Living with arthritis: Carson’s story

Seventeen-year-old Carson comes from a close-knit family of athletes and had been playing baseball for a decade when consistent, unexplained pain left his family stumped and looking for answers. The next 18 months were filled with countless physical therapy and orthopedic appointments. When an MRI of his spine lead the radiologist to assume they were from a middle-aged person who’d played a lifetime of contact sports, rather than a 15-year-old boy, finally the family had a clue that Carson’s pain was not just an overuse injury.

At the time, pre-diagnosis, Carson was traveling a couple hours roundtrip every few days for orthopedic appointments related to wrist, elbow and shoulder pain.

He was ultimately referred to Dr. Andrew Shulman, a CHOC Children’s pediatric rheumatologist, and finally Carson’s family had the answers they’d been seeking for years. Carson was diagnosed with Juvenile Ankylosing Spondylitis, a form of arthritis that affects the spine and sites where muscles, tendons and ligaments attach to bones in the body. Juvenile Ankylosing Spondylitis is diagnosed in 1 in every 50-100,000 children per year.

He was also diagnosed with Pain Amplification Syndrome, a condition in which patients develop abnormal pain sensitivity. The nervous system processes normal sensations from movement and environmental experience as pain signals.

Andrew Shulman, M.D.
Andrew Shulman, M.D.

Looking back as far as middle school, a lot of Carson’s issues were tied to this condition. He had tried everything from water therapy to hypnosis, but nothing worked. Then Dr. Shulman recommended acupuncture, and Carson’s mom Andrea explains how Ruth McCarty, director of Chinese medicine and acupuncture at CHOC, was ‘unbelievable in getting Carson to a good place.’

Additionally, Carson’s multidisciplinary care team includes physical therapist Robin Beauregard and pediatric gastroenterologist Dr. Mitchell Katz. Carson’s family is also a key component of his care team.

“Dealing with these diagnoses is a team effort,” says Carson. “My dad carries me up the stairs when my Pain Amplification Syndrome flares up and I can’t walk, and I squeeze his hand during Humira injections. My mom helps me mentally, and she’s made this so much easier to manage. Dr. Shulman has given us a path forward.”

Despite still making his school’s baseball team while fighting a dual diagnosis, Carson could no longer cope with the week or two of pain that came with playing a single inning. Now he works out daily in a gym whether he’s experiencing a flare up or not, which helps with both diagnoses. To fill the void that competitive baseball left, he often plays catch with his friends and former teammates.

“Carson’s journey with arthritis is a powerful one. It speaks to the importance of diagnosing arthritis, and the outcomes we can achieve with therapy,” says Dr. Shulman. “His experience shows that multidisciplinary care has been transformative.”

Dr. Shulman offers the following guidelines on when to refer for further evaluation:

  • Persistent joint swelling, stiffness, limited range of motion.
  • Musculoskeletal pain not responding to rest, supportive care, modification of activity and exercise.

For a full list of referral guidelines, click here.  To contact Dr. Shulman, please call 714-509-8617. 

Learn more about rheumatology services at CHOC Children’s.


Meet Dr. Laura Totaro

CHOC Children’s wants its referring physicians to get to know its specialists. Today, meet Dr. Laura Totaro, a pediatric hospitalist at CHOC Children’s at Mission Hospital.

Dr. Laura Totaro

Q: What is your education and training?

A: I attended Loma Linda University Medical School and graduated in 2011. I then became part of the first UC Irvine/CHOC Children’s pediatric residency class and graduated from the program in 2014. I was board-certified in Pediatrics in 2014.

Q: What are your administrative appointments?

A: I am the hospitalist representative for both the CHOC Children’s at Mission Hospital Intensive Care Committee and the CHOC Children’s Infection Prevention Committee.

Q: What are your special clinical interests?

A: I am most interested in infectious disease and autoimmune disorders.

Q: How long have you been on staff at CHOC?

A: Two years.

Q: What are your most common diagnoses?

A: Seizures, asthma, bronchiolitis, pneumonia, and gastroenteritis/dehydration.

Q: What would you most like community/referring providers to know about you or your division at CHOC?

A: In an effort to better facilitate transfer of care, we now offer 24/7 hospitalist coverage at both CHOC campuses.

Q:  What inspires you most about the care being delivered here at CHOC?

A: The CHOC community provides a unique focus on healthcare for kids that goes beyond just the basics. The entire care team including the doctors, nurses and additional staff who strive to provide personalized care that not only treats a physical illness but also addresses the needs of the entire family. I am inspired by the culture of physicians and nurses that are constantly learning and trying to provide the best care they possibly can. It is such a pleasure to work in a place where everyone seems to truly enjoy their job and are trying to find ways to be even better at them.

Q: Why did you decide to become a doctor?

A: I grew up in a healthcare-focused community where I was exposed to medicine from a young age. I was inspired by the doctors around me and was fascinated by the human body. I also wanted a career that would allow me to help others here in my immediate community and abroad.

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

A: I would run a travel blog and be a food critic.

Q: What are your hobbies/interests outside of work?

A: Travel, exploring new restaurants, art, and music.

Q: What’s the funniest thing a patient has ever told you?

A: I was examining the mouth of my patient when he proudly showed me his loose tooth and whispered to me that his family had a secret. He then excitedly admitted that his mom was the tooth fairy!  His mother looked at me quizzically and then burst out laughing when she realized what had taken place. Earlier she had admitted to him that she played the role of tooth fairy at home but her son took this quite literally and believed it to actually be her secret full time job for all children.

Meet Dr. Alejandra R. Suzuki

CHOC Children’s wants its referring physicians and patients to get to know its specialists.  Today, meet Alejandra R. Suzuki, MD, FAPA, child psychiatrist.   Born and raised in Argentina, she is of Japanese descent and is fluent in English, Spanish and Japanese. She joined CHOC’s medical staff in 2015, and is proud to be part of the hospital’s mental health initiative.

Dr. Alejandra Suzuki

Where did you complete your education and training?

After finishing medical school at the University of Buenos Aires, Argentina, I entered a residency program in ophthalmology.  My interest in neuro- ophthalmology sparked research opportunities for me in Japan.  A few years later, I came to the U.S. to continue my research in neuro-otology at the University of Miami.  I had always been interested in the brain, but the mind intrigued me.  I decided to change career paths and pursue psychiatry.  I completed my psychiatry residency at USC, followed by fellowship training in child psychiatry at UCLA.  There, I became interested in autism and participated in research on morphometric MRI studies in children with autism.

I am board certified in general psychiatry and child psychiatry.

What excites you most about CHOC’s mental health initiative?

I am honored to have joined CHOC as it announced its commitment to a mental health initiative.  CHOC envisions the integration of physical and mental health.  Our mental health care delivery focused on the individual and benefits the patient as a whole.  I’m very excited about collaborating with primary and subspecialty providers at CHOC.  Given my multi-cultural background and past experiences, CHOC is the ideal place for me to practice.  I look forward to contributing to the growth of our mental health initiative and to providing excellent care to our patients.

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

If I weren’t a physician, I would probably be a musician.  I used to play the piano and love classical music.

What are your hobbies and interests outside of psychiatry?

Being from Argentina, I love the Tango, though I have to admit I am not the best dancer.  I also love the music of Astor Piazzola.

In the Spotlight: Raj Vyas, M.D.

A pediatric plastic surgeon specializing in reconstructive plastic surgery has joined CHOC Children’s. Dr. Raj Vyas sees patients with a variety of complex conditions including clefts and craniofacial anomalies.

“Care at CHOC is delivered in such a multidisciplinary fashion, allowing for complex higher-level discussions and nuanced treatment planning in both standard and exceptional circumstances. There is also an emphasis on safety and process improvement, both critical for a state-of-the-art facility serving a complex and diverse patient population,”Dr. Vyas says.

Dr. Raj Vyas

The Southern California native attended UCLA David Geffen School of Medicine. It was during his third year of medical school that he learned plastic surgery was his newfound passion.

“I unexpectedly fell in love with plastic surgery, particularly craniofacial surgery, after rotating on the service,” Dr. Vyas explains.  “I had little appreciation for the depth or breath of plastic surgery before this experience. I remember seeing a child with hypertelorism undergo a facial bipartition and I was fascinated.”

Following medical school, he completed a plastic surgery residency in Boston at the Harvard Combined Plastic Surgery Residency Program. He then completed a craniofacial surgery fellowship at New York University Medical Center, in New York, where he treated children and adults undergoing facial reconstruction for congenital anomalies or after suffering trauma and cancer. He also gained expertise in microvascular surgery and virtual surgical planning.

Dr. Vyas is working with the team at CHOC to build a multidisciplinary program in facial reanimation. By combining craniofacial surgery with microsurgery, he hopes to restore facial form and function in children and teens with facial paralysis.

“We have a great team at CHOC. Dr. Daniel Jaffurs has been an incredible mentor,” Dr. Vyas says. “My goal is to help make the program the best in Southern California and beyond.”

Dr. Vyas enjoys working with virtual scanning and 3D modeling technology available at CHOC, as it helps him plan and ensure optimal safety and precision before a procedure.

“Today, we are able to use cone beam CTs to significantly minimize radiation exposure while still obtaining high quality 3D imaging. This allows for virtual surgical planning that is both precise and extremely effective in reducing uncertainty in the OR,” Dr. Vyas explains. “In neonates with upper airway obstruction, for instance, who are scheduled to undergo mandibular distraction, we are able to customize bony osteotomies in a way that prevents injury to dental structures and nerves, while optimizing distraction vectors that improve the airway and maintain cosmetic considerations. We can also virtually anticipate the extent of facial movements and design custom splints that facilitate orthognathic (upper and lower jaw) surgery. The benefit of these types of pre-planned procedures are expanding as surgeons utilize this technology in a variety of craniofacial reconstructions.”

When this dedicated physician is not busy helping patients at the hospital, he volunteers with Global Smile Foundation, a nonprofit organization that treats children with facial congenital deformities in underserved countries. Most recently he went to Trujillo, Peru, where he helped over 100 patients.

“It’s so rewarding to work with children,” he says. “Their reconstructions have a long-life impact.”

Dr.Vyas has given many national and international presentations and authored numerous book chapters and peer-reviewed articles in leading specialty journals. He is board certified in plastic surgery and a member of the American Society of Plastic Surgeons, American Society of Craniofacial Surgery, American Cleft Palate-Craniofacial Association and International Cleft Lip and Palate Foundation, among other professional organizations.

In his spare time, Dr. Vyas enjoys spending time with his wife. He also likes hiking, biking and playing tennis.

To refer a patient to CHOC, please call 1-888-770-2462. To contact Dr. Vyas, please call 1-844-827-8000 option #5.

Meet Dr. Svetlana Gorodetski

CHOC Children’s wants its referring physicians to get to know its specialists. Today, meet Dr. Svetlana Gorodetski, a hospitalist at CHOC Children’s at Mission Hospital.

Svetlana GoradetskiQ: What is your education and training?
A: I attended medical school and had my residency at UC Irvine.

Q: What are your special clinical interests?
A: Hospital medicine

Q: How long have you been on staff at CHOC?
A: Seven years

Q: What are your most common diagnoses?

A: Asthma exacerbation, pyelonephritis, acute febrile illness in neonates, appendicitis, pneumonia, bronchiolitis and acute gastroenteritis

Q: What would you most like community/referring providers to know about you/your division at CHOC?
A: At CHOC Mission, we are a 24/7, attending-only service, easily accessible to outside pediatricians not only if they are in need of hospitalizing a patient but also for any advice or opinion they might need from a hospitalist. We create a continuum of care, starting with outpatient pediatrician and continuing into hospital care, and communicating with the pediatrician upon the patient’s discharge.

Q:  What inspires you most about the care being delivered here at CHOC?
A: At CHOC Mission, we have a very coherent and devoted group of physicians committed to providing excellent care 24 hours a day.

Q: Why did you decide to become a doctor?
A: I wanted to be able to deliver care necessary to sick children at the time when they needed it most.

Q: If you weren’t a physician, what would you be and why?
A: A veterinarian. I love pets! Just like our children, they bring happiness and love into people’s lives.