Author Archives: Brady.Gervais

Traveling with kids during the holidays

Dr. Molly Martyn

By Molly Martyn, MD

With the holiday season coming, many families are making plans to travel to see family and friends.  Airline travel with infants and young children can be both joyful and stressful.  Travel is often unpredictable, but advance preparation can go a long way when it comes to traveling as a family.

The Travel Security Administration (TSA) and Federal Aviation Administration (FAA) both have tips on their websites for safe airline travel with children.  Below are some ideas and information to help your trip go more smoothly.

PLANNING AND PACKING

1.  Many families find it helpful to use a checklist for packing, something you can use for the next time you travel.  Keep a pencil and piece of paper nearby while you go through your daily routine with your child and make notes of things that you will need to remember to pack.  In general, the less gear you have to tote around the better, but having an extra pacifier or a favorite comfort object with you will help make life easier for everyone.

2.  For older children, talk with them in the week prior to your trip about what they can expect at the airport and the new things they will get to explore and experience with a trip to the airport, an airplane ride, and at their destination.

3.   Check with your airline ahead of time regarding checking car seats and strollers.  If you bring a car seat or booster seat, they can often be checked as an extra piece of luggage without additional fees.  Most airlines will allow you to check a stroller at the gate, which is helpful because it means you can use your stroller to go through security and navigate the airport.

4.  Pack more food in your carry-on bag than you think you will need in case your travel is delayed or you find yourself waiting on a runway.  If you are traveling with an infant who drinks formula, bring extra.  If you are traveling with young children, pack plenty of nutritious, filling, familiar snacks that do not need to be refrigerated.

5.  Baby formula, breast milk, and jarred baby foods are allowed through security, but must be presented to a TSA officer.  Pack them separately from your other liquids or aerosols.  You can read more on the TSA website.

6.  Bundle diapers, wipes, a changing mat, and a few plastic bags together so that they are easy to access for diaper changes.  Pack extra clothes in your carry-on.  Footed pajamas are a good option because it is only one item of clothing to change in case of an accident, spit-up, etc.

SAFETY TIPS

1.  Children less than 2 years of age can legally travel in a parent or guardian’s lap, which is what most families opt for given the cost savings.  The American Academy of Pediatrics recommends that children travel in their own airplane seat, restrained in a car seat appropriate for their size and age.  A car seat that can be used in an airplane will carry a label stating that it is certified for use in both motor vehicles and airplanes.  Once children are 40 pounds, they can use the aircraft seatbelt.  Unlike in cars, booster seats are not routinely used for airline travel.

You can find out more information on the FAA’s website.

2.  Babies and small children can be carried through TSA screening (strollers and car seats have to go through the XRay machine).  TSA should not ask travelers to do anything that will separate them from their children.

3.  Have a plan with older children about what they would do in case you get separated while traveling (a place to meet, who they can safely ask for help, etc).

IN THE AIR

1.  Changes in altitude during take-off and landing can cause uncomfortable pressure and fullness in ears.  You can help keep infants comfortable by having them nurse or suck on a bottle (this mimics what older children and adults learn to do to “pop” their ears by yawning or chewing on gum).

2.  To occupy older children, pack a bag of “special treats” such as books/crayons/games to be used on the plane.

3.  Look forward to a safe arrival at your final destination!

Good luck and travel safely.  If you want to read more, here are some good sites and additional tips:

1.  TSA Policies: http://www.tsa.gov/traveler-information/traveling-children

2.  FAA Car Seat and Safe Travel Information:http://www.faa.gov/passengers/fly_children/crs/

3.  American Academy of Pediatrics Travel Tips:http://www.aap.org/en-us/about-the-aap/aap-press-room/news-features-and-safety-tips/pages/Travel-Safety-Tips.aspx

Recipe: Perfect pot roast

Nothing says comfort food like a perfectly tender pot roast with a pile of mashed potatoes. It’s a staple in my fall/winter cooking repertoire, and once you’ve tried it, I’m convinced it’ll become a regular meal at your house too. Browning the beef is what develops the wonderfully rich, deep flavors in this recipe, so be sure not to rush this process. I like to braise the roast with a mix of carrot, celery, leeks, fennel and rutabaga, but feel free to use whatever combination of veggies you’d like. — Andrew Zimmern

Photograph by Madeleine Hill

Ingredient List
• 3 to 4 pounds beef chuck roast
• 2 cups flour
• Bouquet garni of fresh thyme, rosemary, bay leaf and parsley
• 4 tablespoons olive oil
• 5 garlic cloves, peeled
• 1 cup tomato puree
• 1 teaspoon black peppercorns
• 4 cups beef stock
• 3 yellow onions, sliced
• 2 tablespoons butter
• 3 medium carrots, peeled and chopped
• 1 medium leek, white and light green part diced
• 2 ribs celery, diced
• 1/2 cup fennel, chopped
• 2/3 cup rutabaga, chopped

Instructions
Servings: 6
Total Time: About 4 hours
Preheat the oven to 300 degrees.
Heat a large oven-proof roasting pan over medium heat on the stove. Add the olive oil.

Season the beef with salt and ground black pepper. Place the flour in a large plastic bag. Dredge the roast in the bag of flour, shaking it free of any excess flour. Discard any extra flour.

Brown the beef in the oil, about 5 minutes per side. Remove meat from pan and set aside.

Add the onions, garlic and bouquet garnish of herbs to the roasting pan, cooking and stirring until nicely colored to a light brown, about 10 minutes.

Add stock and tomato. Bring to a boil and cook for 5 minutes. Add the meat back to the pan. The top of the roast should ‘crown’ out of the braising liquid.

Place a 5-inch square of foil on top of the exposed meat.

Place roasting pan in a 300-degree oven, covered for 3 hours.

Meanwhile, place the butter in a large sauté pan over high heat. When foaming, add the carrot, fennel, leek, celery and rutabaga and sauté for 5 minutes. Season with salt and pepper.

After the meat has been cooking for 2 hours, add the vegetables to the roasting pan.

Test the pot roast for tenderness after the last hour of cooking; a fork should turn easily in the roast (you may need to cook longer than 3 hours depending on the size of your roast).

Place the roasting pan on stove top. With a slotted spoon, reserve the meat and vegetables to a serving bowl. Bring the liquids to a simmer and reduce by about half. Pour the reduced liquids over the meat and vegetables and serve.

Five Question Friday: Jesse Stremcha

Give to the Max Day — Minnesota’s day of generosity – is just around the corner on Nov. 14. So, there’s no better time to interview Jesse Stremcha, who’s played a huge role in leading our online giving efforts, than now.

What is a typical day like for you at Children’s? Busy!  Lot’s of emails, lots of meetings, lots of work all trying to get the community excited about investing in Children’s success and the health of Minnesota kids.

What fires you up most and brings you back to Children’s, day after day? We have a great mission.  I know every day I get to work with smart, driven people to support that mission.  That…and…a good workout and a great cup of coffee in the morning.

Why is philanthropy important? I think we all have an urge to help others.  Philanthropy is one important mechanism for doing that.  I love this quote from Jimmy Buffett, “Some of it’s magic, some of it’s tragic, but I’ve good life all the while.”  I feel really lucky to do the work I do and have the opportunities I have and I make sure I can help others have “some of the magic.”  I give to organizations that make that happen in ways I can’t alone.

You’re helping support our Give to the Max Day efforts. Why should people support Children’s on GTMD? Give to the Max Day is an awe-inspiring day of generosity: More than 53,000 donors giving over $16.3 million to more than 4,300 nonprofits IN ONE DAY. WOW! I think people should give just to be part of something so amazing and so special to Minnesota.

If that’s still not enough, there’s great reasons to support Children’s:

1.  We do lots of stuff — Child Life, Sibling Play, Pet Therapy, Music Therapy and on and on– that makes Children’s a special place for kids.  Donors pay for that.

2.  We don’t turn kids away. One in three kids we see needs financial assistance of some kind.

3.  We provide some of the best care in the world in some of the best facilities in the world because donors invest in great health for kids.

We know you’re huge into biking. Where is your favorite place to go for a ride? I’m no good at favorites. I love to ride lots of different places. I think every trail and ride has a charm of its own. My ‘bread and butter’ ride is the River Road loop between the Ford and Franklin bridges. I also consider Lebanon Hills my “home” mountain bike trail, but I love Murphy-Hanrahan and Cayuna Lakes, too. I’ve recently discovered gravel riding and love to cruise the back roads around my hometown of Northfield, Minn.

Trevor Eder-Zdechlik to ‘Lead the Team’ at Vikings game

Just a month ago, 14-year-old Trevor Eder-Zdechlik was diagnosed with chronic myelogenous leukemia (CML). It’s a cancer of the bone marrow and blood. While it’s rare for kids to have CML, there are some effective oral chemotherapy options available, and his treatment plan is already underway, his parents said. The hope is that Trevor responds well and can avoid future procedures such as a bone marrow transplant.

“The reality is that there is no cure, and he’ll likely have to remain on these drugs for the rest of his life. Trevor’s positive attitude about beating CML is an inspiration to all of us,” his parents said.

Trevor plays football, basketball and baseball. When he’s not playing sports, he’s watching them. He is also an honor student.

We welcome Trevor and his family as he leads the Vikings onto the field before their match-up Thursday evening against the Washington Redskins.

Photo challenge: Color your support for Children’s for Give to the Max Day!

 

Color your support for Children’s for Give to the Max Day (Nov. 14) — the Great Minnesota Give Together — starting Nov. 7. Upload a photo corresponding with each day’s chosen color to Facebook, Twitter or Instagram and use the hashtag #childrensmngtmd. We will use all submitted photos to create a mosaic to be revealed on Give to the Max Day. In addition, we’ll randomly draw a different participant each day to win a poster of the mosaic.

 

You can also support Children’s by donating on Give to the Max Day! Like to plan ahead? Donations can be scheduled prior to Nov. 14.

Recap: MRI-guided laser ablates Gavin’s tumor

Even superheroes don’t always win the first round in a fight.

But, 7-year-old Gavin Pierson came out ahead this week. Gavin, who has a brain tumor that he nicknamed Joe Bully, underwent Visualase MRI-guided laser surgery on Oct. 29. He is the first person in the country with a mature teratoma to have the surgery.

Nothing has come easy for Gavin, who has endured five craniotomies, chemotherapy and countless drugs since his diagnosis a year and a half ago. That included the MRI-guided laser surgery, in which it took two attempts before his tumor could be ablated. But, Gavin had an army on his side. Led by Dr. Joseph Petronio, a team of neurosurgeons, radiologists, nurses and our partners set out to fight Joe Bully.

Here’s a synopsis of how Joe Bully went down:

At approximately 8:09 a.m., Gavin was transported to the OR for sedation.

Bone-in fiducials were placed at approximately 8:46 a.m. A fiducial is an object placed in the field of view of an imaging system and appears in the image produced to provide a point of reference.

Gavin was taken to CT for scans at about 9:05 a.m. and returned to the OR around 9:30 a.m.

With the help of Dr. Richard Patterson, Dr. Petronio began mapping out a plan for placing small flexible laser probes to the intended target area – the tumor.

Around 10:26 a.m., Dr. Petronio created two burr holes before placing the probes.

About 30 minutes later, Dr. Petronio removed Gavin’s shunt, which was unrelated to the Visualase procedure.

Gavin was taken around 11:18 a.m. to MRI for additional scans. The MRI allows the physician to precisely monitor treatment using special Visualase software.

However, Gavin’s tumor deflected the probes. Ablation was halted.

The probes were removed, and skin fiducials were placed to for additional scans.

Gavin’s determined team took him back to the OR, where Dr. Petronio mapped out a new plan and entry point for another probe.

At approximately 3:39 p.m., Gavin was wheeled back to MRI.

About 45 minutes later, the team started ablation, in which laser light heated and destroyed the target area. Temperature maps showed the team the extent of the tissue being destroyed.

Pow! A significant portion of the tumor – an area that Dr. Petronio was unable to reach during craniotomies – was incinerated! Equally significant was the way the lesion responded to Visualase. Because of the type of tumor and its biology (relatively low blood perfusion), the laser distributed the heat extensively and the thermal distribution corresponded nicely to the shape of the tumor and the tumor/normal brain interface, Dr. Petronio said.

“To me, this represents perhaps the most significant development in Gavin’s case, in that we found, perhaps for the first time, that ‘Joe Bully’ has a weak spot, or an Achilles’ heel,” Petronio said. “I’m really encouraged about what we will be able to do with future ablations.”

By 3 p.m. on Oct. 30, Gavin was on his way home – less than 24 hours after surgery.

If you haven’t been following Gavin’s story, catch up here.

Recipe: Spaghetti squash crumble

If you’re looking for an alternative to mashed potatoes or roasted veggies, you gotta try this spaghetti squash crumble. It’s the ultimate, sweet-and-savory fall side dish that just screams comfort food. The yellow winter squash is also low in calories and packed with nutrients, such as beta-carotene and fiber. — Andrew Zimmern

Photo by Madeleine Hill

Ingredients

Squash filling

  • 2 medium sized spaghetti squash
  • 1/3 cup minced parsley
  • 1 tablespoon fresh thyme leaves
  • 1 stick butter
  • 1 pinch ground nutmeg
  • 1/4 teaspoon ground cinnamon
  • Pinch ground allspice
  • Pinch ground ginger
  • 1/4 cup minced shallots
  • 3 minced garlic cloves
  • 1 cup diced tomato, drained

Crumble topping

  • 2 cups fresh bread crumbs
  • 1 stick salted butter, melted
  • 2/3 cup ground Pecorino Romano
  • 1/4 cup brown sugar
  • 1/3 cup thinly sliced almonds, lightly toasted

Instructions

Servings: 8 to 10
Total Time: 2 hrs 45 min

Preheat the oven to 325 degrees.

Halve the spaghetti squash and remove the seeds. Place on a large shallow baking dish or sheet pan, and season with salt and pepper. Roast the squash, flesh side up, for 90 minutes.

After the squash are cool enough to handle, scrape the flesh into a large mixing bowl with a fork.

Sauté the shallots and garlic in 2 tablespoon of the butter until translucent, about 5 minutes. Stir that mixture into the spaghetti squash.

Melt the remaining 6 tablespoons of butter, and pour into the squash. Then, add all the herbs, spices and tomato. Fold together. Season with salt and pepper and reserve.

In a separate mixing bowl combine one stick of melted butter, the bread crumbs, cheese, almonds and the brown sugar.

Place the squash mixture in a large oval or rectangular baking dish and sprinkle the ‘crumble’ over the top.

Cover loosely in aluminum foil and bake for 25 minutes at 325 degrees.

Remove the foil and raise the temperature to 425 degrees. Cook until ‘crumble’ is crispy, roughly an additional 25 minutes.

 

Gavin’s story: Fighting his villain with a laser

Gavin Pierson takes on Joe Bully

If this were a comic, Joe Bully would be the villain. A villain that’s about to go D-O-W-N, according to Gavin Pierson.

Joe Bully is the rare tumor inside 7-year-old Gavin’s brain.  But on Oct. 29, with the help of Dr. Joseph Petronio and his latest weapon – an MRI-guided laser – Joe Bully is going to be annihilated, vaporized, defeated.

“It’s a one-two punch,” Petronio has said of the laser, which is complemented by an experimental drug Gavin takes.

Petronio and Gavin’s family started vying for the laser last winter. The laser uses heat and MRI imaging to kill brain tumors. It has already been used successfully on a young Children’s patient with epilepsy. The saga to reach this day has been long, and not without plenty of ups and downs – like the experience of any superhero.

A villain is born

The story began a year and a half ago.

In a matter of just days, Gavin went from being a normal, healthy boy going to gymnastics and playing sports to struggling with double vision and having trouble looking directly at others. At his sister’s seventh birthday party, Gavin’s dad, Steve, asked his wife’s aunt, a pediatrician, to look at Gavin. Armed with a flashlight, she examined Gavin’s eyes. Seconds later, she suggested Steve and Nicole take their son to the emergency department at Children’s Hospitals and Clinics of Minnesota.

During the drive to Children’s, Nicole recalled that she and Steve were worried. They knew something was wrong with Gavin and feared he could go blind.

“I remember us saying, like literally looking at each other and saying, ‘Gavin loves this world so much and nature and science, and oh my gosh, what if he couldn’t see it.’”

Hours later, it would be Steve and Nicole who were blindsided.

Two physicians performed tracking tests on Gavin before order a CT scan. The family stayed in the emergency department following the tests. They were still there when a physician and surgeon returned to talk with Steve and Nicole. Steve could tell by the expressions on their faces that they didn’t have good news, he said.

“I kind of wish at that moment, it was like fast, and I was like can we just press pause because I’m not ready to hear what you have to say.  Unfortunately you don’t get to press pause, and that’s the thing about illness,” Nicole said.

It appeared Gavin had a brain tumor about the size of a golf ball, the physicians said.

Steve didn’t hear past tumor. “It was still ringing in my head that they just said my son has a tumor in his brain,” he said.

The saga continues

In addition to the tumor, Gavin had developed hydrocephalous – fluid on the brain. He needed immediate surgery to place an EVD to drain the fluid. Following surgery, Gavin was admitted into the pediatric intensive care unit (PICU), where he spent the next eight days while his parents, along with a team of specialists, determined a course of action.

A biopsy indicated Gavin had a mature teratoma, a benign tumor. But his alpha-fetoprotein level was heightened, a potential red flag for cancer. Gavin needed to undergo chemotherapy for five months.

During treatments, Gavin watched as many movies as he wanted, played games, watched The Dude in Star Studio. It was like a hotel for him, Nicole said.

“From the beginning, he wasn’t scared of anything. He just felt like, ‘Alright, well, they’re going to fix me, and I’m going to fight and big deal. Move on,” Nicole said. “He just seemed like it was nothing. It was just a breeze for him.”

A few months into treatment, an MRI showed the tumor had doubled its original size. At the same time, results from Gavin’s blood test showed there was no cancer in his body.

The cancer was gone, but the Piersons and Gavin’s doctors had a growing problem on their hands, his tumor. Because it was benign, neither chemotherapy nor radiation would obliterate it. Gavin needed surgery.

On June 21, 2012, Gavin underwent his first of three craniotomies in six weeks to reduce the tumor. Complications quickly followed. He developed a blood clot, then needed a Hickman and two shunts. It was one issue after another.

In November, Gavin had his fourth craniotomy. Dr. Petronio, his neurosurgeon, was making headway. The tumor was shrinking.

But Gavin couldn’t undergo craniotomies forever. His oncologist, Dr. Kris Ann Schultz, reached out to Pfizer about an experimental drug that had only been used in adults. She asked for compassionate use, allowing Gavin, the first child, to try it. Pfizer declined.

It wasn’t all bad news that month. During the summer, Gavin had developed agnosia, in which Gavin couldn’t process words he heard. His family learned sign language – about 200 signs – which Gavin picked up quickly and still remembers.

Nicole recalls the first day Gavin heard words again. She was at home, on family leave, with Gavin and his brother, Gage, and she was talking to Gage in the front room of their home. She told him to put on his shoes because they were going to the library. Gavin ran into the room, “Mom, I heard you say library,” he said.

Tears.

November and December were good months for the Pierson family.  Gavin continued to recover from the fourth craniotomy. But around Christmas 2012, he started leaning to one side again. Nicole knew something was wrong. On Christmas Day, she called Dr. Petronio. Two days later, Gavin had an MRI, which showed the tumor had grown.

This is not Gavin’s fate

Gavin’s favorite hero is Batman. He doesn’t have a super power. His power is that he can do what no human can do. Gavin needed someone like Batman.

On Jan. 7, 2013, Dr. Petronio told Steve and Nicole that Gavin likely only had a few months to live. Craniotomies every few weeks and months weren’t going to cut it. They needed another weapon.

Nicole and Steve became desperate. Dr. Schultz contacted Pfizer again. Meanwhile, the Piersons reached out to local media and created a petition on Change.org, anything that might sway the drug company to grant Gavin use of the experimental drug, Palbociclib, which had only been used in clinical trials in adults.

“When the standard approach isn’t working, you have to work hard to find a better answer. There are new treatments being developed all the time and it’s our job to try to match those emerging technologies to the patients who will benefit from them,” Dr. Schultz said.

The day before Gavin’s fifth craniotomy, the company agreed to discuss Gavin’s case at their compassionate use meeting.

“As the parent, you are supposed to make things better…and you just look at how sweet he is and you just, you know, we just felt like, oh my gosh, we just can’t give up,” Nicole said. “This is not his fate, and we were willing to go anywhere at that point and do anything.”

So was Gavin’s care team.

Gavin underwent his fifth craniotomy. Unlike the previous ones, he didn’t bounce back quickly. He needed therapy. It was six weeks before he could walk again.

There had to be a better answer.

Be strong and brave

It came while Gavin recovered from the craniotomy. Pfizer agreed to compassionate use, and Dr. Petronio found a laser that could potentially help destroy the tumor. For the first time in a long time, the outlook was good.

Gavin has been taking Palbociclib since he was approved for it last winter, and it has helped stabilize the tumor. The MRI-guided laser surgery will help decrease the size of the tumor.

His parents have never given up in their fight for Gavin.

“We have to keep pushing forward because, I’m telling you, it has not been easy.  I want it to be easier for other families,” Nicole said.  “I don’t want another kid to have to have five craniotomies before we have a drug that works or before we have a laser.”

The surgery, guided by MRI images, allows precise targeting. It’s also minimally invasive. Unlike previous surgeries, it’s expected Gavin will only have to spend a day or two overnight in the hospital.

He is so sweet to everyone he meets.  He has never made an enemy.  He is here for a higher purpose.  He is going to do great things in his life,” Steve said. “I want to make sure he gets the chance to do that, and that’s why, I think, one of the big reasons we keep pushing because every kid deserves a chance.”

Robby Kruger to ‘Lead the Team’ at Vikings game

When Robby Kruger was 1-and-a-half years old, his parents realized something was amiss with how his legs were growing – one grew faster than the other. At the ages of 4 and 9, he underwent bone lengthening operations to correct the condition. Robby broke his other leg this summer while playing a friendly game of kickball, which is when his doctors discovered he had osteomyelitis, an infection in the bone. He faces another series of surgeries before reaching adulthood.

Robby, now 12, is a seventh-grader who enjoys playing baseball and football. He and his family have enjoyed the care they have received at Children’s Hospitals and Clinics of Minnesota and are extremely proud of the adversity he’s overcome. We welcome the Kruger family as Robby leads the team in Sunday’s game against the Green Bay Packers!