Dr. Mary Zupanc awarded prestigious Arnold P. Gold Humanism in Medicine Award

Dr. Mary Zupanc has achieved many superlatives over her long career in medicine; accolades and awards have followed.  But the co-medical director of the CHOC Neuroscience Institute and UCI professor of pediatrics and neurology considers the Arnold P. Gold Foundation Humanism in Medicine Award her highest honor of all.

Dr. Mary Zupanc, co-medical director of the CHOC Neuroscience Institute

The Child Neurology Society (CNS) has announced that Dr. Zupanc will receive this special distinction at their annual meeting in October 2021.  She is only the eighth individual to be thus honored in the 50-year history of the society, which represents the nation’s pediatric neurology subspecialists.

The Humanism in Medicine Award will be presented to Dr. Zupanc — who specializes in childhood epilepsy — for practicing “extraordinary and ongoing humanism” throughout her medical career. Included in the criteria noted by her peers are:

  • Compassion and empathy in the delivery of patient care
  • Respect for patients, families and co-workers
  • Cultural sensitivity in working with patients and family members of diverse backgrounds
  • Effective, empathetic communication and listening skills
  • Understanding of patients’ need for interpretation of complex medical diagnoses and treatments
  • Comprehension and respect for the patient viewpoint
  • Sensitivity to patients’ psychological well-being and patients’ and families’ emotional concerns
  • Ability to instill trust and confidence

“You may be the greatest scientist in the world, but if you don’t have empathy and compassion for patients and families, you can’t advance the field of medicine,” says Dr. Zupanc. “To me, as a clinician bringing science to the bedside – this is the ultimate award.”

This award also has personal meaning and sentiment for Dr. Zupanc, because as a faculty member at Columbia University, she and Dr. Gold – the award’s namesake – became good friends.

“Dr. Gold was one of the kindest, gentlest, most intelligent child neurologists I’ve ever known,” she says.  “He had a real compassion for children, and we just hit it off.”

Dr. Gold, who died in 2018 at the age of 92, frequently complimented Dr. Zupanc: “He went out of his way to tell me that I had taught him some things about epilepsy that he didn’t know,” she says. “I was sure that couldn’t be the case, since he was senior to me, with such knowledge and wisdom. But he insisted, and that was the kind of person he was; always offering encouragement and making people feel special.”

A trailblazer for both women and the epilepsy subspecialty

Dr. Zupanc has received many accolades over the years, including being the first woman to graduate top of class from UCLA Medical School, and at a time when women were just beginning to be have more representation in medicine.  She was later named one of 10 “outstanding young women in America.”  She has garnered many teaching awards from medical students and residents, and continues to be listed among the best doctors in America.

Dr. Zupanc is board-certified in four different medical specialty areas: pediatrics, neurology, neurophysiology and epilepsy. Her primary mentor, Dr. Raymond Chun, encouraged her to return to her home state of Wisconsin and become a child neurologist. Dr. Zupanc initially hesitated, but ultimately agreed, thinking it would simply be a good learning opportunity from her mentor. While there, she learned that pediatric epilepsy didn’t have many treatment options aside from a handful of drugs. However, there was exciting innovation with pediatric epilepsy surgery just starting to be performed in young children. 

“Epilepsy surgery in children was in its infancy at this time, and people thought we were crazy,” Dr. Zupanc says. “The advances we’ve made since then are astonishing. We can do things we’d never dreamed of before.”

Now, she says, she feels like Sherlock Holmes when she works with a new patient. Each child is different, and a physician must determine how to best help them in terms of their specific situation – medically, socioeconomically, culturally and religiously. It’s imperative to partner with families, listen to them and come to an agreement, Dr. Zupanc says.

A legacy that goes beyond awards

Throughout her career, Dr. Zupanc has been very active in the CNS and the Child Neurology Foundation, a parent/provider advocacy group linked to the CNS. A handful of her other legacy accomplishments include her work in infantile spasms and epilepsy surgery; transitioning care of pediatric patients to adult care; and, most recently, chairing the CNS relative value unit (RVU) task force, resulting in a seminal article about physician workload, compensation and burnout.  

As a clinical professor in academic medicine, she has continued to teach medical students, residents, fellows and colleagues, as well as mentor young faculty, especially women.

“Fifty percent of medical school classes are now women, but there is still a glass ceiling in terms of being leaders in our field,” she says. “We’ve come a long way, but the progress is slow. Having diversity, inclusion and equity in medicine makes the field better and stronger.”

Dr. Zupanc was recruited to CHOC 10 years ago to build the neurology division. She now considers her greatest accomplishment to be CHOC’s designation as a Level 4 Epilepsy Center – the highest level of specialization – providing “complex forms of intensive neurodiagnostic monitoring; extensive medical, neuropsychological and psychosocial treatment; and complete evaluation for epilepsy surgery, including intracranial electrodes and a broad range of surgical procedures for epilepsy.”

Since arriving at CHOC, she has grown the pediatric neurology division from four physician subspecialists to the present 16, specializing in areas such as epilepsy, sleep disturbances, movement disorders, concussion, stroke and autism. This growth has resulted in the reorganization and consolidation of the neurology division with the neurosurgery division, becoming today’s CHOC Neuroscience Institute. 

In working at CHOC, Dr. Zupanc has found inspiration from helping families who believe they have no hope. When they arrive here, she says, some feel as though their lives are falling apart; their child may have difficult-to-control epilepsy or is struggling developmentally. The quality of care they receive from CHOC is transformative and changes their lives, she says.

Medical outreach, both nationally and internationally

To only give honor to Dr. Zupanc’s academic and scientific accomplishments would be to miss a great part of what her life has been about, as reflected by the Humanism in Medicine Award. Throughout her medical career, she has continually been involved in family and community outreach and advocacy; actively participated in family support groups; and developed outreach programs for underserved communities.

Her passion and advocacy have even reached beyond national borders. She was a member of the board of directors of Physicians for Social Responsibility, the American section of the International Physicians for the Prevention of Nuclear War (IPPNW), when the group was awarded the Nobel Peace Prize in 1985. In that role, she traveled with an American delegation to the Soviet Union and met with like-minded Soviet physicians to share ideas for pulling their nations back from the brink of nuclear disaster.

More recently, Dr. Zupanc traveled to India, Armenia and Vietnam on missions of teaching and providing medical care in areas where doctors are rare and medical specialties often non-existent. Back home, her passion is family-centered care, and she is a regular guest speaker at family support groups.

“My patients and their families have taught me so much,” Dr. Zupanc says. “They’ve taught me humility, how to truly listen, to be open-minded and that deeply caring for the patient and family reaps great rewards.”

“One of the wonderful things about child neurology,” she explains, “is that you often embark on a decades-long journey with families.” She still receives letters and cards from patients she treated 30 years ago. “You transform a child’s life and a family’s life. That’s what this profession is all about, and why it has always been more than a job for me. It’s a calling.”

Learn more about the CHOC Neuroscience Institute.

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VIRTUAL PEDIATRIC LECTURE SERIES: Mandibular Distraction

CHOC’s virtual pediatric lecture series continues with Mandibular Distraction for Neonatal Airway Obstruction: New Insights and Future Directions.

This online discussion will be held Tuesday, March 30 from 12:30 to 1:30 p.m. and is designed for general practitioners, family practitioners and other healthcare providers.

Dr. Raj Vyas, chief of plastic surgery at CHOC, will discuss several topics, including:

  • How to diagnose neonatal airway obstruction resulting from micrognathia and glossoptosis
  • Refering patients for multidisciplinary team evaluation
  • Managing the unstable airway in such children before, during and after mandibular distraction osteogenesis surgery.

This virtual lecture is part of a series provided by CHOC that aims to bring the latest, most relevant news to community providers. You can register here.

CHOC is accredited by the California Medical Association (CMA) to provide continuing medical education for physicians and has designated this live activity for a maximum of one AMA PRA Category 1 Credit™. Continuing Medical Education is also acceptable for meeting RN continuing education requirements, as long as the course is Category 1, and has been taken within the appropriate time frames.

Please contact CHOC Business Development at 714-509-4291 or BDINFO@choc.org with any questions.

Personalized medicine, surgical innovations advance pediatric brain tumor care

The Neuro-Oncology Treatment Program at the Hyundai Cancer Institute at CHOC is doing more than providing the most advanced care for pediatric brain tumors — it’s also helping to shape the future of personalized medicine and surgical innovations.

CHOC offers a full range of standard treatments for brain tumors, as well as personalized therapies for many tumor types, such as medulloblastomas, based on genetic subtyping. Experimental treatments are available through Children’s Oncology Group and other consortium and industry-driven clinical trials. Some of these studies — including a trial developed by a CHOC neuro-oncologist to investigate a vaccine for diffuse intrinsic pontine glioma — are part of CHOC’s robust early-phase clinical trials program, according to Dr. Chenue Abongwa, pediatric neuro-oncologist at CHOC.

Dr. Chenue Abongwa
Dr. Chenue Abongwa, pediatric neuro-oncologist at CHOC

CHOC also partners with some of the country’s foremost healthcare institutions, including Mayo Clinic, to apply the latest genomic sequencing and molecular studies in studying each individual tumor.

When a patient presents with a brain tumor, a wide range of specialists are involved from the beginning. “We have a multidisciplinary neuro-oncology tumor board that includes neurologists, neurosurgeons, neuroradiologists, radiation oncologists, pathologists and a neuro-oncologist, and we involve other specialists as needed,” says Dr. Abongwa. “This expertise allows us to select the treatment likely to be the best option for each child while minimizing the risk of side effects.”

Each patient at CHOC is treated via an individualized, precision medicine approach. When surgery is necessary, CHOC has four highly experienced, board-certified pediatric neurosurgeons who can apply some of the most advanced surgical capabilities. “We have the latest in surgical navigation, and we partner with neurologists at CHOC to offer surgical neuromonitoring to track certain nerve potentials during resections,” says Dr. Suresh Magge, medical director of neurosurgery at CHOC and co-medical director of the CHOC Neuroscience Institute. “If we’re operating near the brain stem, it’s important to know if there’s potential for damage in surrounding structures.”

Dr. Suresh Magge
Dr. Suresh Magge, medical director of neurosurgery at CHOC and co-medical director of the CHOC Neuroscience Institute

Several of the surgical therapies CHOC offers are minimally invasive alternatives to craniotomy. One example is endoscopic surgery, which may be appropriate for tumors located in the ventricles. Neurosurgeons can visualize and resect these tumors using an endoscope inserted through a small incision.

“Certain tumors, especially those located deep in the brain, are amenable to laser interstitial thermal therapy (laser ablation),” Dr. Magge says. “This has revolutionized the treatment of certain types of lesions. We can insert a catheter through a small incision down to the deep part of the brain and ablate the tumor without harming surrounding structures. A ROSA™ (robotic stereotactic assistance) robot allows us to insert the laser with a high degree of precision. Patients experience minimal blood loss and typically go home within a day.”

Once treatment concludes, patients ultimately enter the Neuro-Oncology Treatment Program’s longstanding late effects program. This multidisciplinary program provides long-term follow-up of patients and connects them with specialists who can treat endocrine, neurocognitive, psychosocial and other side effects of treatment.

“For some tumors, such as medulloblastomas, we’ve reached the point where we’re achieving good rates of cure, as high as 80% or more,” Dr. Abongwa says. “So now we’re focused on minimizing the long-term effects of treatment. Most institutions don’t have a strong, long-term follow-up program for pediatric patients. Over time, our program has become quite robust and multidisciplinary. That’s another area of benefit that we offer our patients. We’re a child- and family-focused institution. That focus is evident in all the programs and services that are available to our patients.”

Our Care and Commitment to Children Has Been Recognized

CHOC Hospital was named one of the nation’s best children’s hospitals by U.S. News & World Report in its 2020-21 Best Children’s Hospitals rankings and ranked in the cancer specialty.

Learn how CHOC’s pediatric oncology treatments, expertise and support programs preserve childhood for children in Orange County, Calif., and beyond.

CHOC-UCI origami mask project gets some national attention

Back in the early days of the COVID-19 pandemic, in late March 2020, Jonathan Realmuto, a visiting scientist at CHOC and a postdoctoral researcher at UC Irvine, got a call from his lab leader, Dr. Terence Sanger.

Dr. Sanger, a physician, engineer, and computational neuroscientist who joined CHOC in January 2020 as its vice president of research and first chief scientific officer, was concerned about the possibility of CHOC running out of masks for its frontline healthcare workers.

“Could you please think about this problem and see if you can come up with a solution just in case the supply runs out?” Dr. Sanger asked Realmuto, who has a Ph.D. in mechanical engineering and whose expertise is wearable robotics, which help people regain and strengthen their movements.

Dr. Terence Sanger, chief scientific officer at CHOC

Since September 2017, the two had been working together after Realmuto earned his doctorate degree from the University of Washington.

Thus began the UCI Face Mask Project, a collaboration between Dr. Sanger and Realmuto that grew to a team of five that includes two other UCI professors, aerosol chemist Jim Smith and environmental toxologist Michael Kleinman, and Michael Lawler, an atmospheric chemist and assistant project scientist who works in Smith’s lab.

The work of the UCI Face Mask Project ultimately led to the creation of what experts call a mask for the masses — an inexpensive face covering that takes its cues from origami, the art of paper folding closely associated with Japanese culture.

No sewing is needed to make the origami mask – just a filter material that can be purchased at a craft or hardware store, a stapler, two elastic straps, and a nose clip fashioned from a metal wire such as a twist tie.

Illustrated directions for creating the origami mask

Realmuto was among several origami mask experts recently featured in a National Geographic story that highlights the inexpensive (less than $1 of materials per mask), disposal masks that can be made by anyone after a little practice. The story details how origami pleats and interlocking folds can result in better-fitting, more comfortable, and more stylish face coverings.

Dr. Sanger, who served in an advisory capacity on the UCI Face Mask Project, played a “very critical role” in developing the mask, which has not been mass produced but was designed in case there is a shortage of face coverings such as N95 masks, the gold standard at preventing expelled air leakage during coughing.

“CHOC and UCI were one of the first out of the gate to work on this,” says Realmuto, who with his colleagues has written a paper, “A Sew-Free Origami Mask for Improvised Respiratory Protection,” that details the research that went into the project.

The team put several masks through rigorous testing using a custom-made mannequin head equipped with a breathing tube and mounted inside a chamber.

The team concluded, in the paper they plan to get reviewed by peers and published, that origami masks combine high filtration efficiency with ease of breathing, minimal leakage that can dramatically reduce overall mask performance, and greater comfort compared to some commercial alternatives.

Because of this, origami face coverings are “likely to promote greater mask-wearing tolerance and acceptance,” the researchers concluded in their paper.

Says Realmuto: “Origami presents this really nice solution where you can use the folds as a way to make seams that won’t leak.”

The team produced a how-to video starring Realmuto, who shows how to construct the single-use masks. They tested a variety of materials that have an inner layer of non-woven polypropylene that can be easily and rapidly sourced locally from a hardware or craft store, in addition to a material made by Filti that can be purchased through the manufacturer.

“For a novice without prior experience,” they write, “construction takes approximately 10 minutes. In our experience, practice decreases assembly time to under five minutes.”

Dr. Sanger and Realmuto have collaborated on another unrelated project that earned them accolades. That project involved developing a non-rigid forearm orthosis – a brace to correct alignment or provide support – to help make it easier for people with movement disorders such as cerebral palsy to feed themselves, open doors, and complete other daily tasks. Their work made them finalists in the Best Paper category at the 2019 Institute of Electrical and Electronics Engineers (IEEE) Conference on Soft Robotics.

In July 2021, Realmuto will become a full-time assistant professor in the Department of Mechanical Engineering at UC Riverside. He says he hopes to maintain his collaboration with Dr. Sanger and CHOC on future projects.

“It’s been a great partnership,”Realmuto says.

For more information about the UCI Face Mask Project, click here.

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CHOC clinicians pitch ideas for new medical devices to UCI students

In the neonatal intensive care unit (NICU) at CHOC, most pre-term babies are not able to take all their food through a bottle until they’re closer to term. They also must rely on a tube connected to a feeding pump.

In hospitals that have a centralized room where technicians prepare feedings for the nurse, the feeding is often delivered pre-drawn up in a syringe since it is unknown if all of the feeding will be given via the tube or if the baby will be able to take some by mouth.

If the baby is alert enough to eat by mouth, the nurse would need to transfer some of the feeding from the syringe to a bottle. If the baby did not take the full volume in the bottle, the nurse would need to draw any remaining milk back into the syringe to be able to deliver it via a tube.

Because of all these steps, there’s a risk of contamination, misadministration (giving the wrong milk to the wrong baby) and a loss of nutrients caused by milk adhering to the side of the containers.

Wouldn’t it be great to create a device that could solve those concerns and make feeding premature infants safer and more efficient?

That was the concept presented by Michelle Roberts, a registered nurse and lactation consultant, to UCI biomedical engineering graduates at the annual UCI BioENGINE Reverse Project Pitch Night.

Undergraduates students in the BioENGINE Program (Bioengineering Innovation & Entrepreneurship) obtain hands-on experience in the technical and business development aspects of biomedical engineering as they work in teams to further develop med-tech startups into marketable products.

Roberts was among several CHOC associates who gave two-minute presentations at the Fall 2020 Reverse Project Pitch Night, held online because of the COVID-19 pandemic. Kicking off the 90-minute session, which featured some 30 presenters, was Dr. Terence Sanger, a physician, engineer and computational neuroscientist who joined CHOC in January 2020 as its vice president of research and first chief scientific officer.

BioENGINE partners with the UCI School of Medicine, the Henry Samueli School of Engineering, the Donald Bren School of Information and Computer Sciences, the Beckman Laser Institute, UCI Athletics and UCI Applied Innovation. 

At Reverse Project Pitch Night, physicians, scientists, clinicians and industry representatives describe their concepts for new medical devices. Students are matched with projects that interest them and are mentored by the presenters to help develop healthcare solutions.

“Physicians and engineers need to work together,” said Dr. Sanger, a child neurologist who specializes in movement disorders. “The goal is to identify an important problem, marry it to a piece of technology, and create a device in a way that will have an impact. Different knowledges have to be brought together, and personally I find that very inspiring.”

In the final quarter of 2020, the CHOC Research Institute sponsored three pediatric-focused projects that were presented at Reverse Project Pitch Night.

One software project, presented by Sira Medical, involves the use of patient-specific, high fidelity 3D holograms to enable surgeons to better understand complicated anatomy, collaboratively plan an operation, and virtually size medical implants — all before stepping into the operating room.

Another project, presented by Adventure BioFeedback, is designed to deliver speech therapy anywhere, anytime. The company is producing a series of audio linguistic tools that can analyze and learn on-the-fly from the utterances of children performing vocal exercises using a smartphone. 

The third CHOC Research Institute-sponsored project, NeuroDetect, places a patient’s own stem cells on a computer chip to replicate the brain chemistry of the neurological disorder in a laboratory environment and facilitate rapid development of precision-guided therapeutics.  

Roberts offered to serve as a mentor on her project along with Caroline Steele, director of Clinical Nutrition and Lactation Services at CHOC. Edwards Lifesciences is involved in designing the device.

Kaitlin Hipp, another CHOC NICU nurse, introduced her project, Touche, at BioENGINE Reverse Project Pitch Night. It’s a hands-free communications system for nurses and healthcare workers that is especially relevant in the era of COVID-19. The Bluetooth device can communicate with several devices – phones, monitors, etc. — thereby reducing or eliminating the need for nurses to touch the surfaces of items.

“We need to be better about using touchless technology in the healthcare setting,” Hipp said. “Long term, think of this as Alexa for healthcare providers.”

Dr. Timothy Flannery, a pediatric endocrinologist at CHOC, introduced Cervos, a non-invasive device to address cervical incompetence, which affects 1 percent of all pregnancies. The goal is to get Cervos approved for clinical trials at medical schools, Dr. Flannery said.

Dr. Sanger, in his remarks, noted CHOC’s critical mission of ramping up research to better address unmet healthcare needs by marrying engineering with healthcare.

“Medicine is about decision making,” Dr. Sanger said. “Biology is so complicated we can’t hope to ever understand it fully. When you want to make decisions in healthcare, you need to take measurements and design interventions that will respond to those measurements. In medicine, the goal is always to make the next big decision. You don’t even need to know the diagnosis if you can make the right decisions.”