March 2014 – Texas Children's News

March 25, 2014

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March 21, 2013 was the day our relationship with Texas Children’s Hospital changed. My husband, Matt, and I are both employees at the hospital, so Texas Children’s is very near and dear to us. We have enjoyed our many years serving our patients and working with the wonderful employees of this organization. I have been a nurse here for 16 years and my husband has worked here for 13 years, currently in the Texas Children’s Heart Center. We’ve spent so many days throughout the years walking the halls of Texas Children’s doing what we love, but on March 21 we realized we were going to be experiencing the hospital as parents, not just as employees.

Luke, our unborn son had been diagnosed with a congenital heart defect – coarctation of the aorta. The fetal cardiac imaging team at Texas Children’s detected this defect through a fetal echocardiogram. This enabled them to see the function of Luke’s tiny heart, at just 22 weeks gestation! Although in disbelief, we were thankful for this early detection as it was critical for many reasons. Not only did it help the medical teams plan for Luke’s delivery, but it also allowed Matt and me to ask questions and fully understand the defect and how it might impact him. Even though we work in health care, we had so many questions and were increasingly anxious about the health of our son. Between our wonderful OB, Dr. Kimberly Bobo, at Texas Children’s Pavilion for Women, and the Heart Center and Fetal Center teams, we felt less anxious and certainly very prepared for the possibilities. We were comforted by the countless support staff and multidisciplinary experts we worked with for the months leading up to Luke’s birth. We were never treated as if our questions and concerns were naive and always felt as if each person we encountered was giving us their full attention and compassion for our situation.

As Luke’s birthdate neared, our excitement, as well as our fears grew – the unknown factors were many, but we knew that his care teams were as prepared as possible to handle any situation. His delivery was uneventful (thank goodness!) and there was a NICU team on hand to start his care immediately. He spent a few days in the NICU being monitored closely. Luckily, he remained stable and after a reassuring echocardiogram, we were sent home. It wasn’t until our one month follow up appointment that we learned the narrowing in his aortic arch had worsened and it was time for surgery.

No parent should ever have to experience their child going through heart surgery and the related recovery. It can be a frightening experience and one that we hope to never have to go through again. That being said, the team of experts at Texas Children’s who cared for Luke is among the best in the country. We found comfort in knowing that this is a very typical day for the surgical and medical teams who cared for Luke as they encounter highly complex cardiac patients on a daily basis and perform high volumes of surgical procedures just like Luke’s frequently. We knew he was in the best hands possible for a positive outcome.

32514TimmonsB640 After a very long day of waiting while Luke was in the operating room, we learned his surgery was extremely successful and spent the next several days recovering with him in the cardiovascular intensive care and cardiac acute care units. Luke had an uneventful recovery period so we were able to take him home just a few days after his surgery. Since that time, we have been followed by his cardiologist and Luke is currently a very happy, healthy 7 month old boy.

We are so thankful for the numerous individuals who looked after Luke during this phase of his life and who continue to ensure he remains healthy. One of the reasons Texas Children’s is so remarkable is the sheer number of clinical and technical experts who are involved in the care of just one child. From cardiology, congenital heart surgery, obstetrics, maternal fetal medicine, cardiac imaging, critical care, and acute care, Luke encountered truly inspiring individuals who are experts in the care of children with congenital heart disease. As a parent, it is almost hard to believe that so many experts are available to us to care for our child. As fellow employees, we are proud to be a part of the amazing team at Texas Children’s and know that we are providing this level of care and compassion to all patients and families.

You can learn more about Luke’s journey by watching this video.

Lindsey Gillespie, a Dallas nurse and mom of three young boys, was expecting a routine pregnancy to deliver her fourth child. But during a scheduled ultrasound to determine the gender of the baby, the nurse noticed something odd. After being fully evaluated, doctors suspected placenta percreta, the rarest and most severe form of placenta accreta. When Lindsey could not find a group who routinely treated cases like hers in the Dallas/Ft. Worth area, she eventually transferred her care to Texas Children’s Pavilion for Women in Houston.

And she’s not the only one. The Pavilion for Women has the largest and busiest program in the country for this condition, treating more than 60 cases in the last three years.

“What’s unique to others has now become routine to us,” said Dr. Michael A. Belfort, OB/GYN-in-Chief at Texas Children’s Pavilion for Women. “That strengthens the case for having this type of surgery done by a team that does it all the time and knows how to do it.”

Placenta percreta, the rarest and most severe form of placenta accreta, is a potentially life-threatening condition that can affect any neighboring uterine structure. Placenta percreta (5 percent of all placenta accreta cases) happens when the placenta grows entirely through the uterine wall and attaches to another organ like the bladder. When it involves the urinary bladder, a multidisciplinary approach utilizing a team of physicians and surgeons representing urology, radiology, and obstetrics/gynecology is the key to successful management. Moms who have had previous cesarean deliveries are at an increased risk to developing the condition.

According to the American College of Obstetricians and Gynecologists, in the 1980s placenta accreta affected 1 in 4,000 pregnancies. Today the rate has spiked, affecting 1 in 533 pregnancies – in large part due to the increased number of c-section deliveries.

This year alone, Belfort estimates that Texas Children’s Pavilion for Women will treat about 30-40 patients with placenta percreta, including Lindsey Gillespie. Five patients are currently awaiting surgery.

While Lindsey was at first nervous to leave her home and give birth in Houston, her husband reassured her she was making the right choice, saying “Wow, you couldn’t be at a better place. The hospital you are delivering at is connected to a children’s hospital, so if anything goes wrong it is right there. That is phenomenal!”

On March 14, Belfort led a team of physicians and neonatologists who performed an Indicated preterm Classical Cesarean section followed by Modified radical hysterectomy on Lindsey. She gave birth to a healthy baby girl and pulled through the surgeries without needing a blood transfusion. While the risks were high, Belfort and his staff were confident and well prepared, with a room full of high-risk physicians, neonatologists and a huge supply of blood, should she have needed a transfusion.

“The safest place to have this kind of surgery is in a place where they do it all the time, have a protocol, have a well equipped and practiced team and are comfortable with this issue,” said Belfort.

When a boy arrived at Texas Children’s with massive, progressive swelling caused by a bite from a southern copperhead, toxicologist Dr. Spencer Greene knew just what to do.

“Doctors at an outside hospital minimized the significance of the bite and had no intention to treat him, even though he was very symptomatic,” said Greene. “We started antivenom, and he responded well. Not only is he back to playing sports and acting like a normal boy, he now is fascinated with snakes, which I think is pretty neat!”

Greene’s passion for helping those who suffer from accidental poisonings and his enthusiasm for the obscure field of toxicology make him an exciting addition to our medical staff. He joined Texas Children’s as a consulting medical toxicologist this past October, and the timing proved fortuitous. Texas now leads the nation in number of snakebites per state, and with the addition of Greene, Texas Children’s boasts the only board-certified medical toxicologist in Houston.

But Greene’s role will extend well beyond the treatment of snakebites. He will diagnose and manage the effects of other poisonous or harmful substances that are hazardous to children and adolescents. Also board-certified in emergency medicine, he will be called upon for his expert opinions on treating accidental and intentional ingestions, toxic substance exposure, envenomation, occupational and environmental exposures or severe alcohol and drug abuse reactions. Greene also will continue his roles as director of medical toxicology and assistant professor of medicine at Baylor College of Medicine.“I consider my consultations to be an opportunity to educate everyone involved in the case, including the patient and/or his or her family, the nurses, the students, and the physicians,” said Greene. “By consulting on patients with toxicological emergencies I can help the admitting physicians and the doctors in the emergency department diagnose and treat patients efficiently and safely.”

Greene takes pride in collaborating with physicians from other specialties and using his unique fund of knowledge to help diagnose and treat patients with an illness or injury that is rarely encountered. His varied list of successful cases range from a young girl who ingested her father’s muscle relaxant and presented to the hospital with altered mental status, and a young man who was having a rare idiosyncratic reaction to the medications he had been given after sustaining a major trauma, to a high-profile case of a man with massive bee envenomation who was stung over 3000 times.

“Medical toxicology has a whole body of knowledge that is not commonly taught to most physicians, and often times toxicologists get to use this information to arrive at some pretty obscure diagnoses,” said Greene.

With his involvement, the goal is to reduce the amount of unnecessary testing that is often performed on patients with toxicological emergencies. Greene also hopes to dispel some myths that may surround toxicology patients and recommend therapy that is evidence-based rather than done “because we have always done it that way.”

In previous positions, such as his post as the program director for the University of Arizona Medical Toxicology Fellowship, Greene worked with adult patients who have chronic psychiatric illness or substance abuse, meaning even if he helped treat the acute toxicological condition, it was often only a matter of time before the patient returned with a similar emergency. He’s looking forward to focusing on pediatric patients, many of whom are victims of accidental poisonings and can expect a full recovery with proper treatment.

“It is very gratifying to know that I can make a real difference in my patients’ lives,” said Greene. “I hope that my involvement will help prevent poisonings at home and will give health care providers some information they can use whenever they treat toxicology patients in the future.”

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Out West is a story of tremendous growth. Over the past three years, Texas Children’s Hospital West Campus has been serving one of the fastest growing pediatric populations and as the population grows, so has the community hospital. To meet the needs of the community, the hospital has expanded its services already and continues to look at the patients to determine what programs, services and initiatives may make the most impact in West Houston.

More than 400,000 patients have taken advantage of the Texas Children’s brand of care provided through West Campus since it opened its doors in 2010. The campus which sits on 55 acres, houses 19 subspecialty outpatient clinics, inpatient hospital services and the only 24/7 dedicated pediatric emergency center in the West Houston area.

Most recently, West Campus opened a new eight-bed Pediatric Intensive Care Unit, allowing the hospital to accommodate patients with higher acuity. Because of the increasing demand for emergency care, the hospital also doubled the number of beds in the emergency center which is staffed by board-certified pediatric emergency medicine physicians. In addition, a 28,500-square-foot, state-of-the-art sports medicine clinic was built, which houses a 3,000-square foot gym, two x-ray rooms, three casting bay sand 16 exam rooms for seamless, patient-centered service. The new space houses advanced technologies, including robotic dynamometry for isokinetic testing, motion recording and analysis to enhance rehabilitation.

Texas Children’s Hospital West Campus has been successful for many reasons, including the dedicated staff. There are currently more than 500+ passionate, hard-working team members who care for patients each day. The team of nurses, child life specialists, imaging technologists, therapists, renowned physicians, and many others are specially trained to diagnose, treat and care for children.

The success story is in part due to the support of the West Houston community. From the beginning, leaders and staff have cultivated these relationships, ensuring that patient families know about the care that is being provided in their own backyard.

Don’t expect the growth to stop any time soon. As leaders and West Campus employees continue to assess the needs of patients, families and the community, they will determine what programs, services and initiatives are most beneficial in the community setting.

Texas Children’s Pavilion for Women opened its doors two years ago and has been exceeding expectations ever since. View the photos below and see if you can guess some of the most memorable moments from the last 24 months.

Then scroll to the bottom of the page for the answers

1. What was the official first day of delivering miracles at Texas Children’s Pavilion for Women?

2. Who was the first baby born at the new facility?

3. Why was the miracle bridge lit up on the first day of inpatient services?

4. Who are the famous babies in this picture?

5. How was the Pavilion involved with the March of Dimes?

6. What other service is important to the diverse group of patients who visit the Pavilion?

7. What are some of the in-utero procedures that have been done at the Pavilion?

8. How many babies were born in year one?

9. Where is the hospital’s first community ObGyn office?

10. What did the Hackett family gift fund?

11. What is the use of the DaVinci robot?

12. Who is Baby Audrina?

Answers:

1. Texas Children’s Pavilion for Women leadership broke the ribbon on the brand new hospital on March 23, 2012, the first day of inpatient services was Monday, March 26, 2012.
2. The first baby born at the Pavilion for Women was Brayten Green, born at 8:16 a.m. March 26, 2012.
3. On the first night of delivering miracles, The Miracle Bridge was lit up in blue to celebrate the first baby born at the Pavilion for Women.
4. The “Perkins Pack,” as they came to be known, was the first set of sextuplets born at the Pavilion for Women. They gained national attention with several interviews on network television.
5. As a center dedicated to high risk pregnancies which cares for many premature babies, the Pavilion was the presenting sponsor for March of Dimes March for Babies 2012.
6. The Menopause Clinic is just one of the sought-after features available at the Pavilion that allow us to care for women at every stage of life.
7. Programs for in-utero spina bifida repair, in-utero heart intervention, and in-utero balloon placement for congenital diaphragmatic hernia were all created within the first year.
8. Within the first a year, about 5,000 babies were born at the Pavilion.
9. The first ever ObGyn clinic opened its doors in Pearland bringing the Pavilion’s outpatient services to the Pearland community.
10. The hospital received a $2 million gift to establish the Maureen Hackett Endowed Chair for Reproductive Psychiatry.
11. The new robotics program and the acquisition of the DaVinci robot allows for the use of cutting-edge techniques to help perform complex surgical procedures that are minimally invasive in both the adult and pedi population.
12. Baby Audrina Cardenas was born at the Pavilion with one-third of her heart outside of her chest. A multidisciplinary team of surgeons performed a six hour open-heart surgery where they reconstructed her chest cavity to make space for her heart.

Dr. Oluyinka Olutoye, Pediatric Surgery, gave the 20th Loren R. Chandler Memorial Lecture in Pediatric Surgery at Stanford University School of Medicine on March 25.

His lecture titled, “Fetal Surgery: Getting a Head Start in Life’s Journey,” described the indications for fetal surgery, described the technique, and reviewed cases, including Fetoscopic Tracheal Occlusion (FETO), Sacrococcygeal Teratoma and Congenital Diaphragmatic Hernia (CDH).

Former lecturers include:

Dr. Marcelo Martinez Ferro, Fundación Hospitalaria Private Children’s Hospital, Buenos Aires, Argentina
Dr. Kathryn Anderson, Children’s Hospital of Los Angeles
Dr. Alan Flake, Children’s Hospital of Philadelphia

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Dr. Michael Speer, Neonatology faculty (center), congratulates Drs. Athis Arunachalam and Jonathan Davies, third-year fellows, the 18th annual Arnold J. Rudolph Memorial Grand Rounds award recipients. The award recognizes third-year fellows in neonatal-perinatal medicine for outstanding teaching, patient care, scientific inquiry and professional integrity.

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