain was now less severe but it still hurt. (It wasn’t sore yet. It was just pure pain).

Seeing Jude againThey hooked up Jude’s central line to the bag of my marrow, his second life. I hobbled over to Jude as I told him that I loved him. He told me that he loved me. But, it meant more than that. Much more “It wasn’t just a little “I love you,” it was an “I’d do anything for you because I love you.”

I still secretly cry when I get off the phone with Jude. But, they’re no longer tears of pain and misery. They’re tears of hope. I’ve cried enough, but the tears still keep flowing out. I will never forget how much pain I went through, I will never forget how many tears I cried through these five months. I will never forget Jude’s resolution to become a “leukemia doctor” and how I promised I would become a pediatric oncologist in Jude’s honor.

But, I will never ever forget how I gave my brother a new chance at life this Christmas.

Maybe it’s strange for me to say I’m not scared at all, but I just know he’ll be all right. He has to be. But, no matter how much pain I go through, how much I hurt, how many times I cry when I’m alone, I will never forget his beautiful smile.

Editor’s Note: Two months after the procedure, here’s what Joshua had to say.
The bone marrow transplant doesn’t really cause any problems in my life. All I have to do is take iron pills every day for the next month or two.

Would I do it all over again? Of course I would. About two hours of pain for a chance to save someone’s life is worth it. So many people need bone marrow donors to make this lifesaving procedure possible.

So, I challenge you to become a donor and give someone else a chance for life. Someone out there needs you. You have the power to save a life.

How you can help
Children’s will play the role of matchmaker this Valentine’s Day, and we want you to help. On any given day, there are some 10,000 people waiting on a bone marrow transplant, including three patients at Children’s. However, 70% of patients who need a transplant don’t have a suitable donor in the family.

On Monday, Feb. 14, 2011, Children's Medical Center hosts the Be The Match bone Marrow Donor Drive from 9 a.m.to 7 p.m. And you can join the registry for free. All it takes to get registered and potentially save a life is a cotton swab of the mouth to determine your tissue type.

The registry is open to healthy people between the ages of 18 and 60, and there is a distinct need for ethnic and racial minorities, who are under-represented on the registry. Because tissue type is inherited, patients are most likely to match someone of their same race and ethnicity, and there is a 25% chance that an immediate family member will match. Learn more at http://www.childrens.com/.

A Real-life Ralphie

If you have ever seen “A Christmas Story,” you know the line “You’ll shoot your eye out.” Nearly every authority figure in the movie says it over and over again to the main character, a fourth-grade boy named Ralphie who wants a BB gun for Christmas. Ralphie ends up getting his wish and actually does shoot himself in the eye when a BB ricochets off of a metal target.

Since the movie is a comedy, it would be easy to dismiss the incident as contrived. But 9-year-old Lane Foreman of Eustace, Texas, knows better.

“I know it really happens,” he said. “Because it nearly happened to me.”

Lane was playing with a BB gun over the holidays when one of his shots ricocheted off of a tree stump and hit him in the right eye. His family rushed him to a nearby emergency room, but his injury looked so bad that the staff decided he needed to be seen by pediatric trauma specialists. So, they referred him to Children’s.

“I thought he was going to lose his eye,” Lane’s mother, Tammy Foreman, said. “I thought he was going to be blind.”

Treat BB guns like ‘real’ gunsStories like Lane’s fortunately don't happen every day at Children’s. In 2010, there were 15 patients admitted to our Trauma service for gun-related incidents. Out of those 15, six involved BB guns.

However, Claudia Romo, the program manager for Injury Prevention at Children’s, still thinks parents should be especially cautious with allowing their children to use BB guns.

“All BB guns aren’t the same,” Romo said. “Some are more powerful than others. And young children lack the developmental and coordination skills to assess danger and handle some of these powerful guns.”

Romo said that she advises parents not to buy BB guns for children younger than 14 but also understands that some parents will anyway.

"If parents are still going to buy them, then they should make sure their children wear protective gear like goggles and a vest,” she said. “They should also store the BB guns in gun safes or lockboxes if they have children of different age ranges. Treat them like real guns.”

No permanent damage for Lane
Lucky for Lane, his eyelid caught most of the BB that hit him and prevented permanent damage to his eyeball. He may need future surgery but is expected to completely recover.

The biggest worry he has now is that he misses being at Children’s.

“He told me the other day that he missed the room service and nurses,” Tammy said. “He took a picture with his nurses to show off to his buddies once he got back home.”

Lane is also informally educating other children about gun safety. He’s even using “A Christmas Story” as a teaching tool.

“When we went to a doctor’s office recently, he went up to a little kid and told him that movie is a great example of why you don’t need to be playing with BB guns,” Tammy said.

Talking about tragedies

In light of the recent shooting tragedy in Tucson and the one-year anniversary of the Haiti earthquake, parents should be prepared to talk to their children about these events.

In fact, First Lady Michelle Obama has penned an eloquent letter to parents that offers some insights into talking with your children about tragedies such as Tucson.

Pete Stavinoha, Ph.D., a child neuropsychologist at Children’s Medical Center in Dallas, says these events provide a starting point for discussions with your children. But, these are also subjects that could raise anxieties in children who see the images on TV or hear about them on the radio or the Internet, so it is important to monitor their time listening to, watching and interacting with the news.

Tips for talking to children

Stavinoha suggests parents:

• Listen to children and encourage them to ask questions at their own level of understanding. It’s OK to say you don’t know all the answers. It’s also OK not to overwhelm them with information that they may not understand.


• Pay attention to younger children’s play and drawings. They may give you a clue about what they are feeling or what they know about these tragedies. This may provide the opportunity to talk about it and perhaps clarify their questions.


• Don’t downplay the seriousness of the situation. Especially for older children, it is important to acknowledge the significance of the event.


• Model healthy parental coping during stressful times. This does not mean hiding your feelings, but rather staying aware of your reactions and showing your children how you deal with a tragedy in a healthy manner.


• Participate in activities that help put you and your children back in control of the otherwise disturbing situation such as attending prayer services.


• Seek support from family, friends, church or other social and emotional supports.

If your child is old enough, watch news reports or read the news together to encourage conversation about the topic. PBS has age-appropriate guidelines about how much news children should be watching and what they will understand about the news that are helpful.

Standing for the first time

Fifteen-month-old Mya Saysanam stood for the first time a few weeks ago. I know because I saw it happen while I was interviewing her family.

Although I wouldn't usually pay much attention to the first stand of any child who wasn't my own, this instance struck me as particularly momentous.

Liver experts at Children's diagnosed Mya with acute liver failure when she was 4 months old. The diagnosis shocked her parents.

In the span of a couple of days, they went from thinking she was completely healthy to not knowing if she would live to see her first birthday, much less stand on her own.

"I went numb when I found out," Mya's father, Sye Saysanam, said.

Children's was the best place to come
There is nothing good about that news for any parent, but if there was any bright spot to be found, it was that Mya came to Children's. As the only pediatric liver transplant facility in North Texas, Children's was the only place near Mya's home in Fort Worth that had the staff with the expertise to treat her condition.

And her condition deteriorated quickly. Just a few weeks after her diagnosis, her liver lost the capacity to function on its own. She had to be admitted to Children's until she could get a transplant, and no one knew for sure when that would be - a month, a year or even longer.

"They gave us a pager to alert us when she received a new organ," Sye said. "I couldn't take my eyes off of it."

"We just prayed and prayed and prayed," her mother, Krista Ketnourath, said.

Brief wait leads to permanent memories
The wait fortunately was short. A perfectly sized liver for Mya became available only two weeks after her admission. Drs. Dev Desai and Meelie Debroy took her in for surgery at midnight.

After staying up all night, Mya's parents saw their daughter emerge from surgery at 8 a.m. It was the first time they had ever seen her with a healthy liver.

"I'll always remember the first time she opened her eyes in ICU and they weren't yellow anymore," said Krista. "I always thought she was a beautiful child, but after that, I just thought, 'Oh my gosh, she really is beautiful.'"

And Krista said she will also never forget seeing Mya stand for the first time and what that symbolized.

"Now she has a new life," she said. "Now she's going to grow up."