Monthly Archives: March 2013

Five Question Friday: Clyde Brotherson

You know what day it is. It’s Five Question Friday, and that means we’re featuring another one of our awesome staff members. Meet Clyde Brotherson, who oversees our Central Processing and Distribution department at Children’s Hospitals and Clinics of Minnesota. he’s worked at Children’s for over three-and-a-half years.

1. You’re the manager of Central Processing and Distribution. What does your department do? The Central Processing department is a 24-hour operation responsible for the sterile processing, maintenance and dispensing of medical supplies, which includes but is not limited to, surgical instrumentation and equipment, required by Children’s caregivers for the care, diagnosis or treatment of our patients. We also maintain a sufficient inventory of surgical supplies used in the operating rooms.

Clyde Brotherson

2. What do you love most about working at Children’s? What I love most about working at Children’s can be summed up in two words: caring and culture. When adults come to this facility they are entrusting us with their most precious possessions: their children. They are depending on us to give the best of ourselves to their precious ones. So it seems that at Children’s we are able to coalesce around a common purpose which is seeking the best outcomes for the children who mean so much to us. I feel that we are then able to transfer that spirit of caring to each other at all levels  within the larger organization.

3. Do you have a favorite memory working here? My favorite memory stems from a get together, which was held by my staff a few years ago. We had a room decorated for the party, and the food was laid out on the table. We were all so hungry and were like a pack of wolves ready to attack the food when one of my staff said, “Wait a minute everyone, we need to pray!”   The  entire staff stood up and immediately prayed. Since we have a very diverse population, the prayer was a very multicultural prayer that included everyone. I was totally surprised by this. I had  never experienced something such as that, and it has remained a very touching and warm  memory for me.

4. Outside of work, how do you spend your time? Outside of work I spend lots of time in two places: with my family and my church. I have a very tightly knit circle of family and friends who are very meaningful to my wife and me. My wife and I enjoy movies, Broadway shows and eating out. My son and I enjoy a very close relationship. We therefore share a lot of activities with each other. In addition to my family, I am very much involved in ministry activity in my church which takes up quite a bit of my time. In addition to this, I love walking and bicycling and am a ferocious gardener.

5. If you could travel anywhere in the world where would it be and why? I would travel to Spain (especially San Sebastian on the northern coast) and to the island of Tobago. I love Spain because I speak Spanish and French and have always set fluency in Spanish as a goal. My wife and I visited Spain last year and loved the culture, the food and the history of the region. I also liked the simplicity that comes from the hearts of the Spanish people. My wife and I are both from the Caribbean Islands. She was born in Trinidad and Tobago. I visited Tobago and was taken by the beauty of that island and the loving nature of the people.

Do you know of a staff member at Children’s who should be featured in Five Question Friday? Send your suggestions to Brady at Brady.Gervais@ChildrensMN.org.

A night in the ED with a child life specialist

A 3-year-old girl needs her bottom lip sutured. A 2-year-old sibling is bored to tears – literally – while she waits for her brother to be released so they can go home. A 7-year-old needs an IV start for blood draws and medicine.

Who are you going to call? The child life specialist.

Mindy Teele, child life specialist

On a recent weekday night in the Emergency Department, Mindy Teele, a certified child life specialist at Children’s Hospitals and Clinics of Minnesota, is in demand. A patient is about to have an IV start, so an RN asks Teele to explain the procedure ahead of time. In another exam room, a patient is waiting for results, so Teele brings toys. A few minutes later, she returns to the patient with the IV start to distract the patient during the procedure.

“Child life specialists focus on the psychosocial and developmental needs of children to minimize their fears, clarify misconceptions, build coping abilities and enhance understanding when kids are in the hospital,” said child life manager, Sheila Palm. “Being better prepared improves long-term adjustment to medical conditions, increases cooperation and reduces pain during procedures.”

Children’s deploys certified child life specialists throughout the hospital – to the medical-surgical, pre-surgery, critical care, and cancer and blood disorders units. Child life specialists work in home care and hospice, too. Children’s also has child life associates who help on some of the units and in the Sibling Play Area. Philanthropy helps support child life specialist services; their work is not reimbursable.

In the ED, Teele helps reduce the stress of what can be a traumatic visit by providing age-appropriate information, coping strategies and parent coaching, Palm said. Gaining cooperation from the patient and family can reduce the time of the procedure, need for sedation and need for an extended ED stay.

A 2008 Children’s study in the ED compared parental satisfaction with their child’s experience during a laceration repair in the presence and absence of child life services. Overall, there was greater satisfaction when a child life specialist was involved.

Patients experienced less anxiety when they left the ED when a child life specialist was involved in their care. Child life specialists received a significantly higher rating than other providers in their efforts to relieve anxiety. Children’s also received a rating of excellent from families more often when a child life specialist was present.

“I find the presence of child life services in our ER to be a tremendous asset. The care that they provide in alleviating the apprehension and pain of the sick and injured children we care for on a daily basis is wonderful. I appreciate working alongside such caring individuals and see their effect in many of the patients I come across during my shifts,” said Dr. Mark Schnellinger.

Teele has worked at Children’s for 13 years, 12 of which she’s spent in the ED. “I feel like my personality fits this environment,” she said. “I like the instant gratification.”

In the ED, time is not on Teele’s side. She often only has minutes to explain and prepare patients and families for a procedure. So she relies on analogies to explain them. Instead of calling herself a child life specialist, she tells patients she’s a teacher – a term kids can understand.

“Anyone can go into a room and tell a child what’s about to happen,” Teele said.

But, a child life specialist is able to assess the child and take him or her through the experience on their terms, she said. If a child needs a CT and loves princesses, Teele might develop a scenario from “Snow White.” If the child is obsessed with video games, Teele explains the procedure like it’s a video game with various levels for advancing.

On this recent weekday night, a little boy is minutes away from having a needle inserted into his hand for an IV and blood draws. Teele explains that the RN will use a J-tip, which helps minimize pain with needles, to make the area feel soft. An RN will then use “soap” to clean the skin. Using the same tools for the procedure, she shows him what everything is supposed to feel like. She shows him the “straw” and explains that, unlike a juice box straw, it will give him medicine to make him feel better.

Later in the evening, she’s called in to help during an IV start with another patient. The ED has run out of J-tips. Armed with a Disney book, Teele holds it up for him and together they identify the characters while the RN inserts the needle, draws blood and then gives the boy medication. Distraction works. The patient remains calm the entire time.

“I think I have a very rewarding job,” Mindy said.

You can make it possible so that every family at Children’s can benefit from the support of this and many other invaluable programs. Please make a donation today.

Five Question Friday: Cesar Gutierrez-Garcia

 

At Children’s Hospitals and Clinics of Minnesota, we offer interpreter services 24 hours a day, seven days a week. Today, we want to introduce you to one of our Spanish language interpreters, Cesar Gutierrez-Garcia. He joined Children’s about three years ago.

Why did you become an interpreter? Before working as an interpreter, I used to work at UPS. However, due to an accident I had because of lack of sleep due to the tough shifts I worked (10 p.m.-3 a.m. and later 3 a.m.-8 a.m.), my girlfriend encouraged me to work as an interpreter–a job where I could put my talents and skills to work and help people at the same time.

How did you decide to work in healthcare? I first started working as an interpreter through agencies. This gave me an opportunity to “taste” different environments such as school conferences, religious services that I would volunteer to interpret, minor legal cases and healthcare. From all these choices, I prefer to interpret religious services and healthcare. I have a passion for healthcare and find of great interest learning about everything that has to do with it. Working in different healthcare places and now at Children’s has fueled the passion and learning experience.

What do you love most about your job? The satisfaction of serving families and providers by providing them with the best service possible. If, when they enter the room they communicate directly with each other, forgetting the interpreter is present, I have done my job. I also love being exposed to the various clinics and learning about the different diseases, conditions and vocabulary and about the wonders of our bodies.

Do you have a favorite memory from working at Children’s? I don’t have a singular memory. There have been many memories that have been very pleasant. Usually, at Children’s, we interpret for parents, but there have been occasions when I have to interpret for children who do not speak English. This gives a special flavor to my job, being able to connect with those children in their own language.

If you’re at Jazzman’s Cafe & Bakery or Starz Cafe, what do you order? Being vegetarian and Mexican limits the options. However, besides getting a well prepared salad, which, by the way, I find very yummy, I get vegetable stir fry or a veggie burger. However, I wouldn’t mind trying tofu or soy dishes, lentils, eggplant, quinoa, couscous. A little bit more variety for vegetarians.

Would you like to recommend a Children’s employee for Five Question Friday? Send your suggestion to social@ChildrensMN.org.

Lasagna al Forno

I prefer to make this classic Italian recipe with hearty eggplant slices and mushrooms in place of meat-heavy layers – it makes for a lighter, fresher meal. That said if you’re craving a meaty ragu, just brown a little ground beef or sausage in the pot before adding your tomatoes. This is a dinner that will make the whole family happy. — Andrew Zimmern

A diet that is based mostly on plants (fruits, vegetables, grains, beans, legumes and nuts) is shown to provide more vitamins, nutrients, and fiber. Those who avoid or limit meat in their diet typically eat fewer calories and are less likely to be overweight than those who don’t. Consider changing one to two meals per week for your family to a meatless meal. Remember to incorporate fruits, vegetables, and other plant-based foods. Below is a great recipe that is both meatless and uses tomatoes, mushrooms, spinach and eggplant. Besides, this might be a great way to get your kids to try eggplant! — The clinical nutrition team at Children’s Hospitals and Clinics of Minnesota. 

Ingredients

28 ounce can chopped tomatoes (I like San Marzano brand best)

14 ounce can crushed tomatoes

3 cloves garlic

2T extra virgin olive oil

2t olive oil, plus some extra for the eggplants

6 basil leaves

1 small minced onion

1 pound lasagna noodles

1 1/2 cups ricotta cheese

12 ounces goat cheese (chevre)

1 pound frozen spinach, defrosted and squeezed ‘dry’

1T fresh thyme leaves

1 pound sliced mushrooms

2 pounds eggplant

Instructions 

Servings: about 10

Place the extra virgin olive oil in a 4 quart sauce pot over medium heat.

Add the onions and cook until glassy and aromatic.

Add the garlic and stir. Add the basil and the crushed and chopped tomatoes. Simmer for 25 minutes, season with sea salt and set aside.

Blanch the noodles in a large volume of rapidly boiling salted water until the noodles begin to soften, roughly 4-5 minutes. Drain and reserve under damp paper towels.

Combine the ricotta, spinach and goat cheese in a mixing bowl, season with crushed fresh black pepper and sea salt. Set aside.

Sauté the mushrooms and thyme in the olive oil over medium heat until caramelized to a honey brown and pull from heat, set aside.

Cut the eggplant into 1/4 inch slices. Brush each slice with olive oil and arrange on a cookie sheet in a single layer.

Broil (one side only) for several minutes until beginning to char. Pull from heat and cool.

Build the Lasagna

Heat the oven to 400 degrees.

Build the lasagna in a nice oven-to-table baking pan (roughly 9×13 or 10×14 inches). First, spread a cup of the sauce in the bottom of the pan, then a layer of roughly a quarter of the noodles, followed by a third of the cheese mixture, then another layer of noodles, a cup of sauce, half the eggplant, a third of the cheese, a fourth of the noodles, the mushrooms, a cup of sauce, the last layer of noodles, the remaining eggplant and the last third of cheese. Season with 1/2 teaspoon of sea salt and freshly ground black pepper.

Drizzle the top of the lasagna with a half cup of sauce and bake, covered with aluminum foil, for 30 minutes at 400 degrees. Remove foil and bake for an additional 15 minutes until hot and bubbly. Be sure to let lasagna sit for 10 minutes prior to slicing, allowing it to ‘set up.’

Serve, passing grated Reggiano parmesan at the table.

Visit Andrew’s website for more great recipes!

 

Five Question Friday: Dr. Rachel Miller

It’s Five Question Friday again when we help you get to know our staff better. Today, we’re talking to Dr. Rachel Miller, a pediatric gynecologist. She’s worked at Children’s Hospitals and Clinics of Minnesota since September 2008.

Why did you go into pediatric and adolescent gynecology?

During medical school and residency, I really liked working with adolescents and young women because they were a group with potential for very high risk decisions and ripe for preventive health. However, they were a relatively “lost” age group in that neither general pediatricians nor adult obstetrician-gynecologists seemed all that comfortable with their specific reproductive health needs. As I got further into my training, I subsequently found that pediatric gynecologic complaints were even more of a conundrum for most clinicians. Pediatric and adolescent gynecology is a growing sub-specialty usually found at large children’s hospitals so I knew that I would have an opportunity to work in a friendly atmosphere.

What are some of the conditions you treat? I treat a range of conditions. Some of them include: abnormal development of the reproductive structures, delayed puberty, endometriosis, menstrual problems, ovarian cysts and sexually transmitted infections. You can find more information here.

What is a “typical” day like for you at Children’s? I spend the majority of my days in one of three clinics seeing patients from birth to 22 years old. I also may have to see a patient in the hospital/emergency department or perform gynecologic surgery. And as medical director, I attend several administrative meetings each month. Each day usually starts between 7 and 8:30 a.m., and I try to be home by 6:30 p.m.

Do you have a favorite memory from working at Children’s? One of my favorite moments was when a young patient of mine in pre-op asked if she could come back tomorrow because she was having so much fun.

What do you love most about your job? The most satisfying part of my job is counseling adolescents on healthy choices and then seeing them in follow-up to find that they are doing just that.

Would you like to recommend a Children’s employee for Five Question Friday? Send your suggestion to social@childrensMN.org.

Patient to patient: How to manage school work when you’re hospitalized

Olivia, Youth Advisory Council member

By Olivia Maccoux

I’ve been a patient at Children’s my entire life (17 years). I’m also on the Youth Advisory Council (YAC) at Children’s Hospitals and Clinics of Minnesota. This is my eighth year as a part of that. YAC is a group of kids and teens who are either patients at Children’s or family to patients here. Our job is to make the hospital a better place to stay and to heal. Because of our experiences, we all understand that the hospital is not where anyone wants to spend their time, but we try to make it a little better and more comfortable.

I was born early at 29 weeks and suffered from brain bleeds at birth. This caused me to develop a condition called Hydrocephalus, which is also known as water on the brain. Hydrocephalus affects everyone differently. It mainly causes headaches, but the headaches are caused by pressure in the brain, which, if not corrected can lead to brain damage.

Because of this diagnosis, I’ve had to undergo over 70, yes 7-0 brain surgeries (all at Children’s) to attempt to fix or at least help the complications from the condition. There’s currently no known cause for Hydrocephalus, but the primary treatment is the placement of a shunt. A shunt is basically tubing that is placed in the brain, which drains the fluid from the brain to the stomach area, which relieves pressure and makes the headaches less painful. With Hydrocephalus, you’re basically looking for a happy medium of pressure (not too high or too low) all the time. With more than 70 surgeries in just over 17 years, that amounts to a lot of time in the hospital.

As a veteran patient and a member of YAC, my job is to try to help kids who are or have been in the hospital. By writing this blog post, I hope to help with something other than just “getting better” or “enjoying your stay.” I want to address something that is very important and also very difficult: Keeping up with school when you’re absent because of health issues. Whether that’s because you’re an inpatient or just don’t feel good enough to be at school, staying caught up can be so hard. I’m a junior in high school, so I’ll mainly address high school students. But my advice applies to those in elementary and middle school.

Be proactive: If you know you won’t be in school, talk to your teachers ahead of time. ALWAYS keep teachers updated, even if it’s just a quick email about little stuff. They’ll be much more willing to work with you if they’re kept in the loop. Let them know what’s going on, why you can’t be in school, and when you think you’ll be returning to school. Share as much as you’re comfortable with.

Plan ahead – if you can: Depending on how serious your medical situation may be, you may not be able to do homework while in the hospital. If you know that’s the case, make sure to plan for that and make a plan for when you will do the work. Having your teacher help you create a plan may also be helpful – for both of you.

Talk to your classmates: If you know friends are in your classes, they can gather homework for you and even tutor you if needed. That way, when you return you kind of know what’s going on.  This is how I’ve survived 11 years of schooling and 17 years of hospital stays.  Everyone’s situations are different, so do what works for you.

Prioritize the work: It totally depends on the situation on whether you can complete homework in the hospital. It depends on how you feel, how hard the curriculum is, how much medication you’re on and how busy you are with treatment while there. When hospitalized I try to prioritize when I feel at least somewhat decent. If there’s homework that I find easier or won’t take long to complete, I try to get that done during my stay (and sometimes even get help from my nurses)! But if there’s homework I need help on, or don’t feel up to doing, I try to schedule a way to do it (and get help on it) once I’m discharged.

Communicate early:  If you’re unexpectedly hospitalized (which has happened to me plenty of times), it can be really frustrating and stressful, just from a medical standpoint plus you have school to worry about, too. At the beginning of each semester or when I get new teachers, I make sure I have their contact information. That way if and when I need it, I have it. If I’m not expecting to be admitted but am, the first thing I do (once I feel good enough) is email my teachers. Most teachers are very willing to help you out. Once your teachers know, you can figure out a plan together and everything will be just fine. Education is very important, obviously, but I’ve learned that the main thing is to always focus on getting better before anything else.

Start early:  If you have a chronic condition and think you might be hospitalized often, my biggest piece of advice would be to figure out a system while you’re young. Especially before high school if you can, as classes get harder, so does staying up with everything.

Good luck with everything, whether it’s educationally, medically or otherwise, and remember you can do anything you put your mind to. Don’t let anything (like being in the hospital) stop you.

Sharing knowledge: National Women and Girls HIV/AIDS Awareness Day

Today is National Women and Girls HIV/AIDS Awareness Day. Women and girls now make up almost a quarter of people living with HIV in Minnesota, and over 70 percent of these are women and girls of color, according to the Minnesota Department of Health.  Women of color have been especially hard hit, accounting for the majority of new infections occurring among women in the United States.

The United States has made great strides in efforts to eliminate the spread of HIV from mother to child, and the number of children perinatally (around birth) infected with HIV in the United States has declined over 90 percent since the epidemic began. We’ve also seen a significant – 21 percent – decrease in new infections among women in recent years. But, the fight is not over.

As the largest provider of care to HIV-infected infants, children, and youth in Minnesota, Children’s Hospitals and Clinics of Minnesota provides medical care to about 75 to 80 children, adolescents and youth infected with HIV and their families annually. Children come to us from all over Minnesota and surrounding states (North and South Dakota, Iowa, Michigan, and others), and all over the world. Many of the children in our care have been adopted from countries in Asia, Africa, Eastern Europe, and the Caribbean.  Many more are first or second generation refugees and immigrants.

In addition to specialized medical care, families can access specialized support services, including education and family case management funded through the federal Ryan White CARE Act program and referrals to additional programs and services throughout the state.

With modern advances in HIV care, women and girls are living longer, healthier lives, and many men and women affected by and infected with HIV are choosing to start to add to their families.

Without medical intervention, about one in four children born to HIV-positive mothers will become infected, but by following current treatment and prevention guidelines, women can reduce their risk of transmission to 1 to 2 percent. Despite this success, however, the prevention of perinatal HIV infection remains complex and requires access to specialized, competent medical care and prevention support services.

Children’s houses the Minnesota Perinatal HIV Program, which exists to eliminate the transmission of HIV from mother to child in Minnesota and ensure men and women living with HIV can give birth to healthy babies, born free of HIV. Our specialized services are open to HIV-infected pregnant women and HIV-negative pregnant partners of HIV-infected men at-risk of acquiring HIV infection.

We provide nursing care coordination, case management, and education services to women, their partners, and their providers during pregnancy and up to six months following birth. In partnership with community providers, we also offer preconception counseling and guidance for couples wishing to conceive safely and prevent HIV transmission. During 2003 to 2012, the program provided services to more than 390 women, 75 percent of whom came from racial and ethnic minority populations and almost 40 percent were African-born.

Women and girls are EMPOWERED by knowledge and actions to change the course of HIV.

Prevention tips:

1. Get tested, know your status! HIV testing is recommended as a routine part of medical care.  Talk to your provider about testing.

2. Educate yourself about your risks! Learn how to prevent HIV infection and how to keep yourself safe.

3. Get connected, get support! If you are living with HIV, find out about the programs and services offered in your area to help you stay healthy and support you and your family in dealing with your disease.

Five Question Friday: Sam Schackman

It’s Five Question Friday — our regular staff profile feature! We want to introduce you to Samantha Schackman, a child life specialist who has worked at Children’s Hospitals and Clinics of Minnesota since November 2011.

Your job title sounds so cool! What do you do as a child life specialist? As a child life specialist, my role is to help minimize the stress that children and teens might face in a health care situation. We strive to normalize the experience for children and families and make some of the hard stuff a little easier. Some of the techniques we use to help children and families cope and adjust to the medical experience include:

  • Preparing children for tests, procedures, and surgery using developmentally appropriate learning materials and language to decrease anxiety and clarify misconceptions
  • Helping children learn about their bodies/illness/injury and reasons for their health care experiences
  • Helping children learn and utilize coping strategies during procedures to reduce anxiety, help promote cooperation with the procedure, and decrease pain
  • Providing opportunities for play and activities to help children relax, learn about their environment, and to promote normalcy
  • Facilitating therapeutic and expressive activities for processing of medical experiences
  • The entire family is affected when a child faces a medical experience, so we work with siblings, parents and other family members to help them adjust, too

Sam Schackman, child life specialist

Why did you become a child life specialist? My niece spent some time at Children’s, and our family had the opportunity to work with a child life specialist in the Emergency Department. The child life specialist helped make some of the hard parts about the hospital a little easier for my niece, which made a huge difference for my family during that stressful time. I have always had a passion for kids and a desire to help people, so after my personal experience with a child life specialist and seeing what difference it made, I knew I had to pursue that same path.

What is your favorite memory from Children’s? It is hard to pick one favorite memory from Children’s, but one that stands out is when I helped a child make pranks to “scare” her nurses (her idea, I promise!).  As we worked together in the playroom, she was laughing and so excited to put her clay creation pranks to use. It was a great memory because I was reminded of the innocence and imagination of children, and how laughter can be such a great healer!

What do you think makes kids great? Kids are great for so many reasons, including their wonderful outlook on life, curiosity, imagination, creativity, innocence, and desire to be independent.  One of the most remarkable characteristics of kids is their resiliency.  From my time at Children’s, I have seen kids face difficulty that some adults might have trouble overcoming, and the kids do it with such courage.  Even in the face of adversity, kids just want to be kids, and that makes them great!

What is your favorite meal at Starz Cafe? That’s another hard question because Starz Cafe has so many great options! I love the wraps, salad bar, and baked potatoes.

Double trouble: Twins suffer concussions 24 hours apart

Karen Schlossmacher Smith, an RN, was working on the critical care floor at Children’s Hospitals and Clinics of Minnesota when she got a phone call. Her daughter, Adrianna, was in the Emergency Department with a concussion. She had gone in for a lay-up at a basketball tournament when she fell to the ground and a fellow player stepped on her head.

It was 13-year-old Adrianna’s second concussion. She was treated and scheduled for a visit at Children’s Concussion Clinic for follow-up care.

Twenty-four hours later, Schlossmacher Smith got another call while at work. This time, it was for her daughter Michelle, Adrianna’s twin. Michelle had suffered a concussion during the same weekend basketball tournament. She took a block, hit her head and momentarily blacked out.

“It wasn’t even funny. I think I was in a little bit of shock and disbelief after the second call came,” she said.

Adrianna and Michelle

Twin girls. Two concussions. One day apart. Unlikely? One might think so. But, this wasn’t their first experience with back-to-back injuries. They once broke their hands 18 hours apart and ended up with casts on opposite hands, Schlossmacher Smith said.

A concussion is a type of brain injury that changes the way the brain normally works, according to the Centers for Disease Control and Prevention. It can be the result of a bump, blow, jolt to the head, or from a blow to the body that causes the head and brain to move rapidly back and forth.

Concussions can have a more serious effect on a young, developing brain and need to be addressed correctly and quickly.

“It takes a child or teenager three to four times longer to recover than an adult due to the rapid brain growth and development,” said Mary Dentz, a nurse practitioner who helped treat Adrianna and Michelle. “If the brain is not given sufficient time to heal from the injury before a child returns to regular activities, the recovery time becomes even more prolonged. Children and teens also experience more severe symptoms and neurological disturbances compared to adults.”

Symptoms from a concussion include having headaches, being sensitive to light and noise, feeling dazed, and being forgetful – to name a few. Adrianna experienced difficulties with vision and balance; Michelle had sensitivity to light and sound, Schlossmacher Smith said.

At Children’s newly launched Concussion Clinic, where Adrianna and Michelle were treated, patients receive a medical evaluation as soon as possible after the injury, which is usually within a week. The clinic, which has a multidisciplinary team, offers physical therapy, audiology, pediatric neurology, neuropsychology, advanced imaging capabilities and an active research program.

Between their Emergency Department visits and continued care, Adrianna and Michelle were seen a total of 15 times between them at Children’s, Schlossmacher Smith said. Physical therapy played a significant role in their recovery.

Children’s physical therapists see every concussion patient as early as 10 days post injury to help the patient return to sports safely, said Elaine Walin, a physical therapist who worked with the twins. An occupational therapist may see a patient if he or she has challenges more than a month after the injury. Therapy aids patients with their visual acuity, balance and tolerance to exertion, Walin said.

Patients return to school and regular activity only when they get an all-clear from a trained health provider. In Minnesota, young athletes who show signs of a concussion must be sidelined until they get a medical all-clear.

That law is important, Dentz said.  “Doing too much too quickly after a concussion can make the concussion symptoms worse and prolong recovery time,” she said.

Contact activities place a child or teen with active concussion symptoms at risk for a second concussion, she said. Having a second concussion before fully recovering from the first one is dangerous and can result in prolonged recovery time, lifelong problems with thinking, memory, processing or balance, and, while rare, death from second-impact syndrome (SIS).

Sports and recreation-related activities account for a majority of concussions. At Children’s clinic, 43 percent of the patients seen suffered concussions while playing hockey.

Sports play a big role in Adrianna and Michelle’s lives. With Adrianna so young and having already suffered two concussions, Smith worries about what will happen if she receives a third concussion.

“I think we will need to call it quits for contact sports,” Schlossmacher Smith said.

There’s not a lot of data on outcomes for children and teens after multiple concussions, but this is currently being studied, Dentz said.  Prolonged recovery time and more severe symptoms occur with each subsequent concussion, but the long-term effects aren’t clear yet.

Adrianna and Michelle continued going to school, but they took a break from physical education classes, music and testing, Schlossmacher Smith said. They took naps in the nurse’s office during gym and music classes, which was what allowed them to continue going to school. At home, screen time, such as watching TV and texting friends, was limited.

“The goal is to allow the brains to rest,” Schlossmacher Smith said. “They look fine on the outside, but definitely felt the effects in different ways.”

Adrianna and Michelle, who are also varsity divers and swimmers, only returned to play in their final state basketball game this past weekend.

The family appreciates the care they received from Dentz and Walin, who kept the girls positive and accountable for their own recovery, Schlossmacher Smith said. The girls’ Roseville coaches, teammates and other families supported them, knowing the importance of a slow recovery even when it impacted the team and resulted in having to pull out of games.

“They understand the long-term consequences,” Schlossmacher Smith said.

Apple cider-roasted pork shoulder

I make my family a version of this practically fool-proof savory pork dish a few times a month. Paired with simple mashed potatoes and sauteed Brussels sprouts, it makes for perfect cool-weather comfort food. Pork and apples have been a winning combination for centuries, so braising pork in apple cider is a no-brainer. And don’t worry about letting it cook in the oven while you run errands or check off that to-do list; safer than a crock pot in my opinion. I love using the leftover pork on a salad or in a mustard-y sandwich. — Andrew Zimmern

Ingredients

1 trimmed, natural pork shoulder @ 3.5 pounds

3 cups flour

2t kosher salt

1t ground white pepper

3T fresh rosemary

2 T minced garlic

2 apples, peeled and sliced

1 large minced yellow onion

2 cups natural apple cider

3 cups chicken stock

3T canola oil

Instructions

Preheat oven to 450 degrees.

Place canola oil in a high-sided Dutch oven over high heat (a 6-quart Le Creuset-type vessel is perfect).

Rub the pork shoulder with rosemary, salt and pepper.

Place flour in a brown paper bag. Add the pork shoulder to the bag, rolling it to evenly coat with flour.

Brown the pork shoulder in the Dutch oven with the canola oil.

Place the pork shoulder on a rack set into a roasting pan, and bake in a 450-degree oven for 20 minutes.

Meanwhile, add onions, apples and garlic to the pan you browned the pork in, cook until lightly colored and glassy. Add the cider and chicken stock, and reduce by half at a medium boil.

Pour this mixture into the bottom of the roasting pan. Place the roast into the 450-degree oven, uncovered.

Turn oven down to 300 degrees and cook for about three and a half hours.

Place pork on a serving platter to let it rest.

Place the roasting pan over a medium-high burner on the stove and and simmer for 10 to 12 minutes or until the sauce is thick enough to coat the back of a spoon. Season the sauce with a pinch of salt and a drizzle of apple cider vinegar.

Slice the roast and serve with the pan juices spooned over.

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