November 29, 2016

113016surgicaloncologyinside250Texas Children’s Cancer Center is renowned for extraordinary care and outcomes and is ranked No. 2 in the nation by U.S. News & World Report. An important part of the program’s success is the multidisciplinary care children here receive – particularly in the area of surgical oncology. Many solid tumors – such as liver tumors, bone tumors, neuroblastomas and sarcomas – require complete surgical removal. Chemotherapy and radiation may be used to shrink the size of the tumor or to keep it from coming back after surgery, but surgical removal is a critical step for children with these cancers. In these cases, oncologists and surgical oncologists must work together to carefully plot the course of treatment and time the surgery just right to give young patients the very best chance at a cancer-free life.

Patient diagnosed with hepatoblastoma

In September 2015, Dr. Maria Garcia Fernandez, a pediatric infectious disease specialist, and Dr. Fernando Padilla, a family practitioner, discovered a mass in their 17-month-old baby Victoria’s abdomen. Fearing the worst, they immediately contacted the Solid Tumor Program at Texas Children’s Hospital, where Victoria was promptly evaluated and diagnosed with stage 3 hepatoblastoma.

Hepatoblastoma is a relatively rare type of childhood cancer, with approximately 200 cases diagnosed per year in the country. Usually occurring in children under the age of 5, there are often no initial symptoms other than the mass.

“Hepatoblastomas tend to present very large, because the liver is tucked under the ribs so the mass is hard to feel,” said Dr. Sanjeev Vasudevan, Victoria’s surgical oncologist specializing in liver surgery. “You have to remove the side of the liver that the tumor inhabits without damaging the normal side and still get the tumor completely out.”

The stakes for this type of surgery couldn’t be higher.

“If you attempt to remove the mass and wind up leaving some of it behind, the prognosis for the child becomes much more serious,” Vasudevan said. “Basically, if you can’t guarantee a negative-margin resection, it’s safer to skip the attempt and go straight to liver transplantation.”

Aggressive chemotherapy treatment

At the time of diagnosis, Victoria’s tumor was 6 cm in diameter and covered both sides of her liver. She had to undergo an aggressive regimen of chemotherapy to see if resection would be an option, or if transplant would be required.

“We were devastated,” Fernandez said. “We didn’t know if the chemotherapy would work, what kind of toll it would take on her, or if she’d have to have a transplant and deal with that her whole life. But, what we did know was that Texas Children’s was the best possible place for us to be. They had the numbers. They had the best track record for treating this type of cancer, whether it’s from an oncology perspective or surgery or transplant or intensive care.”

Only a handful of major centers in the country are equipped to take a case like Victoria’s. Of the 200 cases diagnosed in the U.S. annually, Texas Children’s treats approximately 10 percent of them.

“In addition to a strong cancer program, you need to have pediatric ICUs and intensivists, surgical expertise, anesthesia and pain services, all for children under the age of 5 – and enough volume to do it well and have good outcomes,” Vasudevan said.

Victoria underwent four intense cycles of chemotherapy. Each time, she was admitted back to the hospital for about a week, fighting fever, neutropenia and RSV. Knowing that four cycles was probably as much as the petite toddler could take, Victoria’s physicians were hoping to take her for surgery after one or two rounds. After the third cycle, she was placed on the transplant list briefly before scans finally showed a glimmer of hope. Victoria underwent a fourth cycle and was scanned again, and the team was delighted to find a margin of healthy tissue that made surgery possible.

“This entire team of oncologists, radiologists, pathologists, surgeons and transplant surgeons met so many times and discussed her case, all diligently trying to figure out what was best for Victoria,” Fernandez said. “It showed tremendous perseverance and dedication, and I will never forget that as long as I live.”

Surgical tumor removal

On January 6, 2016, Victoria went in for surgery, and she didn’t come out for more than nine hours. The vicinity of the tumor to the main portal vein, the primary blood supply to the liver, was close and required special attention to ensure that the tumor was completely removed.

“When operating on the liver, there is a high risk of disrupting the blood vessels and the bile ducts,” Vasudevan said. “What makes it really complicated is the fact that the liver is brown and completely opaque, and you can’t see the tumor. You rely on ultrasound guidance and external cues, the rest is up to feel and experience.”

Victoria’s procedure went smoothly. Vasudevan removed the tumor and the left lobe and was able to preserve about 60 percent of her liver.

There is a 30 percent chance of liver insufficiency post surgery, but after four or five days, the liver begins to regenerate and compensate for its loss. Victoria was stable and extubated by the next morning, and she went on to have two more cycles of chemotherapy to ensure no microscopic seeding had occurred. She has since celebrated her second birthday and returned to her normal, vibrant self.

Although Victoria is still checked regularly for signs of recurrence, overall her prognosis is excellent. She has an approximately 90 percent chance of an event-free, five-year survival.

“This is exactly why I got into this field,” Vasudevan said. “It’s an amazingly rewarding thing to do. Cancer is so devastating, in general, and to see a small 1- or 2-year-old child robbed of her whole life…that’s motivation enough for me.”

For more information about our Surgical Oncology Program, click here.

112916nursingtownhallflyer350The countdown clock is ticking! In less than one week, Texas Children’s Nursing will host its second virtual town hall on Wednesday, December 7, from 1 to 2 p.m. at the Pavilion for Women Conference Center.

Nursing has partnered with the Corporate Communication team to organize this event to engage our team of more than 3,000 dedicated nurses that make up Texas Children’s largest employee population.

During the first virtual town hall in June, approximately 600+ nurses participated via live attendance, group viewing of the livestream or watching the livestream via their smartphone, tablet or personal computer. Building on the tremendous success and impressive turnout of the first town hall, the goal this time around is to increase nursing participation significantly through a series of strategic marketing efforts.

“To help our nurses register early for the town hall, we created an electronic flyer with a registration link that was disseminated to nursing leadership via Nursing Congress and which is now available on our Voice of Nursing website,” said Jody Childs, senior project manager and co-organizer of the town hall event. “We helped nurses register as they arrived to their council meetings on Shared Governance Day which resulted in 65 nurses being registered for the town hall, all of whom received registration stickers to remind their peers to sign up as well.”

As a result of feedback from our first town hall, seating capacity has been expanded at the Pavilion for Women Conference Center and nurses are encouraged to attend the face-to-face town hall. For nurses who cannot attend the live event, there will be several gathering locations to view the live stream:

  • Clinical Care Center (for Ambulatory Services) – D.0900.30, ninth floor
  • West Campus – WC.150.10 (first floor)
  • The Woodlands Outpatient Facility (board room, fourth floor)
  • Health Centers – Sugar Land, Cy-Fair, The Woodlands, Kingwood, Clear Lake)
  • The Center for Children and Women (Greenspoint and Southwest)
  • Forming your own huddles? Please submit sign-in sheet to

As always, patient care is our first priority and we know that not all nurses will be able to attend the live event or live-stream. However, those nurses will still be able to participate by viewing the event on-demand at their convenience.

Hosted by Chief Nursing Officer Mary Jo André, the town hall will include a discussion of FY16 nursing accomplishments, FY17 nursing priorities and system updates. Two videos will be presented – a sneak peek of Texas Children’s The Woodlands Hospital which will open spring of 2017 and a time lapse video spotlighting the progress on the pediatric tower which will open in August 2018. Also, the town hall will include extra Q & A time for nurses to submit their questions. Nurses watching the livestream remotely will be able to participate in this session thanks to our use of virtual technology.

“By leveraging new technology at our first town hall, we were able to engage more nurses in a town hall than we ever had before,” André said. “As our team continues to grow, it will be increasingly important for us to see opportunities to make communication easier and more effective. I encourage our nurses to pre-register so they can attend my town hall on December 7.”

Click here to pre-register for the Nursing Town Hall.

November 22, 2016

Simulations test readiness of new Outpatient Facility in The Woodlands

Ready, set, go!

“Are you OK?” a nurse asks a patient who stumbled to the ground after an unsteady walk to an exam room at the new Texas Children’s Hospital The Woodlands Outpatient Facility. “Help!”

A slew of medical staff come rushing to the girl’s aid, some comforting the patient’s mother and others tending to the girl’s lethargic condition. During what looked like controlled chaos, medical staff rolled equipment into the exam room, ran up and down hallways to gather more help and within what was just a few minutes stabilized the patient.

This was one of 11 scenarios played out during a three-day simulation at the Outpatient Facility before its doors opened for business on October 4. The purpose of the simulation was for medical staff to test their new environment, not their clinical abilities. Were there enough supplies? Is medical equipment in the right place? Is the room set up properly?

“Architects are great at creating these beautiful environments but are they friendly to the providers who are actually seeing patients,” said Julie Barrett, director of outpatient and clinical services in The Woodlands. “Testing those environments to see if we’re able to provide high quality patient care is what we hope to learn from simulation.”

Jeanette McMullin, a nurse in the surgery clinic at the Outpatient Facility, participated in the exercise and said it gave her a good feel for her new clinical space.

“It really took me through the process of what we would do for a patient given the situation and the supplies on hand,” McMullin said. “For me, the outcome was clear and that is we are able to function very well in this new environment.”

Barrett said a robust simulation is planned prior to the hospital opening in April. These efforts will be tailored to inpatient providers and will be led by many of the same simulation team leaders, all of whom are based in The Woodlands and have been trained at the Texas Children’s Simulation Center at Main Campus.

“The staff, providers and leaders have done a wonderful job,” she said. “I am amazed at how vitally important this simulation has been. It’s been a great learning opportunity.”

For more information about the Outpatient Facility, click here.

“Our son was supposed to be born on Christmas Day but he decided Election Day was more fun,” said Whitney Kubik whose son was born six weeks early at Texas Children’s Pavilion for Women. “I was honored that Kemp was chosen to be the first one to walk through the door. I am very excited because he gets to go home soon.”

In recognition of World Prematurity Day on November 17, Texas Children’s Newborn Center and the Pavilion for Women leadership unveiled a symbolic green doorway that represents the end of a family’s NICU journey and the beginning of a new chapter when they get to bring their baby home for the first time.

“Whether you’re in the NICU for two months or two years, it can be tough on families,” said Desiree Bradley, a NICU mom and member of Texas Children’s Newborn Family Advisory Committee. “We thought about different concepts and came up with the idea of a discharge door to mark this momentous milestone.”

Bradley and her Newborn Family Advisory Committee members Shannon Essex and Ane Alfred presented their design sketch to Texas Children’s Facilities Operations team who recreated what was in the hearts and minds of these mothers and children.

On World Prematurity Day, Texas Children’s was one of three hospitals nationwide that partnered with the March of Dimes to promote its national “Give Them Tomorrow” initiative to raise local, national and global awareness of prematurity, the number one cause of death for babies in the U.S. and around the world.

More than 380,000 cards and letters – one for each premature birth in the U.S. annually – were created by families across the country. With the help of representatives from the University of Houston men’s basketball team, stacks of inspirational cards were delivered to Texas Children’s NICU families in honor of this significant day.

“I’m very glad that we had patient families here, community representatives, our physicians and nursing leadership who came out to show their support,” said Chief of Neonatology Dr. Gautham Suresh. “Because it is only with partnerships amongst all the stakeholders that we can make a dent in the rate of prematurity and improve the outcomes of premature babies and their families.”

During this special occasion, Texas Children’s was named the top corporate sponsor of the 2017 March for Babies in Houston – the No.1 March for Babies in the country.

Cris Daskevich, senior vice president of the Pavilion for Women, will serve as the chair of the walk which rallies support from across the Houston community to combat prematurity. Michelle Riley-Brown, executive vice president and president of Texas Children’s Hospital The Woodlands, will be chairing the Montgomery County March for Babies event in May and Information Services Senior Vice President Myra Davis, Assistant Vice President of Women’s Services Ivett Shah and NICU Vice President Judy Swanson will co-lead the Texas Children’s system-wide campaign.

“We are proud to partner with the March of Dimes in these efforts and grateful for their many decades of support to Texas Children’s and Baylor College of Medicine,” Daskevich said. “Over the last 10 years, the March of Dimes has provided more than $16 million in grants more than all other Houston area institutions combined.”

112316drmarybrandt175Pediatric Surgeon Dr. Mary Brandt has been reappointed to the Board of Governors of the American College of Surgeons (ACS) as the Governor-at-Large representing ACS fellows in the ACS South Texas Chapter. This is the second three-year term for Brandt.

In her position as a Governor-at-Large, she will facilitate communications between ACS Fellows and members of the Board of Governors. Brandt’s duties include attending local meetings, participating in the Surgical Training Workgroup and attending national leadership meetings.

Brandt is director of the Adolescent Bariatric Surgery Program and director of the Anorectal Malformation Clinic at Texas Children’s Hospital. She is also a professor of Surgery at Baylor College of Medicine.

November 15, 2016

111616newpfwwebsite350In case you haven’t already noticed, the websites for Texas Children’s Hospital and Texas Children’s Pavilion for Women have a new look and feel.

Sporting bright colors, vibrant photographs and iconography, the websites have been redesigned to better reflect Texas Children’s branding and marketing materials. The websites also have been revamped to incorporate best practices and user study feedback.

New features of the websites include:

  • A new content management system that allows for quicker, more timely updates
  • Incorporated branding (pictures, colors, icons) to match Texas Children’s current marketing material
  • Reorganized navigation based on usage data/analytics so that visitors can easily find the most searched-after content
  • Revamped website search that provides more accurate results
  • Improved responsiveness on mobile/tablet devices
  • New online health libraries provides valuable information to current/prospective patients as well as assists with search results through Google, Bing and other search engines.

Both websites have seen tremendous traffic with the Texas Children’s Hospital website garnering almost 6 million page views this year from 1.3 million different users and the Pavilion for Women website receiving 1.2 million views from 411,000 users. In addition, statistics have shown improvement in the amount of page views, average load time and bounce rate.

Work on Texas Children’s websites will continue with a new face and feel for Texas Children’s Pediatrics and Texas Children’s Urgent Care coming soon. A new safety and outcomes page also will be unveiled, offering our patients and their families the most complete and accurate information possible about how we are doing as a health care system.

Click here to see the new look of the Texas Children’s Hospital website and here to get a feel for the new website for the Pavilion for Women.

The web team would like to hear your feedback and answer any questions you might have about our new websites. Please direct your comments to

Growing up, it took awhile for Michelle Roy to warm up to other children in her neighborhood and school classrooms. A bilateral cleft lip and palate caused her to be shy, introverted and at times feel a little isolated.

“I didn’t have anyone to share my experiences and feelings with,” she said. “I didn’t have access to a network of kids in similar situations.”

Fortunately, that’s not the case for the many children Roy now works with as a physician assistant to pediatric plastic surgeon Dr. Laura Monson. Monson helped start Camp Keep Smiling in 2014, a camp for children with cleft lip and palate.

The camp recently wrapped up with a record-setting number of campers and incredible experiences for the patients and staff members alike. Camp Keep Smiling provides a safe, fun environment for patients between the ages of 10 and 16 to engage in meaningful social interaction and gain self-confidence. The camp, hosted by nonprofit Camp for All, offers activities like canoeing, fishing, archery, ropes courses, basketball and arts and crafts. Admission is free of charge for patients as it is supported directly by donations.

This year, 61 campers attended Camp Keep Smiling versus the 30 who attended in 2014. Monson leads the camp with other team members from the plastic surgery division. Physicians, nurses, OR staff and child life specialists serve as counselors who notice tremendous strides in the campers towards the end of the session. Oftentimes, campers have never met another child with cleft lip and palate and this gives them the opportunity to form friendships with those who are just like them.

“Children with cleft lip and palate often will have four or more surgeries throughout their lifetime to address not only appearance issues but speech and dental issues as well,” Monson said, adding that cleft lip and palate affects one out of every 700 births. “Camp Keep Smiling was created to help these children better understand their condition, meet people who are going through the same thing and help them deal with some of the difficult social interactions they might have growing up.”

Christy Hernandez, a registered nurse with Texas Children’s Outcomes and Impact Service, has been helping organize the camp since its inception and said it is amazing to watch the campers open up to one another over the weekend while participating in super fun activities.

“It’s life changing for many of them,” she said. “It’s a time when they can forget about their medical condition and just be kids.”

Roy participated in the camp for the first time this year as its counselor coordinator and saw firsthand what a great opportunity it is for children with cleft lips and palates to gain confidence in themselves, and meet and build relationships with people who look and often feel the same way they do.

“Camp Keep Smiling is a very valuable experience for these children to have,” she said. “I feel blessed to be a part of it and to let them know there’s a bright future ahead of them.”

Click here to watch ABC-13’s story about Camp Keep Smiling.