CHOC Children’s leaders observe International Women’s Day

As the world celebrates International Women’s Day, we turned to CHOC Children’s female physicians and nursing leaders for insight and words of encouragement to other women pursuing healthcare careers.

Melanie Patterson, vice president, patient care services, and chief nursing officerWhen beginning your career in medicine, don’t focus on one trophy. The fields of medicine and nursing have so many opportunities within them; be courageous and try new things. The most important aspect of leadership and of career success is to be kind. Remember to form your own opinion — go into every relationship with your eyes open and stop looking through others’ eyes; they don’t always have 20/20 vision.

Dr. Mary Zupanc, pediatric neurologist and epileptologist & co-medical director of the CHOC Children’s Neuroscience Institute

When I went to medical school, women were not encouraged, and it was hard. There were a lot of things that happened that made it very difficult, but medicine is truly one of the most gratifying professions you will ever have. Every patient is different. I believe that if you really and truly listen, a patient and their family will give you the diagnosis you’re searching for. Everyone’s story is so fascinating, and that makes our work like being a detective. Sometimes I feel like Sherlock Holmes searching for answers. Then once you do find an answer, you need to work with the family to make sure the treatment works for their lifestyle, culture and religion. That makes the work challenging, fun and meaningful.

The best piece of advice that I’ve ever received is to never apologize for excellence. Anyone would want their doctor to strive for excellence – and that goes for any profession.

Amy Waunch, nurse practitioner and trauma program managerNever underestimate your capabilities. Do not shy away from opportunities and always take on new challenges. Believe in yourself but don’t be afraid to ask for help. You may not have all of the answers all of the time, but you do have the ability to learn and grow.

Spot growth opportunities when they present themselves because they are the key learning opportunities. You will know because they make you uncomfortable and your initial impulse will be that you are not ready.

Dr. Azam Eghbal, medical director, radiologySince I was 7 years old, I wanted to be a doctor and becoming one has been the best decision of my life. As a female immigrant, I was told that I could never get to medical school, which, of course, motivated and challenged me even more to do so. The best advice I’ve gotten is don’t be discouraged about all your falls and obstacles. Think how you can succeed to get where you want to be.

Dr. Amber Leis, pediatric plastic surgeonMy advice for women pursuing a career in medicine is to trust yourself! Early on in your career, it’s easy to be overcome by feeling like you are not up to the task ahead of you. Your unique qualities will become your greatest strengths, so just keep chasing your passion.

I have great faith that if I stay true to my core principles, the right path will open in front of me. I try not to set specific goals for the future and instead I give my best to where I am. It keeps me focused on what I am doing now, and not distracted by trying to maneuver into some future place.

The best piece of career advice I’ve ever gotten has been, “You get to choose what kind of person you will be.”

Dr. Jasjit Singh, medical director, infection prevention & controlMy advice for women pursuing a career in medicine is to follow your passion! There are few other careers that offer the personal satisfaction and the intellectual rigor that medicine does. Find a good mentor early in your career. Later, make sure your practice partners have abilities that you respect, and the talent to make your shared time together meaningful.

I learned early on that delegation and time management are important, particularly if you want to balance a medical career and family. You can’t always do it all, and prioritization is tantamount to success in all the different spheres of your life.

One of the best pieces of advice that I got was from a mentor during fellowship, who told me, “It’s not enough to just be a good clinician.” He showed me the importance of asking good research questions and pursuing new knowledge. He also encouraged my love of teaching upcoming generations of pediatricians!

Dr. Katherine Williamson, pediatricianI love being a pediatrician. I help take care of kids every day and partner with their parents to help keep them healthy. To me, being successful is loving what you do, because then working hard and being motivated to do well doesn’t feel like work – it’s fulfilling a passion.

When asked to give advice, I always say these three things: be yourself, don’t rush, and follow your heart every step of the way. Be yourself, always. No matter how busy or loud life gets, never lose sight of you who you are and what you want to do.  Don’t be in a rush. Enjoy the journey because that is where you learn who you truly are. Lastly, follow your heart in every decision you make. When I look back on what got me to where I am in my career, I realize that it was not one or two big decisions that were the deciding factor, but instead it was a million little decisions along the way. And with each of those decisions I followed my heart and my passion.

Seizure-free after a rare epilepsy diagnosis

Thanks to the expertise of a CHOC Children’s epileptologist, a 12-year-old boy diagnosed with a rare type of epilepsy is seizure-free and has a bright future ahead – the significance of which is underscored in November, Epilepsy Awareness Month.

Gabriel Lucak had been a healthy, normally developing child until age 3, when he suddenly began experiencing seizures.

CHOC Children's Neuroscience Institute patient Gabriel Lucak poses by the ocean
CHOC Children’s Neuroscience Institute patient Gabriel Lucak

What began as a tonic-clonic seizure in May 2008 rapidly progressed to include myoclonic, atonic, and atypical absence seizures. On his worst days, Gabriel experienced up to 50 seizures a day.

“It was like living out a surreal nightmare,” said his mother, Nicole.

Gabriel was initially diagnosed with myoclonic-astatic epilepsy, also known as Doose syndrome. His seizures were difficult to control, and doctors attempted many different treatments, including eight months on a ketogenic diet. During this time, Gabriel was hospitalized numerous times to modify his medication and control his seizures.

Searching for answers

A low point for the Lucak family came about nine months after the seizures began. While hospitalized for respiratory syncytial virus, Gabriel’s seizures increased significantly. An electroencephalogram (EEG) recorded seizures occurring about once a minute and a slowing brain wave frequency. Magnetic resonance imaging (MRI) revealed decreased brain volume. Gabriel’s health was rapidly deteriorating.

Joe and Nicole desperately began looking elsewhere for help, and in March 2009 found a beacon nearly 1,400 miles away in Dr. Mary Zupanc, a pediatric neurologist and one of the nation’s leading epileptologists, who was then practicing in Wisconsin.

Under Dr. Zupanc’s care, Gabriel was placed on a new treatment program. He stopped following the ketogenic diet and began taking a new antiepileptic medication. He underwent a two-week long-term video EEG monitoring study, which revealed he was experiencing a fifth type of seizure – tonic – during sleep.

CHOC epileptologist Dr. Mary Zupanc holds a model of a human brain..
CHOC Children’s pediatric epileptologist Dr. Mary Zupanc

A new diagnosis

Dr. Zupanc then knew that Gabriel’s epilepsy had evolved into a more severe form called Lennox-Gastaut syndrome (LGS). This rare type of epilepsy is marked by seizures that are difficult to control, and typically persist through adulthood.

In addition, Dr. Zupanc diagnosed Gabriel with cerebral folate deficiency, a rare metabolic condition, following a spinal tap and extensive testing on his cerebral spinal fluid. He immediately began taking a folinic acid supplement and following a strict dairy-free diet.

Under this new treatment plan, Gabriel was seizure-free within two months. A second spinal tap showed a normal level of folate, and another MRI had normal results. The Lucaks were thrilled.

“Gabriel could have suffered severe brain damage, or he might not have survived at all,” Nicole said. “That’s how critical it was for us to have found Dr. Zupanc when we did.”

A bright future

Today, Gabriel is an intelligent, creative and artistic 12-year-old who dreams of being a paramedic when he grows up.

He remains under Dr. Zupanc’s care, traveling from San Diego to the CHOC Children’s Neuroscience Institute and its level 4 epilepsy center for appointments and annual long-term EEG monitoring.

Gabriel is also under the care of Dr. Jose Abdenur, chief of CHOC’s metabolics disorders division. Gabriel, his younger brother, Nolan, and his parents have all participated in several research studies involving genetic testing for both epilepsy and cerebral folate deficiency.

Recently, Gabriel was weaned off the antiepileptic medication and continues to be seizure-free.

“He has the opportunity to live a full life in good health, thanks to an amazing series of events that led to experienced doctors, correct diagnoses and effective treatment,” Nicole said.

Learn more about the CHOC Children’s Neuroscience Institute.

Infantile Spasms: What Pediatricians Should Know

Though seizures in children are always worrisome, pediatricians should be especially watchful for infantile spasms, a type of epilepsy that occurs in young infants typically between ages 3 and 8 months, a CHOC Children’s neurologist says.

These seizures should be considered a medical emergency due to the potentially devastating consequences on the developing brain, Dr. Mary Zupanc says. Many children with infantile spasms go on to develop other forms of epilepsy because a developing brain undergoing an epileptic storm essentially becomes programmed for ongoing seizures and cognitive/motor delays.

To that end, here’s what pediatricians should look for:

  • Infantile spasms often occur in clusters, with each spasm occurring every five to 10 seconds over a period of minutes ranging from three to 10 minutes or longer.
  • Though there is almost always a cluster of spasms in the morning when the child awakens from sleep, infantile spasms can occur at any time during the day or night.

Infantile spasms can be easily missed because they can mimic common symptoms and conditions such as sleep disturbances, gastroesophageal reflux, startle and shuddering attacks.

Diagnosis, treatment

If infantile spasms are suspected, a pediatrician should quickly refer the child to a pediatric neurologist. CHOC neurologists admit these children urgently for long-term video electroencephalogram (EEG) monitoring to confirm the diagnosis.

Infantile spasms are diagnosed on the basis of clinical spasms, in association with a markedly abnormal EEG showing a hypsarrhythmia pattern. A hypsarrhythmia pattern is characterized by very high amplitude electrical activity and multifocal areas of the brain demonstrating epileptic discharges.

High-dose adrenocorticotropic hormone, or ACTH, is CHOC neurologists’ first line of treatment for infantile spasms, per the American Academy of Neurology’s 2004 practice parameter. Vigabatrin (Sabril), the parameter states, is probably effective in the treatment of infantile spasms, especially in children with tuberous sclerosis and infantile spasms.

If started within four to six weeks of seizure onset therapy has better success at stopping spasms, eliminating the hypsarrhythmia pattern and improving developmental outcomes regardless of etiology.

The course of treatment is approximately six weeks. During this time, and for two to three months after the ACTH course, immunizations should not be administered. The effectiveness of ACTH may be as high as 85 percent, though a recent published study placed the efficacy at a slightly lower percentage, regardless of etiology.

Side effects, causes

Side effects of ACTH, a steroid, include high blood pressure, increased appetite and weight gain, increased sugar in the blood, temporary suppression of the immune system, and sometimes gastritis. All side effects are monitored during the time of the ACTH, and they disappear after the course of treatment.

Successful therapy is marked by two achievements: the cessation of the infantile spasms and the elimination of the hypsarrhythmia pattern. But because clinical spasms can be very subtle and the hypsarrhythmia pattern may sometimes only be seen during deep sleep, therapy’s success can only be confirmed through objective long-term video EEG monitoring.

The etiologies for infantile spasms can include:  tuberous sclerosis; cortical dysplasias; stroke; infection including meningitis and encephalitis; hypoxic-ischemic injury; trauma; or genetic conditions such as Down syndrome and metabolic disorders.

 

What CHOC Physicians are Grateful for this Thanksgiving

As Thanksgiving approaches, CHOC Children’s physicians explain what they’ll consider when giving thanks this holiday.

 

“CHOC has provided me with lifelDr. Neda Zadehong blessings. I am grateful to have grown up at and with this hospital, from the initial CHOC Tower to the current Bill Holmes Tower, through pediatric residency training and beyond.  To now be a member of such a remarkable team of providers — including our nurses and support staff — is both humbling and inspiring. Every day, I am especially thankful for the families who cross our threshold, and entrust the care of their most precious children to us. With continued commitment and dedication toward the health and well-being of our children, the future will be brighter than any of us can imagine.”
– Dr. Neda Zadeh, genetics

 

Dr. Kenneth Grant

 

 

“I am thankful to be working for an organization that creates an environment where our patients become our family. I am also grateful that CHOC Children’s has the foresight to invest in the innovative ideas we have to improve the health care we provide.”
 – Dr. Kenneth Grant, gastroenterology

 

 

 

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“I am thankful for the opportunity with be partnered with an excellent children’s hospital. I am also thankful for the pleasure of working with other positive people who provide outstanding care to the children of Orange County. Together, we work to improve the care and services we deliver to our most important resource — our children.”
– Dr. Daniel Mackey, pediatrics

 

 

 

 

Dr. Lilbeth Torno

“I am grateful for the incredible team we have in oncology, inlcuding   doctors, nurse practitioners, physician assistants, nurses, the research team, members of ancillary services, our inpatient, clinic and OPI staff, administrative support, and other subspecialists, who all have great minds and compassionate hearts, and walk the difficult cancer journey with our patients and their families. I am humbled to be with such great company here at CHOC, who care deeply for children.”
– Dr. Lilibeth Torno, oncology

 

 

 

goodman_tg“I am most grateful to the people behind the scenes at the hospital who do all the invisible jobs that are so important to keep CHOC Children’s running: the housekeepers, lab and x-ray technologists, bio-medical engineers, pharmacy technicians, scrub technicians, security guards and maintenance staff that work tirelessly, 24-hours a day.”
– Dr. Gary Goodman, critical care

 

 

 

 

 

Dr. William Loudon

“I am most thankful for the ability to practice alongside of the caring and professional staff and physicians at CHOC, who all share the common goal of caring for children. Working together, we are able to tackle incredibly complex and varied problems that present in the amazingly diverse population of children that we serve.”
Dr. William Loudon, neurosurgery

 

 

 

 

 

 

“I am thankDr. Amy Harrisonful for so many things here at CHOC. I feel truly blessed every day to have found a professional community of like-minded caregivers who share a passion and dedication for continued improvement in the care we provide. I am also so grateful for the opportunity to meet and care for such incredibly courageous patients and to become a part of their families. Finally, I am thankful to my teams within the pulmonary division, the Cystic Fibrosis Center and the muscular dystrophy clinics for their selfless care of our patients. I wish our entire community a healthy and happy holiday season.”
Dr. Amy Harrison, pulmonology

 

choc_zupanc

“I’m thankful for the opportunity to serve my patients and families, and to help them secure bright futures through CHOC’s world-class care. I am also so grateful to work among a team that is steadfastly committed to the health and well-being of children in our community and beyond. “
Dr. Mary Zupanc, neurology

 

 

 

 

 

 

 

aminian

“I am thankful for the platform CHOC has given us to provide service to a community that inspires me daily. I am humbled to just be part of it all.”
Dr. Afshin Aminian, orthopaedics

Dr. Mary Zupanc joins national pediatric neurology board of directors

A CHOC Children’s neurologist has been elected to the board of directors of a national pediatric neurology organization.

Dr. Mary Zupanc, Division Chief of pediatric  neurology at CHOC and director of the pediatric comprehensive epilepsy program, has been named councillor of the west for the Child Neurology Society, a nonprofit professional association of pediatric neurologists in the United States, Canada and worldwide.

CHOC Children's

“I’m thrilled for an opportunity to expand my work of advocacy for children with neurologic conditions at CHOC to a global level,” Dr. Zupanc said.

She begins her term in October 2016 at the organization’s annual meeting in Vancouver, Canada. The Child Neurology Society’s board of directors comprises councillors of the east, Midwest and west; a president; a past-president; and a secretary-treasurer.

“The Child Neurology Society is fortunate to be able to draw on such a deep pool of bright, capable, community-oriented leaders willing to offer their time and talent to help shape the future of child neurology through the Child Neurology Society,” the group said in its announcement.