CHOC Specialist Appointed to CalOptima Board

A CHOC Children’s specialist has been appointed to CalOptima’s board of directors.

Dr. Paul Yost, chair of CHOC’s anesthesiology division, was sworn in Aug. 4.

Paul Yost, M.D.

He was appointed by the Orange County Board of Supervisors as one of six new members to guide the agency that administers health insurance programs for low-income children, adults, seniors and people with disabilities in Orange County.

“I am honored to join the CalOptima Board of Directors,” Dr. Yost said. “This role presents an exciting opportunity to serve our community’s children and families in a new way.”

He attended medical school at Baylor College of Medicine in Houston. Dr. Yost performed his anesthesiology residency at UCLA and his pediatrics residency at the University of Miami.

Dr. Yost’s CalOptima seat is reserved for a physician who is affiliated with a contracted health network. His term ends in August 2020.

Olympic Medalist Turned Physical Therapist

When athletes of any caliber come to physical therapy appointments, they often struggle with emotional hurdles as big as their physical challenges. Working with an expert who understands their struggles can make it easier to cope, especially when that expert is a former Olympian.

Robin Beauregard, a physical therapist at CHOC Children’s and two-time Olympic medalist in women’s water polo, understands the physical challenges that can sometimes stand in the way of achieving athletic goals.

“Having a career in athletics helps me establish a rapport with my patients, particularly my history with sustaining and overcoming injuries,” she says. “Sincere empathy creates a stronger bond than sympathy.”

Shortly before the team was named for the Sydney Olympics in 2000, the first time women’s water polo was to be recognized as an Olympic sport, Beauregard dislocated her knee and didn’t know if a recovery was possible. Distraught but determined, she committed fully to her physical therapy plan, as well as a rigorous conditioning program, and made the team. They’d win a silver medal that year, and a bronze four years later. She was later inducted into the USA Water Polo Hall of Fame.

Beauregard’s experience with physical therapy in the midst of her Olympic career ultimately played a big role in her professional career.

“I was not the perfect patient, but it prepared me for being a physical therapist because it gave me an idea of asking only what is reasonable of my teen and young adult patients,” she says. “I really do understand their worry of not being able to get back to the top level in their sport, but also weighing the risks of not wanting to cause further or permanent injury.”

Growing up in Southern California, Beauregard loved to be outdoors and was always active. Having an older brother who was also athletic made her competitive, too. She started swimming competitively for a local club team on her fourth birthday simply because her brother swam, and she wanted to be as a good as he was. Water polo came into play just four years later, and by age 8 she joined a competitive club team.

But when she got to high school, there was no girls’ varsity team. Instead of giving up on her passion, she simply joined the boys’ team instead. Playing with the boys didn’t faze her, or them, since they’d been competing together for almost a decade by that point. When opponents made comments about playing with a girl, she channeled it into her game and used it as fuel to play even harder.

After high school, she attended UCLA to play water polo, and originally planned on becoming an orthopedic surgeon. She later changed her path to physical therapy, which would ultimately give her a different kind of interaction with patients and athletes.

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.

Pingmd, Secure Texting App: Q&A with Dr. Grant

CHOC Children’s has partnered with pingmd, a secure, HIPAA
compliant messaging app, which allows you to securely send text messages, videos and images to our specialists available within the network. We spoke with Dr. Kenneth Grant, pingmd physician champion and assistant division chief of gastroenterology/nutrition division at CHOC, to provide us with the latest on this new tool.

Dr. Kenneth Grant

Q: What are the main benefits of using pingmd?

A: Communication is much more efficient with this platform, and less likely to interfere with normal workflow. The triage of messages is also more efficient.

Q: What has your experience been so far with the new app?

A: Phenomenal. I can respond to a lot more requests in a more timely manner. I can use my smart phone, tablet or computer. The app has been working very consistently and speed has notably improved recently.

Q: Do community physicians have direct access to CHOC specialists with this tool?

A: Yes, once a community physician provides his/her email and practice affiliation to CHOC Business Development, the physician will then receive an invitation to pingmd. Once signed up, community physicians have access to the directory of CHOC specialists who are actively using pingmd. Messages are marked when sent and viewed. The app makes it clear when a user is offline. The CHOC specialists concierge is also available on pingmd, or by calling 714-509-4013.

Q: Is there a cost to sign up?

A: There is no cost for CHOC physicians or community physicians.

Q: Who should physicians contact to learn more or to sign up?

A: Please contact CHOC Business Development at 714-509-4329, or, provide your email, address and practice info to lcastelo@choc.org.