Ocean Institute brings unique experience to CHOC mental health patients

Patients in the CHOC Children’s Cherese Mari Laulhere Mental Health Inpatient Center (MHIC) have a friend in Dana Point’s Ocean Institute, a non-profit aimed at educating SoCal youth.

The organization’s mission, “Using the ocean as our classroom, we inspire children to learn,” comes to life in the MHIC, where patients age 3-17 receive hands-on maritime education. It is a unique partnership – one that both patients and staff are passionate about.

After volunteering at CHOC for a long time with medical patients, Ocean Institute Distance Learning Programs Coordinator Danelle Hickman met with MHIC leadership to determine if bringing the Ocean Institute program onto the mental health unit would be feasible. It was a unique idea; few inpatient centers have any volunteers, let alone regular visits from a group of them. But despite the special considerations, everyone was determined to make it work.

After mental health-specific training, members of the Ocean Institute began their valued work in the MHIC in early 2019. Led by Hickman, the STEAM-inspired (science, technology, engineering, art and mathematics) program includes discussion, questions and answers, hands-on education, activities and art projects. The group also brings in sea animals for patients to see and touch.

Patients in the Cherese Mari Laulhere Mental Health Inpatient Center are able to see and touch live sea creatures during Ocean Institute lessons.

Hickman is passionate about offering patients an engaging experience.

“Our mission is to serve students from all walks of life. We are proud to provide programs for CHOC patients. This fills a community need for more than ‘feel-good’ programs; these powerful educational adventures aim to be life-changing.”

In an early December visit, their eighth of the year, Hickman and two Ocean Institute volunteers began the lesson by asking patients and staff to introduce themselves and discuss their favorite ocean animals. Answers around the table included sharks, whales, sea otters, sea turtles, seals and others. One patient chose jellyfish because of a memorable scene in the Disney-Pixar film “Finding Nemo.” Another patient chose dolphins, finding them “graceful but powerful when they need to be.”

The team then presented the patients with three varieties of live sea star and two preserved sea turtles. The group passed around the animals, noting some of them felt soft and others rough. The observation turned into a discussion about the difference between vertebrates and invertebrates; the patients worked together to figure out which category each animal falls into.

In one lesson, patients were introduced to a few different species of sea star and were able to compare and contrast their features.

Seeing the lesson unfold makes it clear why the Ocean Institute partnership is so valued in the MHIC.

“The thought of bringing ocean life onto an inpatient mental health unit was new for me,” says Director of the MHIC Dani Milliken. “Luckily, Danelle was so amazing, kind and flexible as we walked through all of our dynamics and special needs. And now, we couldn’t be happier with how the program has fit into our unit. Patients absolutely love having the Ocean Institute visit, and the buzz of excitement lasts long after each session. Even our most isolative patients enjoy interacting with the animals and teachers.”

For patients on the unit, the visits are about much more than learning about the ocean.

“Having community members come onto an inpatient mental health unit and be side by side with patients, learning and growing with them, is truly remarkable,” says Milliken. “It has been such an incredible journey so far, and we are so lucky to have the Ocean Institute program here at CHOC for such a vulnerable population.”

To Hickman and the Ocean Institute team, the joy of the partnership comes through seeing the kids as future ocean stewards who deserve to learn, play and discover during their time at CHOC.

The program’s STEAM-based curriculum incorporates creative expression as an important part of the learning process.

“Our programs allow patients to be heard and show them that others outside the hospital care about their thoughts and feelings. The program content affords them a way to visually and creatively express themselves, making choices that support the unique artwork that they create. Discussing the ocean and the animals that live there provides a positive common ground from which to build confidence in a safe environment.”

The partnership has become so cherished on both sides that the Ocean Institute, thanks to a generous donor gift, is bringing the program to CHOC’s MHIC twice per month in 2020.

Learn more about the Ocean Institute and the Cherese Mari Laulhere Mental Health Inpatient Center.

CHOC earns $1 million grant to advance rare disease genome-editing therapy

With an aim of addressing a critical and unmet need in rare disease research, CHOC Children’s will advance rare disease genome editing therapeutics, thanks to a $1 million grant from The Larry and Helen Hoag Foundation.

The funding will help form CHOC Children’s Center for Advancing Rare disease Editing (CARE), allowing researchers to further their work to use genome editing to rapidly generate, characterize and treat preclinical models of rare disorders with known pathogenic mutations.

Genome editing therapy has the potential to permanently correct underlying pathogenic mutations in patients with some rare diseases. This treatment addresses the root cause of the disorder, eliminating the need for more standard therapies like enzyme replacement and stem cell transplantation that often require repeated treatments.

“CHOC is at the forefront of operating at the interface of translational research and clinical care of rare disorders,” said Brent Dethlefs, executive director of the CHOC Children’s Research Institute. “Our ultimate goal is to provide patients with rare diseases with an objective, rigorous assessment of whether genome editing therapy has the potential to advance their current standard of care.”

The work will build upon CHOC’s existing successes in developing preclinical models of rare diseases. For example, CHOC’s lysosomal storage disorders research team has already generated the first preclinical models of Pompe disease – a rare and fatal disorder that affects the heart and muscles – that are suitable for genome editing therapy and exhibit molecular, biochemical and functional analogy to patients with the severe infantile-onset form of the disease.

“Given the success of this project, we have received multiple inquiries from research colleagues seeking to collaborate and patient advocacy groups hoping to generate additional preclinical models of rare disease, but until now, we’ve never had the resources to participate,” CHOC scientist Dr. Jeffrey Huang said. “We believe that CARE has the potential for rapid growth given the intrinsic scalability of genome editing as a strategy to generate preclinical models and develop novel therapeutics.”

The Hoag Foundation funding complements a grant CARE recently received from the CHOC Children’s Foundation’s One Wish Grants awards. The grant awards unrestricted funds to outstanding ideas that drive advancement toward CHOC’s strategic goals.

The mission of The Larry and Helen Hoag Foundation is to educate, empower and create greater opportunity for at-risk children to become independent, productive and contributing members of society; support medical research and technology to enhance the health and well-being of children; and support such other compelling purposes that will enhance the quality of life for residents in Southern California.

Learn more about the CHOC Children’s Research Institute.

How pediatricians can help teens get better sleep

Having a teenager in the home can be, for many families, a reminder that there are simply not enough hours in the day. Between school, athletics, after-school commitments, social events and family commitments, many adolescents today feel like they are running on fumes.

While some families accept low sleep as a fact of life for teens, health agencies such as the American Academy of Pediatrics (AAP) are urging adolescents to prioritize sleep for several reasons.

Why are teenagers so low on sleep, and why is sleep so important to them?

Sleep is a topic CHOC Children’s pediatrician Dr. Kate Williamson encounters daily. She estimates that most of her teenage patients are chronically low on sleep.

Dr. Katherine Williamson, CHOC Children’s pediatrician

She points to two key considerations about adolescent sleep:

  1. Adolescents have a different sleep cycle than all other age groups. Their biological clocks signal them to sleep later at night, which mean they need to wake up later the next morning. An alarm set for 5:45 a.m. can feel like the middle of the night to an adolescent body.
  2. Adolescent sleep deprivation contributes to obesity, depression, increasing rates of suicide and declining academic performance, among many other consequences. At a time when academic pressures could not be higher, it’s a dangerous combo.

Williamson is not alone in viewing poor sleep hygiene as a public health crisis. The AAP points to low sleep as a contributor to physical and mental health problems in teens, calls for later school start times and suggests teens sleep eight to 10 hours per day.

The recently signed Senate Bill 328 will require most middle schools to start at 8 a.m. or later, and high schools at 8:30 a.m. or later, beginning July 2022. But legislation is the first step, Williamson says, in a conversation that needs to include parents, educators, health officials and many others.

How can pediatricians help?

For many families, more sleep can be low on a growing priority list—especially when barriers like parent work schedules or differences in socioeconomic status can make changing the routine feel impossible.

This is where pediatricians can step in to help families understand that sleep needs to be the priority for their teens.

Here are some steps pediatricians can take to help teens adopt better sleeping habits:

  1. Start the conversation. Make a point to ask adolescent patients about their sleeping habits and discuss how they could improve.
  2. Talk to patients and parents about the research, including possible consequences of chronic sleep deprivation.
  3. Point out any symptoms you can spot already, such as stress, moodiness or depression.
  4. Urge families to adopt a new sleep routine, and point out that the benefits will outweigh the logistical challenges.
  5. Encourage parents to talk about sleep hygiene with school officials and their workplace/s. Healthier adolescent sleep requires collaboration both within the family and among the wider community.

“Sleep should be addressed by all pediatricians to all teenagers,” Williamson says. “We need to assure families that there is more that goes into this conversation than a new law. It’s about widespread mental health among California’s youth.”

Read more about kids and sleep on choc.org.

Coronavirus: what providers should know

What is coronavirus?

Coronaviruses is one of a large family of viruses worldwide. Many coronaviruses cause mild upper respiratory infections, but coronaviruses that infect animals can evolve and become a new human coronavirus strain. These can cause more severe illness. The current outbreak, which began in Wuhan, Hubei Province, China, is known as 2019-nCoV and has spread to several other countries, including the U.S.

What can I tell patients who are concerned about coronavirus?

If a patient and their family have not recently traveled internationally, the risk of acquiring 2019-nCoV right now is low, says Dr. Jasjit Singh, a pediatric infectious disease specialist at CHOC Children’s.

“Please remind your patients that at this point in our community, influenza is a more immediate concern,” says Dr. Singh. “We are in the midst of influenza season, and thus far in the U.S., the CDC has reported 15 million cases of influenza, including 8,200 fatalities – 54 of which have been children. Therefore, a good way to avoid a severe respiratory illness is to get the influenza vaccine.”

How can patients and families prevent coronavirus infection?

There is no vaccine for 2019-nCoV. The best way to prevent infection is to avoid exposure in the first place. As of Jan. 27, 2020, The CDC has recommended that people avoid all nonessential travel to China.

What was the source of the 2019-nCoV outbreak?

Public health officials are still working to identify the source of the 2019-nCoV outbreak. Many of the earliest patients infected had links to a large seafood and animal market, suggesting animal-to-person spread. However, recent patients have not had exposure to animal markets, suggesting person-to-person spread is occurring. This can happen via respiratory droplets spread when someone with coronavirus coughs or sneezes.

What are symptoms of coronavirus?

Reported illnesses have ranged from people showing little to no symptoms to severe illness and death. Symptoms of coronavirus can include fever, cough and shortness of breath. Symptoms can appear in as few as two days after exposure to as many as 14 days after exposure.

Currently, diagnostic testing for 2019-nCoV can only be done at the CDC. The respiratory pcr panel at CHOC Children’s (RP-pcr) tests for 4 routine strains of coronavirus and does not pick up this strain.

What should I do if I suspect a patient has contracted coronavirus?

Patients in the U.S. who meet the following criteria should be evaluated as a patient under investigation (PUI) in association with the outbreak of 2019-nCoV in Wuhan City, China:

  1. Fever AND symptoms of lower respiratory illness (e.g., cough, shortness of breath), and in the last 14 days before symptom onset:
    • a history of travel from Wuhan City, China
      or
    • close contact with a person who is under investigation for 2019-nCOV while that person was ill
  2. Fever OR symptoms of lower respiratory illness (e.g., cough, shortness of breath), and in the last 14 days before symptom onset:
    • Close contact with an ill laboratory-confirmed 2019-nCoV patient

If a case of nCoV is suspected, providers should notify infection prevention staff at their facility immediately, as well as local or state health officials.

What precautions should providers take when seeing patients?

Providers who care for patients with respiratory illness should take the following precautions:

  • If caring for patients with respiratory symptoms and fever, obtain a detailed travel history.
  • Continue to evaluate for other common respiratory illnesses currently circulating, such as influenza and RSV.
  • In addition to standard precautions, use Airborne and Contact with an N95 mask, eye protection, gown and gloves.
  • If a provider suspects a patient has contracted nCoV, they should notify both infection prevention at their facility and local or state public health authorities immediately.

In the Spotlight: Dr. Tammam Beydoun

CHOC Children’s welcomed Dr. Tammam Beydoun to the radiology department in October 2019. Tasked with kicking off CHOC’s Interventional Radiology program, his passion is to use minimally invasive procedures for blood vessel and lymphatic issues. We chatted with him about returning to his hometown of Southern Calif. and his time with CHOC so far.

Dr. Tammam Beydoun, CHOC Children’s interventional radiologist

Where did you receive your education and training?

I did my undergraduate degree at University of California, Irvine, then attended medical school at Touro University California College of Osteopathic Medicine. My radiology residency was at Michigan State University, and my pediatric diagnostic and interventional radiology residency was at Phoenix Children’s. Then, I completed my vascular interventional radiology fellowship at the University of Cincinnati.

What is your role at CHOC?

I was hired to build the new Interventional Radiology (IR) program at CHOC, which is now the only pediatric IR service in the county. IR uses imaging guidance to deliver minimally invasive, targeted treatments across the body. Building on a foundational knowledge of medical imaging, interventional radiologists can navigate the body using imaging to access, diagnose and treat nearly every part of the body, often with just the puncture of a needle. In the past, this used to require open surgical procedures, but now IRs can directly access a target through the skin without a scalpel; they can use the body’s innate transport systems (blood vessels, lymphatics, intestines, etc.) to reach nearly any target.

It’s a satisfying niche that can impact both children and adults. It’s rewarding to work with a large, multidisciplinary team alongside plastic surgery, hematology/oncology, dermatology, general surgery, otolaryngology and other specialties.

Do you have any special clinical interests?

I’m especially interested in biliary (bile duct) and vascular malformations. Abnormal blood vessels and lymphatics can be painful and can lead to a risk for infection and other complications. But using IR, these cases can be treated mostly with minimally invasive needle pokes.

What are some new programs or developments within your specialty?

The IR program itself is new to the county and brings important services to the children at CHOC. We can do a lot of procedures here to help reduce pain, recovery time, length of stay and cost for families. We hope to bring that to an outpatient setting in the future. We’re also working on building a dedicated space for IR, which will continue to supply the team with the most advanced equipment.

What would you most like providers in the community to know about your team at CHOC?

Most people don’t know that IR can affect almost every specialty, such as gastrointestinal, OBGYN, nephrology and many others. It’s a field that can touch almost every part of the body, and there can be a minimally invasive solution for almost every problem – even persistent nosebleeds.

Why did you decide to become a doctor?

If I had to choose a moment when I knew it was for me, I’d pick the Hoag Clinical Care Extender program in 2001. I would see physicians come into people’s lives and change them instantly. As a physician, you can quickly earn a patient’s trust and, with that, really change the course of their life for better. As a person who likes to take responsibility and initiative, I knew I wanted to do that for others. Even if I can’t help them myself, I wanted to be someone who could find them the care they need. It’s a privilege—a heavy privilege—and I don’t take that lightly.

What inspired you to work at CHOC?

It has been my goal to be at CHOC since 2012. I decided in residency that it was my goal to bring IR to SoCal and to CHOC. It’s taken a lot of time and effort, but it happened! This is my hometown, so it’s good to be home and to deliver care where I want to be. CHOC really is the place to go. It’s already a destination for very special care that’s not given anywhere else, and it just keeps improving. The trajectory is steep; CHOC is going places.

What drew you to interventional radiology?

I was drawn to IR because it’s kind of like being MacGyver—a lot of creative troubleshooting. In IR, no two cases are the same. You have a specific set of tools and can use them in any combination to do what you need to do, and you can modify it for any body part and almost any disease. You can go through the groin to work on the nose. You can work with glue, coils or stents. You can see through people with X-rays or CT scans. Each patient requires a novel approach, so I might have to come up with a different way to do something. That’s really fascinating to me.

If you weren’t a physician, what would you be and why?

An engineer. I love solving problems, troubleshooting and anything related to computers, servers or electrical equipment. I’m always taking things apart and rebuilding them.

And a racecar driver, but that dream might be past me now.

What are some of your outside hobbies?

I used to do a lot of outdoor rock climbing, which I’ve pared back on and now do safely indoors. I also love anything automotive, as well as snowboarding.

What have you learned from your patients?

Gratitude and patience. I can’t imagine what some patients go through. Even for the relatively short moment I’m involved in their lives, it can seem like it would be overwhelming. But they do it with patience and gratitude.

Learn more about interventional radiology at CHOC Children’s.