September 3, 2014

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Hormonal changes during and after pregnancy may trigger depression in some women. In fact, between 10 and 15 percent of pregnant women and new mothers may experience some symptoms of depression. But their condition can be far more than simply feeling “blue” or “down.” For many, it can have a debilitating effect on their health, their family, their careers and their relationships.

To address the need for earlier screening and treatment of maternal depression, the Texas Children’s Pavilion for Women launched a pilot program in May to screen patients multiple times throughout their pregnancy and postpartum period. The effort is part of the Women’s Mental Health Delivery System Reform Incentive Payments (DSRIP) program, focusing on expanded access to health care services.

“Our goal is to identify women with maternal depression as soon as possible and get them into care because maternal depression is treatable,” said Dr. Lucy Puryear, medical director of The Women’s Place – Center for Reproductive Psychiatry and Baylor College of Medicine psychiatrist, who oversees the program. “How we deal with this can have a profound impact not only on the physical and emotional well-being of the mother, but on the life of the child and the family overall.”

As part of the program, women are screened for maternal depression using the Edinburgh Postnatal Depression Scale multiple times throughout their pregnancy (during the first and third trimesters) and postpartum (at two weeks in the pediatrician’s office and at six weeks by their obstetrician), and those requiring follow-up mental health services are referred for care.

“Our overriding goal is to learn from the patients we’re currently screening in order to develop a model for the early diagnosis and treatment of maternal depression using several combined strategies,” said Dr. Puryear. “Texas Children’s Pavilion for Women is uniquely positioned to oversee this project because of the unique Reproductive Psychiatry program and faculty at Baylor College of Medicine.”

Dr. Lisa Valentine, a Baylor College of Medicine psychiatrist hired to treat patients as part of this program, practices at The Women’s Place at the Pavilion for Women, The Center for Children and Women at Greenspoint and at Pearland Ob-Gyn. Two Texas Children’s Pediatrics practices, Pearland and Shadow Creek Ranch, are serving as pilot sites for the project. Providers and staff at these pilot sites have been trained to implement standardized screening and referral.

At Texas Children’s Pediatrics Pearland, every new mother is screened for postpartum depression at the initial well-child visit, which occurs approximately two weeks postpartum, referring those needing services. Referrals are processed quickly and most patients are seen within seven days of being screened. Select providers at Texas Children’s Pediatrics Shadow Creek Ranch have also begun standardized screening.

Future plans focus on educating and training staff at obstetric clinics and additional pediatric clinics to implement standardized screening and referral; adding additional providers, including a psychiatrist, therapist and social worker; and expanding to additional sites with the intent of integrating maternal mental health services where women are already seeking treatment.

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By Dr. Charles Hankins

As a Texas Children’s neonatologist, I have treated many premature and critically-ill infants in the Neonatal Intensive Care Unit (NICU). When babies are born prematurely, their lungs and other organs are still developing. They are entering the most critical stage of their young lives. Their parents entrust their newborns to us to provide the highest level of care possible.

Our mission at Texas Children’s Hospital has always been to build a healthy community of children. In some cases, this begins in premature and critically-ill infants. To achieve the best neonatal outcomes, Texas Children’s has partnered with community NICUs in the Greater Houston area to ensure these patients receive the right care at the right time and in the right place.

As chief medical officer for Texas Children’s Hospital West Campus, I serve as the primary medical liaison to community physicians and work closely with them to expand access to patient care in the community setting, which is particularly important for the families of our NICU patients.

With a commitment to family-centered care, every effort is made to keep these infants close to their families in the community. Texas Children’s provides these local NICUs with administrative and clinical support, giving patients access to the latest treatments available in neonatal and pediatric care, state-of-the-art equipment and pediatric subspecialists.

If a child is born in one of the community hospitals and needs care offered only in a Level IV NICU, that baby is transferred immediately to our main campus at Texas Children’s Newborn Center, ranked No. 2 in the nation. When these babies graduate to a lower level NICU, the family can request transfer back to their community hospital and maintain the continuity of care which is so vital to helping these newborns thrive.

Texas Children’s is proud to work with these hospitals to provide high-quality care to newborns:

  • Houston Methodist West Hospital
  • Houston Methodist Willowbrook Hospital
  • Houston Methodist San Jacinto Hospital
  • Houston Methodist
  • St. Joseph Medical Center
  • CHI St. Luke’s Health – The Woodlands Hospital
  • CHI St. Luke’s Health – The Vintage Hospital

More than 2,000 NICU infants are cared for each year at Texas Children’s Newborn Center, making us one of the largest, most experienced NICUs in the country. Partnering with community NICUs in the Greater Houston area will ensure our critically-ill babies receive high-quality care, while helping us carry out our mission of creating a community of healthy children.

August 26, 2014

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It wasn’t a typical Monday morning for Dr. Timothy Lotze, a neurologist at Texas Children’s. Besides making his usual hospital rounds to see patients, Lotze paid a visit to 14-year old Joseph Garza’s room. But, this visit was extra special.

Trading in his white lab coat for a comfy red T-shirt, Lotze participated in the Ice Bucket Challenge to help raise money and awareness for amyotrophic lateral sclerosis (ALS), a neurodegenerative disease that severely impacts a person’s ability to move.

Lotze accepted the challenge from Texas Children’s Muscular Dystrophy Association representative Dalia Deleon on behalf of Garza, who suffers from an extremely rare form of pediatric ALS.

View the video:

“I am so grateful to Dr. Lotze for taking on this challenge to help raise awareness for ALS,” said Lorrie Garza, Joseph’s mom. “Hopefully, they’ll find a cure so no other family or child has to go through this terrible disease.”

A year before Garza’s diagnosis, Lorrie noticed her son was having trouble lifting his arms and began walking with a limp. His condition grew worse, but doctors in his hometown of Brownsville weren’t sure what type of neurological disorder he had. Once Garza was transferred to Texas Children’s, he and his family met with Dr. Lotze, who diagnosed Garza with ALS in May of this year.

While ALS primarily affects adults, there are children who suffer from this debilitating disease that attacks nerve cells in the brain and spinal cord which control voluntary muscle movement. Patients with ALS progressively lose their ability to eat, speak, walk and eventually breathe.

“Since the disease impacts voluntary muscle action, patients in the later stages of ALS may become completely paralyzed,” said Lotze. “It’s important for us to continue to support research and raise community awareness about ALS so we can find a cure for this horrible disease and improve the quality of life for these patients.”

That’s exactly what Texas Children’s researchers Dr. Hugo Bellen and his team strive to accomplish. In their laboratory at the Jan and Duncan Neurological Research Institute at Texas Children’s and Baylor College of Medicine, they are examining the role of genes in ALS to help find ways to suppress degeneration and improve a patient’s functionality.

“A subset of ALS patients have mutations in a gene called VapB,” said Bellen. “We are trying to understand the specific role of this gene by studying fly and mouse models of ALS, caused by mutations in this gene.”

Bellen and his team have discovered that the VapB protein circulates in the blood and functions as a hormone. It binds to receptors on muscle cells to control the function of the muscle mitochondria, the cell’s powerhouse. In the mutants, the muscle mitochondria do not function properly anymore, and this in turn affects the function of the neurons that innervate the muscles, ultimately causing these neurons to die.

“Although the causes of ALS are not well understood, we are making significant progress on how the disease may develop, which could lead to better therapies or possibly a cure in the future,” said Bellen.

As for Garza, his mom says he’s not giving up hope. “He’s already told me he’s going to fight,” said Lorrie. “And I tell Joseph, “We will fight together.”

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Texas Children’s President and CEO Mark A. Wallace took a fun break to raise awareness for a very serious cause on Thursday. Watch him take the ALS ice bucket challenge and see who he’s called out.

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Read the newest “Super Star” Q&A featuring Jennifer Neidinger, Adolescent and Sports Medicine, Renal, Rheumatology and Pediatric Adolescent GYN clinics. “A Texas Children’s Hospital Super Star is someone who strives for excellence in every patient/family interaction,” Neidinger said. “Someone who leads by example and goes ‘above and beyond’ to meet the needs of our patients and families – with a smile.”

 
 
 
 

Q&A: Jennifer Neidinger, July – September 2014 Leader

Your name, title and department. How long have you worked here?
My name is Jennifer Neidinger, RN. I am the 11B Clinic Manager for Adolescent and Sports Medicine, Renal, Rheumatology, and Pediatric and Adolescent GYN services. I began my career at Texas Children’s Hospital in September 2001 (12½ years).

What month are you Super Star for?
I am the Super Star Leader for July-September 2014.

Tell us how you found out you won a super star award.
My director, Ryan Breaux, announced my recognition as a Super Star during our Leadership meeting. Following this surprise recognition, our Leadership Team hosted a wonderful breakfast for our team to celebrate together.

What does it mean to be recognized for the hard work you do?
It is such an honor to be recognized as a Super Star within an organization which is so full of Super Star employees and leaders. This recognition is so special to me because I feel so lucky to be part of such an amazing team.

What do you think makes someone at Texas Children’s a super star?
A Texas Children’s Hospital Super Star is someone who strives for excellence in every patient/family interaction. Someone who leads by example and goes “above and beyond” to meet the needs of our patients and families – with a smile.

What is your motivation for going above and beyond every day at work?
The patients and families who trust us to provide their care every day.

What is the best thing about working at Texas Children’s?
I am humbled by the strength and bravery of our patients and their families. I am honored by the commitment and compassion of the staff. I am excited about the strides in pediatric care at Texas Children’s Hospital, and I am so fortunate to work here.

Anything else you want to share?
This recognition is such an honor which I would like to share with my colleagues, the staff of 11B, my physician partners and my leadership team. I am so fortunate to be part of this “family” and am so pleased to represent the organization as a Super Star Leader.

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By Dr. Jennifer Arnold

Soon after adopting Will and Zoey in 2013, our lives were thrown a major curveball when I was diagnosed with Stage 3 choriocarcinoma. After months of treatment and finally kicking cancer into remission, I went back to work this spring as medical director of Texas Children’s Simulation Center. Returning to my job has been a big adjustment for our entire family, but it’s also worked out for the best! It’s really important to me to raise our kids as independent go-getters who work hard to achieve their goals in life. I hope that by seeing Bill and I enjoying our careers – despite obstacles that have come our way – they will learn the value of perserverance and overcoming challenges.

Being a mom is the toughest and most rewarding job. I know everyone says that, but it’s true! It’s not easy to keep up with everything at work and at home when we have so much going on – in fact, it’s a constant challenge. Here are some of the ways that I try to balance it all:

Take things one step at a time
No matter how much is going on, I have to take a deep breath and think to myself, I can only accomplish one thing at a time. Personally, I believe my perspective has changed since becoming a cancer survivor. I don’t sweat the small stuff anymore but instead move towards the things that really matter. I also try not to get caught up in what other people think. I know that work didn’t stop while I was away, and I’m still trying to catch up. I’m really focused on getting back to some important initiatives we are working on in the Simulation Center. I am staying focused on what I think is important for the program and our institution. I’m constantly honing in on what needs to get done one step at a time in order to achieve our larger goals.

Prioritize and organize
Making lists and setting a routine works really well in my work and home life. Before kids, I didn’t think life could get any busier – well I was wrong. Life is crazy busy and it’s getting more difficult to keep up. I am not sure whether it’s residual “Chemo Brain,” the fact that I have turned 40, or becoming a new parent of two toddlers, but it is so easy to lose track of all the work and home “To Do’s” that need to be addressed. With my love-hate relationship with technology, I am trying to better harness tools to help me stay organized. There are so many new applications for your smart phone, tablet, and PCs that you can access anywhere to keep lists and project documents close at hand. Sometimes I have to do work from unusual places, so making everything easily accessible is key. When it comes to everything at home, it helps that Bill and I are pretty good about dividing and conquering! Prioritizing family, health and work is sometimes a struggle, but Bill and I try to keep each other in check. It’s hard for both of us to be away from the kids during work, but it’s easier because we have a good system in place with a fantastic nanny and family support.

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Don’t feel guilty for not doing it all
Sometimes you have to say no, and sometimes it’s ok to just be “good enough” rather than perfect. My best friend recently sent me a card describing how to do this. It’s a trait that I don’t think any mother is good at, but I try to remind myself that no one is perfect. This is tough for me to wrap my head around as I am a perfectionist – both as a professional and as a mom. I have to accept I can’t do everything, and I certainly can’t do it on my own. I’m lucky to have a great support system and so many people to rely on for help. First, my husband has been my sounding board when times were tough getting back into work. Second, my parents and nanny have been essential for helping us take care of the kids. Third, all of my colleagues have been so supportive and welcoming – which has helped me transition back into the swing of things. All of these people have made it possible for me to keep my family and my career on track.

Treat yourself
This one may come as a surprise, but I think it’s important to stay balanced and happy. I need to do this more often when I am stressed out. I try to make time once in a while for something that makes me happy. It can be something as small as watching my favorite TV show or getting a manicure – but I find that attending to my needs and putting myself first every once in a while makes me better equipped at dealing with everyone else’s expectations and the demands of being a working mom. Even though I often complain to Bill that filming our TLC television show on the weekends feels like one extra burden on our very busy lives, it allows us to take time to enjoy life and do fun stuff. Instead of just hanging out at the house with the kids on a Saturday afternoon, we can do something fun we might not otherwise do. I have learned that it is ok to reserve the weekends for quality family time since I’m not around much during the weekdays. I think we’re able to appreciate our time together as a family more since we have less of it with the busy demands of my career. I still feel tired at the end of the day, but at the same time, I’m so happy to get into a routine and just be boring for awhile.

82714BWJArnold640-3Be prepared
Having a Plan A and a Plan B makes me feel very comfortable about immersing myself back in work. Thankfully, we have an outstanding nanny. Kate is great with Will and Zoey, and with her background in child life, I feel comfortable that we have an expert to help care for our kids. But having my parents close by as a backup is also very reassuring. Zoey is much more comfortable, and she and Will are growing so much. They start school this fall so I am nervous, and at the same time, excited to see them flourish outside of our family unit.

Cancer kept me from my work for too long, but the silver lining was a lot more time with our newly adopted kids. When I returned to work, I was nervous about leaving them and not being around as much. It took me a few weeks to adjust, but I am comfortable knowing that little day-to-day issues won’t be a distraction since we have support and a plan (and a backup plan) in place.

August 19, 2014

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A pediatrician sees hundreds of patients a year. Some stick out in their mind more than others, but for Dr. Michael Bishop, pediatrician at Texas Children’s Pediatrics Grand Parkway, the Stovall family is one that he will never forget.

Last year, while on vacation in Galveston, Bishop experienced shortness of breath which prompted his wife to drive him back to Houston for immediate evaluation. Following a week in the hospital with more questions than answers, he was diagnosed with atypical hemolytic uremic syndrome (aHUS), a rare genetic disease that affects kidney function. Once diagnosed, Bishop was given both oral and IV medication, but dialysis four nights per week also was required due to the failure of his kidneys to recover from the illness.

Shortly after the diagnosis, his daughters started a Facebook page to raise awareness about aHUS and the importance of kidney donation. Because the disease is genetic, none of his family members were able to donate, thus the need to broadly share his story. Patients at his practice started asking about the Facebook page and how they could help.

“The support from my patients and their families was overwhelming,” said Bishop. “I believe that I have been blessed by God to be given the privilege of taking care of children and their families. I never thought I’d receive the greatest gift of all from one of them.”

Jennifer Kennedy-Stovall’s three sons have been patients of Bishop’s since they were born. Now 10, eight and four, the boys are frequent visitors to Texas Children’s Pediatrics Grand Parkway whether for a well-child check-up or an acute illness. Bishop had been out of the office during a few of the Stovall boys’ visits and Jennifer wondered if he was battling a serious health issue. When the family saw Bishop during their next visit, they noticed that he just wasn’t the same – he wasn’t cracking jokes, he was more introverted and more than just the physical changes that occurred since his diagnosis, his personality had changed as well. Bishop shared the news of his diagnosis and his need for a kidney. Kennedy-Stovall walked out of the room and had a feeling.

“I walked out of the room and knew that I had to do something to help,” said Kennedy-Stovall. “I began the living donor kidney screening process that day.”

Kennedy-Stovall went through four rounds of intense screening to determine if she was a match for Bishop. Through blood tests, numerous blood pressure screenings, medical history reports, scans, x-rays and consultations with a nephrologist and social worker, Kennedy-Stovall found out that she was a match.

“When I found out I was a match, my husband and I didn’t hesitate,” Kennedy-Stovall recalls. “I felt like this was something I had to do from the moment Dr. Bishop told me he needed a transplant and I couldn’t have been happier to do this for him.”

Ironically, Kennedy-Stovall and one of her sons had a visit scheduled for the next day with Bishop. She went to the appointment not knowing if he had heard the news yet. She asked if he had any news to share and Bishop said there was testing ongoing, but that no match had yet been reported to him. Little did he know that, momentarily, she told him that she was going to be his living donor.

The families prepared, and the surgery was scheduled. The surgery was successful for Bishop and Kennedy-Stovall, and their recoveries were seamless. On July 16, Bishop celebrated his one year transplant anniversary and is thriving. The Bishops and Stovall families have grown incredibly close through their journey, oftentimes sharing lengthy family dinners together.

“I can’t believe it’s been a year,” said Bishop. “So many thoughts come to mind, but unpayable gratitude is at the top of the list. My patients are my second family, and they mean a lot to me. I’m so proud that I can come back to the practice and continue to do what I love because of this unbelievable gift from Jennifer and her family.”