Meet Dr. Jonathan Auth

CHOC Children’s wants its medical staff and patients to get to know its growing team of physicians, including primary and specialty care providers. Today, meet one of our pediatricians Dr. Jonathan Auth.   After graduating from USC Keck School of Medicine, he completed his residency at UCLA, for which he served as chief resident.  He’s been on the CHOC medical staff for seven years.

Dr. Jonathan Auth, CHOC Children’s pediatrician

Q: What are your clinical interests?

A: I am especially interested in newborn care.

Q: What are your most common diagnoses?

A: I see a lot of patients with fevers, viral upper respiratory infections, conjunctivitis, gastroenteritis, asthma, allergy, rhinitis, rashes and eczema. I also provide well child care.

Q: When did you decide to become a pediatrician?

A: Growing up in a large family with seven brothers and sisters, I always enjoyed being around children. As a young child, I enjoyed taking things apart and putting them back together.  Combining my love for fixing things and my personality as a people person, it became clear to me in high school that I was called into a life of medicine.

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

A: A teacher. So much of what I do every day is teaching and explaining how the body works.  I love having the answer and being able to see the look of understanding develop on another person’s face as he or she comprehends a concept for the first time.

Q: What are your hobbies and interests outside of medicine?

A: I enjoy gardening, woodworking, food, wine and the cinema.

Q: What’s the funniest thing a patient said to you?

A: Children really do view the world differently. Referencing my patients’ charts during office visits, I will frequently acknowledge recent birthdays.  Patients are often in awe, wondering how I knew it was their birthdays.

Dr. Auth and his colleagues at Sea View Pediatrics, are part of the CHOC Children’s Primary Care Network. You can reach him at 949- 951-5437.

Meet Dr. Reshmi Basu

CHOC Children’s wants its medical staff and patients to get to know its growing team of physicians, including primary and specialty care providers. Today, meet one of our pediatricians Dr. Reshmi Basu.   Following medical school at University of California, San Diego, she completed her residency at CHOC. She’s been a member of the CHOC medical staff for eight years.

What are your clinical interests?

I am especially interested in asthma, sleep issues in children (infants through adolescents), and helping new mothers breastfeed.

Are you involved in any research?

I am a physician leader for the American Academy of Pediatrics, Chapter Quality Network U.S. Immunization Project. Practices here in Orange County and across the nation are participating in the project to improve vaccination rates for children two years and younger.

What are your most common diagnoses?

In our practice, we see a lot of patients with viral respiratory illnesses, ear infections, abdominal pain, asthma, allergies, eczema and headaches. We also spend much of our time on routine well checks for infants, teens and young adults. These appointments are important for keeping children current on vaccinations, and making sure they are growing and developing normally. We work hard to address parents’ concerns during these visits, as well.

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

I am proud to be a CHOC Children’s provider because CHOC undoubtedly provides the highest quality of care for patients and families. One of my patients was being treated for cancer during the holidays. Not only did CHOC make sure she received the most advanced medical care, the hospital’s child life team did everything they could to bring the holidays to her. Her room was filled with inspirational banners, Christmas lights and even beautiful new bedding on her hospital bed.

When did you decide to become a pediatrician?

I decided to become a pediatrician after my pediatrics rotation in medical school. I had always liked working with children, and was already drawn to pediatrics after volunteering at CHOC Children’s at Mission Hospital. (I grew up in Mission Viejo.) As a volunteer, I enjoyed spending time at the hospital, whether it was holding the babies or coloring with children. After my pediatrics rotation, though, I realized that children need advocates to fight for them, and that is something I wanted to do. My goal is to help all my patients grow and thrive to become healthy, successful adults.

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

I pursued medicine and eventually pediatrics because of my interest in science and my love for children. If I wasn’t a pediatrician, then I think being a teacher would be another way for me to help children.

What are your hobbies and interests outside of medicine?

I enjoy spending time with my husband and children. I have a 5-year-old daughter and 3-year-old son who keep me very busy. We like being outdoors, whether it’s playing at the park or riding our bikes. We travel as often as we can. I also like to read, when I can find any free time.

What’s the funniest thing a patient said to you?

Several of my pre-school aged patients have told me I look like Doc McStuffins. This helps me to connect with them and put them more at ease during their visits. I dressed up as Doc McStuffin for Halloween a few years ago, and my younger patients were star struck!

Dr. Basu and her colleagues at Pediatric & Adult Medicine, Inc. are part of the CHOC Children’s Primary Care Network. You can reach her at 714-565-7960.

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.

 

New Coordinated-Care Tools for High-Risk Asthma Patients Improving Health, Costs

Asthma is among the illnesses CHOC is focusing on as a component of its population health initiative. (Other acute care conditions of focus include: bronchiolitis, community acquired pneumonia, acute gastroenteritis, headache and acne.) As a prevalent health care problem in Southern California, asthma results in emergency (ED) visits, hospital admissions, school days missed and administration of complex medications to manage the condition.

In an effort to better coordinate care for these patients, CHOC recently reviewed the data on how frequently children with asthma go to the ED and what their physicians are doing to care for them.  After identifying the care gaps, CHOC provided physicians with clinical care guidelines and tools to help them implement the guidelines. CHOC has also created a patient registry, which helped identify patients who required an asthma action plan. CHOC demonstrated an 18% reduction in ED visits, year-over-year, for patients in their largest primary care practice, CHOC Clinics, which coordinates care for 27,000 of Orange County’s highest risk children.

CHOC Children's

CHOC also identified a subset of its highest-risk Medi-Cal patients with asthma (cohort of 178 children with frequent ED visits, hospitalizations, and/or use of oral steroids) and enrolled them in the CHOC Breathmobile program, a mobile asthma clinic. Over a 15-month period CHOC saw a reduction of:

  • ED visits from 104 to 12
  • Hospital admissions from 13 to 0

As part of CHOC’s comprehensive pediatric system of care, the organization has shifted its approach to become a “promoter of population health,” rather than focusing only on hospital care. To that end, CHOC is outreaching to practicing pediatricians to help them better coordinate care for their patients. The new guidelines and tools to coordinate care for high-risk asthma patients is just one example of how this shift is truly improving children’s health and lowering health care costs.

For more information, please contact Dr. Mike Weiss or Shahab Dadjou, CHOC’s division of population health, at 714-509-9229.

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.