Category Archives: Research

Children’s doctors’ study shows increase in ER visits from self-inflicted injuries among teens

A motion blurred photograph of a child patient on stretcher or gurney being pushed at speed through a hospital corridor by doctors & nurses to an accident and emergency room

Self-inflicted injuries among teens made up 1.6 percent of emergency room visits in the U.S. in 2012. (iStock photo)

Emergency room visits for self-inflicted injuries among U.S. teens increased from 1.1 percent in 2009 to 1.6 percent in 2012, according to a study by Drs. Gretchen Cutler and Anupam Kharbanda of Children’s Hospitals and Clinics of Minnesota.

The study, “Emergency Department Visits for Self-Inflicted Injuries in Adolescents,” published today in the July issue of Pediatrics, examines 286,678 adolescent trauma patients, 3,664 of whom sustained a self-inflicted injury (SII).

The study aimed to describe ER visits for self-inflicted injuries in teens from 2009-2012 by tracking trends in mechanism of injury and identifying factors associated with increased risk of self-harm behaviors. The most common form of SII are cutting and/or piercing injuries, while firearm injuries decreased.

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RESOURCES: Patient and family education materials about cutting

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subscribe_blogOther findings 

  • Females are more likely to experience cutting and/or piercing injuries and higher ER-visit rates than males.
  • Males are at greater risk of dying from their injuries, likely due to their use of more lethal forms of injury such as firearms.
  • Teens with comorbid conditions, especially those with greater than two conditions, are at the greatest risk for SII.
  • The authors found that risk of SII is lower in African American adolescents than in white teens.
  • Teens with public or no health insurance are at increased risk of death from their injuries than those with private insurance.

The authors conclude that these findings identify potential subgroups of adolescents who would benefit from SII-prevention efforts.

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RESOURCES: Patient and family education materials on emotions and behavior

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The research showcases the leadership role Children’s plays within this community and nationally when it comes to caring for children. Stories about the study also appear in the Star TribuneHealthDay and MedPage Today.

Gretchen Cutler, MD, is a scientific investigator for the Center for Acute Care Outcomes and Anupam Kharbanda, MD, is an emergency department physician at Children’s Hospitals and Clinics of Minnesota.

Mental health is a part of overall well-being

We move through the world as a unique, integrated, whole person. And so do the children for whom we care. (iStock photo)

We move through the world as a unique, integrated, whole person. And so do the children for whom we care. (iStock photo)

Mike Troy, Ph.D, LP

Mike Troy, Ph.D,

Mike Troy, Ph.D,

It’s good that we devote a month — May — to mental health. Through these efforts, the community works to build greater awareness about mental health, break down stigma and lend support and hope to those who deal with mental-health issues in their lives. Yet, I find myself hoping for a time when we don’t have a special month for mental health.

Why would a clinical psychologist who is encouraged by the progress that has been made in mental-health awareness over the course of his long career hope for that? Let me start to answer this way: In which month do we recognize medical health?

Obviously, there is no such month. And the reason is that society doesn’t need to be convinced that our physical health is tied to our overall well-being. We assume that flu will lead to missed time at school or work; we know that cancer will require treatment; and we recognize that continued lack of treatment of high blood pressure could result in a stroke or heart attack. And yet despite equally compelling evidence, we often fail to recognize that emotional and behavioral problems have a direct and profound impact on current and future well-being.

Indeed, our health care systems continue to be organized in ways that imply that we move through the world with separate identities — one physical and one psychological, with divided systems of care. But this division is artificial. In reality, we move through the world as a unique, integrated, whole person. And so do the children for whom we care.

While we have much more work to do, at Children’s we recognize that mental health care is health care. This understanding is being validated by a growing body of research that speaks to the powerful interaction of biological, psychological and social factors on the developing brain, gene expression and overall health. We know, for example, that significant and sustained adversity early in life contributes to a wide range of behavioral, learning and health problems throughout development. And there’s an abundance of scientific evidence linking behavioral disorders of childhood to poor physical health throughout the lifespan. Consequently, monitoring risk and responding with appropriate evaluation and treatment for emotional, behavioral and developmental problems is as important as it is for medical problems.

subscribe_blogThis is why we’re grateful that more than 4,000 families during the past year have turned to Children’s for help when confronted with the challenge of understanding and treating mental-health problems such as anxiety, depression, autism spectrum disorder and ADHD. Additionally, Children’s supports our mental-health professionals as they work to bridge psychological and physical health while working as members of clinical teams ranging from the feeding clinic to the hematology/oncology clinic.

While society still has a long way to go, I am hopeful that increasingly we are viewing and valuing mental health in a more enlightened way. Seldom am I met with skepticism when I speak to a medical audience about the impact of mental health on overall health. The pediatric health care industry is investing in more intensive and robust screening methods to identify potential issues earlier, as well as advancing models for delivering care that integrate mental- and behavioral-health services into medical settings.

I embrace this momentum, while also recognizing that much more work needs to be done before we no longer need a single month devoted to mental health. What will that look like? Children who struggle, for example, with depression will be treated with the same understanding, compassion, and support as those with cancer. Health care systems and insurers will view physical- and mental-health services as equal contributors to the developmental well-being of all of our community’s youth. And families will be able to access mental-health services as readily as any other essential health care services.

In the meantime, I join with others in recognizing this month as an opportunity to shine a light on mental health and a way of letting the children and families we see every day know that they have our support.

Mike Troy, Ph.D, LP, is the medical director of Behavioral Health Services at Children’s Hospitals and Clinics of Minnesota.

The trouble with toe walking

Casts

If there’s limited motion in the ankle and a child is consistently toe walking, he or she is put in serial casts or carbon-fiber braces.

Toe walking can seem cute, at first. But if it persists after a child is about 20 months old, it can be a problem.

Toddlers develop a heel-toe walking pattern about 20 weeks after they begin walking alone and no longer should be toe walking, said Nicole Brown, DPT. If left untreated, toe walking can lead to future injury or pain in your child.

“I think with little ones, everyone thinks it’s adorable because you don’t know if it’s causing problems,” said Sara McGrane, whose daughter, Molly, started seeing Brown when she was 5 years old.

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CHILDREN’S GRAND ROUNDS: New evidence in toe walking

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At her daughter’s checkup when she was 3, the primary care physician told her parents they needed to encourage her to stop walking on her toes, McGrane said. When she was 4, the parents were told again to keep working with Molly. It was at her visit when she was 5 that her primary care physician noticed she was toe walking and referred her to the Children’s Rehabilitation Clinic in Minnetonka.

subscribe_blog“When she was little, it was cute,” she said. “She had always been a toe walker.”

Often, Brown doesn’t see patients until they’re 6 or 7 years old. There’s a misconception that kids will grow out of toe walking, she said. Those who are seen at 2 or 3 years old have a better prognosis, and treatment time generally is shorter. She has treated patients as young as 18 months and as old as 13.

“We want to get these kids in earlier,” she said. “By the time they’re 6 or 7, they can have structural damage to their foot.”

Treatment varies and depends on the severity of the condition. If Brown can see a patient before there’s limited range of motion, she can retrain the child to resume a normal walking pattern through physical therapy, which on average lasts six months, she said.

If there’s limited motion in the ankle and the child is consistently toe walking, he or she is put in serial casts or carbon-fiber braces, she said. The serial casts are like a typical fiberglass cast for a broken leg. They’re taken off every week and put back on to accommodate the new range of motion that was achieved. Once a child’s motion improves, Brown uses ankle braces. Physical therapy also is part of the prescription and on average lasts about a year.

In Molly’s case, her heel cord was tight enough that she required bracing, McGrane said. She met with Nicole for physical therapy for about 10 months.

“We were amazed at how quickly the process went,” McGrane said. “We are big believers in the program.”

What is toe walking?

Toe walking is a diagnosis in which a person walks with bilateral toe-to-toe walking pattern. There may be a medical cause or it may be idiopathic in nature.

How does Children’s treat patients who toe walk?

  • We offer serial casting, orthotic intervention and physical therapy treatment for treatment of toe walking.
  • Serial casting has been proven to be an effective intervention for toe walkers in treatment of tight heel cords to increase the range of motion and to also weaken the heel cord muscle to allow us to retrain the child’s walking pattern.
  • Children’s and Orthotic Care Services have designed a new type of solid ankle foot orthotic that mimics serial casts for treatment of toe walking.
  • The orthotic brace is a two-pull carbon-fiber solid ankle foot orthotic. The carbon fiber on the outer shell decreases the amount of available multi-planar ankle motion, which mimics the effects of serial casting through increasing range of motion through the heel cords as well as weakening the heel cords but allows the child more flexibility in that they can take off the brace to shower or participate in certain activities.
  • After serial casting or carbon-fiber-bracing intervention has been completed, children are then placed in a two-pull plastic ankle foot orthotic to retrain their gait pattern to allow for a consistent heel-toe walking pattern.

Children’s research in toe walking

We compared outcomes in treatment of toe walking gait with carbon-fiber-orthotic intervention and serial casting. Children were enrolled in this study, and results have shown good outcomes. The research study offers financial assistance as well as a team approach in the treatment of a child’s toe-walking pattern.

Healthy childhood development important for all

Mike Troy, Ph.D,

Mike Troy, Ph.D, LP, is Children’s medical director of Behavioral Health Services.

Mike Troy, Ph.D, LP

I had the honor this past week of participating in a panel discussion about the importance of early childhood development to healthy communities. Hosted by Healthy States, an initiative of American Public Media and Minnesota Public Radio, the topic of the evening was “Community Responses to Toxic Stress.” As readers may know from our recent report and community engagement work, the subject of early childhood development is near and dear to my heart and a significant focus of Children’s Hospitals and Clinics of Minnesota.

My colleague and friend, Dr. Megan Gunnar, of the University of Minnesota’s Institute of Child Development presented scientific research on the essential role of a safe and nurturing social environment for healthy brain development. She also described how high levels of environmental stress in infancy and early childhood can lead to enduring problems in learning, physical well-being and social development. We know that birth to age 3 is an incredibly formative time for a developing mind, with 700 new neural connections made every second. But if a child lives in an environment with persistent challenges (toxic stress) such as poverty, poor nutrition and inadequate housing without the buffer of positive caretaking relationships, it prevents those connections from forming in an effective and efficient manner. Experience shapes brain architecture, and a poor early foundation affects development throughout the lifetime.

Q4_mighty_buttonPanelists MayKao Hang, president and CEO of the Wilder Foundation, and Sondra Samuels, president and CEO of Northside Achievement Zone, and I discussed how our organizations are helping to mitigate toxic stress and foster healthy child development. I left this lively discussion energized to continue Children’s work with community partners to help foster healthy development in children. Some of my thoughts include:

  • One way parents and community leaders can help is to encourage consistent monitoring of child development. At each well-child appointment and over time, we screen our young patients for normal development and identify challenges. Early intervention is key and can change the trajectory of a child’s life.
  • We can motivate leaders and others to action by educating them about the science of early brain development and the unequaled opportunity for healthy development that is presented during the first few years of life. Behavioral and emotional problems often have their roots in unhealthy conditions (toxic stress) in early, foundational stages of life.
  • What babies need is essentially the same across all communities: attentive and loving relationships, safe and stable environments, healthy food and developmentally appropriate activity.

Healthy development happens in the home and in the community through relationships with families, friends and neighbors. We all can play a role in supporting a strong start. Our collective focus must be on healthy development for all children.

Mike Troy, Ph.D., LP, is medical director of Behavioral Health Services at Children’s Hospitals and Clinics of Minnesota.

NBC News: Sharing the story of Children’s cancer and blood disorders expertise

Michael and Megan Flynn with sons Andrew, 7 months, and Thomas, 5, and daughter Olivia, 3 (Photo by Julie Ratkovich Simply Bliss Photography)

NBC News shared the story and collective work of Children’s Hospitals and Clinics of Minnesota’s blood and cancer disorders team, including Dr. Kris Ann Schultz, Dr. Yoav Messinger, Gretchen Williams, CCRP, and Anne Harris, MPH, among others, who have led the way in enabling the early detection and effective treatment of children in families affected by rare genetic cancers.

via NBC News: One rare cancer leads to another: Cancer registry saves baby’s life

In 2009, while trying to understand pleuropulmonary blastoma (or PPB, a rare early childhood lung cancer), researchers leveraging data from Children’s International Pleuropulmonary Blastoma (PPB) Registry uncovered an unexpected cause: a mutation in DICER1, a master controller gene that helps regulate other genes. By leveraging those learnings and coupling it with new data from the International Ovarian and Testicular Stromal (OTST) Registry – a “sister” registry of the International PPB Registry – Children’s has recently discovered that the DICER1 gene mutation may underlie many additional rare childhood genetic cancers and could tell us something fundamental about how most cancers arise.

Children’s presented its promising findings this weekend at the American Society of Clinical Oncology (ASCO) Annual Meeting, advancing the potential for early diagnosis and proactive treatment of children in families affected by PPB, as well as other rare genetic cancers such as certain ovarian, nose, eye and thyroid tumors.

With the establishment of the International PPB Registry in 1988 and the International OTST Registry in 2011, Children’s, along with our partners, have become the world’s leading experts on how to care for children with PPB and other cancers marked by the DICER1 genetic defect. As a result, PPB could be among the first cancers routinely curable before it progresses to a deadly form.

Children’s work and ability to follow the science continues to be made possibly entirely by philanthropy, including the St. Baldrick’s Foundation and the Pine Tree Apple Tennis Classic.

Congratulations to the Children’s cancer and blood disorders team!  Thank you for your commitment and your amazing, groundbreaking work.

Study: Concussion recovery time doubles when injury is sustained during school year

A patient visits the concussion clinic at Children's — St Paul on March 11, 2014. (Photo by Scott Streble)

A patient visits the Concussion Clinic at Children's — St Paul on March 11, 2014. (Photo by Scott Streble)

Concussions and the treatment after one is sustained have been at the forefront of media coverage in recent years. What once was viewed by some as brag-worthy or a badge of honor now is being taken seriously for its potential immediate and long-term effects.

While progress has been made in how the seriousness of a concussion is perceived, it’s still relatively unknown when it’s acceptable for individuals, including children, to return to normal cognitive and physical activity after suffering one.

According to a study by the Concussion Clinic at Children’s Hospitals and Clinics of Minnesota, a child who sustains a concussion during the school year takes significantly more time to recover than one who suffers a similar injury during the summer.

“We were surprised at the magnitude of the differences,” Robert Doss, PsyD, co-director of the Pediatric Concussion Program and one of the study’s researchers, said. “We weren’t surprised that it was in that direction; just simply that the magnitude was what it was.”

Researchers took patients seen in the Concussion Clinic at Children’s from 2011-12 — 43 children who suffered concussions during the school year and 44 injured in the summer — and monitored their progress. For the children who sustained a concussion in the summer, the average number of days to recover was 35. Recovery time more than doubled (72 days) when the injury was sustained during the school year.

Another study, “Returning to Learning Following a Concussion,” published in October in Pediatrics, the official journal of the American Academy of Pediatrics (AAP), explains the difficulties children experience in a school setting after suffering a concussion. Post-concussive symptoms often can linger or increase in severity without proper adjustments to a child’s environment or academic routine. Research suggests that academic demands and school environment may be a barrier to recovery.

Because each concussion and child is different, the AAP study recommends creating a multidisciplinary team to facilitate a student’s recovery and help him or her return to normal activities. Those four teams are: 

  • Family (student, parents, guardians, grandparents, peers, teammates and family friends)
  • Medical (emergency department, primary care provider, concussion specialist, clinical psychologist, neuropsychologist, team and/or school physician)
  • School academic (teacher, school counselor, school psychologist, social worker, school nurse, school administrator, school physician)
  • School physical activity (school nurse, athletic trainer, coach, physical education teacher, playground supervisor, school physician).

“It’s important to understand the individual child,” Doss said. “It seems like our practitioners are noticing more responsiveness by the schools to put forth accommodations for these kids. Some schools are more accommodating than others. Some seem to have a grasp of concussions.

“Overall, I think our perception is that schools are more receptive and thinking about it more actively. They’re instituting programs on their own, so they’re prepared for what comes next.”

Subjects were evaluated and treated in the Concussion Clinic after presenting with symptoms consistent with mild head trauma.

Researchers identified two groups based upon whether they recovered from their concussions during the school year or summer months and were ages 7 and older. The school year was defined as September through May. The school group was matched to the summer group by age and gender.

The average age of the children in the study at the time of injury was 14 years old.

Date of recovery was defined as the final visit date in the Concussion Clinic.

Doss also cautions parents and kids that they aren’t out of the woods once recovery is complete.

“It seems pretty clear in some of the guidelines that prior history of a concussion puts you at a higher risk for subsequent concussions,” he said.

However, according to the Children’s study, there’s little empirical support for the amount or duration of cognitive and physical rest after a concussion and the time frame for children to safely return to normal daily activities without experiencing ongoing cognitive or physical deficits.

According to the “Returning to Learning” study, cognitive rest refers to avoiding potential cognitive stressors, such as texting, video games, TV exposure and schoolwork. However, to date, there is no research documenting the benefits or harm of these methods in either the prolongation of symptoms or the ultimate outcome for the student following a concussion.

“Should the kids not be on Xbox versus playing a little bit of Xbox?” Doss said. What may be best during recovery depends on the case. “How much schoolwork is appropriate?”

Doss said the perceptions families and academic institutions have about concussions are evolving.

“Schools across the U.S. did not seem to be prepared. You bump up against the usual: The kids look fine. They’re not limping. They have an injury that’s not visible,” he said. “The general population is dealing with this heightened awareness of concussions.”

Variables collected for analysis included school grade, prior concussion history, loss of consciousness with presenting injury, first clinic visit ImPACT computerized cognitive testing raw scores — verbal memory composite, visual memory composite, visual motor speed composite, reaction time — ImPACT post-concussive symptom  scores, and history of depression and anxiety, migraine, other neurological problems, learning disability or ADHD.

The study was conducted by Robert Doss, PsyD, Neuroscience Center of Children’s Hospitals and Clinics of Minnesota, and Minnesota Epilepsy Group, P.A.; Kara Seaton, MD, Emergency Department of Children’s Hospitals and Clinics of Minnesota; and Mary Dentz, RN, CNP; Joseph Petronio, MD; Julie Mills, RN, CNP; Jane Allen, RN, CNP; and Meysam Kebriaei, MD, of the Neuroscience Center of Children’s Hospitals and Clinics of Minnesota.

Patient determined to change the future for those with hydrocephalus

By Olivia Maccoux

Team Liv WALKS for hydrocephalus research.

I was born at 29 weeks and was diagnosed with a condition called hydrocephalus (abnormal amount of spinal fluid in/around brain). I’ve lived with and dealt with the condition for the past 17 years and will continue to for the rest of my life.

A life with hydrocephalus means NOTHING is certain. It is both physically and emotionally draining on me and everyone around me. This is a life threatening condition, and the sad part is the lack of research that is being done to help the over one million Americans who live with it. Treating hydrocephalus costs more than $1 billion annually, yet, the National Institute of Health invests approximately only $1 million a year on hydrocephalus research.

Over the last 50 years, there has been no significant improvement in hydrocephalus treatment and absolutely no progress toward prevention or a cure. The only treatment is brain surgery, where a surgeon implants a device called a shunt to drain the fluid. However, 50 percent of shunts fail within two years.

I’ve never had a shunt last for two years. I’ve actually had times where the shunt has only lasted a few hours, which resulted in my immediate return to the operating room for a new one. To date, I’ve endured more than 90 brain surgeries and have been in critical condition because of hydrocephalus.

The Hydrocephalus Association organizes WALKS every year to raise money for treatment and research. I’m determined to help change the future for everyone who struggles with hydrocephalus and its complications.

My WALK team, Team Liv, is also committed to helping this cause. We’re looking for anyone who would like to walk with us, donate, or both! Donations of any size are gratefully received and are tax-deductible. Your donation will help support critical research so that I and the one million other Americans living with the challenge of this condition can lead a better life. Learn more about donating.

Olivia is a patient and a Youth Advisory Council member. Read Olivia’s blog post earlier this year on juggling school during a hospitalization.

Addressing preemie care head on in 2013

By Dr. Ellen Bendel-Stenzel

As the Star Tribune so beautifully illustrated with its Thanksgiving cover story, “Home After 98 Days In Preemie Land,” the issue of prematurity is a heart-wrenching and persistent challenge for doctors and parents-to-be.  Preterm birth can, and does, affect every race, ethnicity, religion, age, socioeconomic status and demographic.

Here in the Upper Midwest, more than 200,000 babies are born every year. And about 22,000 of those babies or little more than 10 percent are born premature. However, as a preterm infant, you couldn’t ask to be born in a better place than Minnesota. We have some of the highest survival rates in the world, and yet we received a “B” on the March of Dimes 2012 Premature Birth Report Card.  Why?  Because even though an infant born beyond 28 weeks gestation, or 7 months of pregnancy, has a nearly 100 percent chance of survival, these infants still remain at risk for respiratory problems, feeding issues, developmental delays and behavioral and social disabilities.

Unfortunately, the amazing medical progress we’ve made over the past 25 years, which lead to the improved outcomes for so many premature infants, has begun to plateau. Now we as health care providers need to take the lead and drive future improvements.

There will always be high-risk pregnancies, and ensuring the best outcomes for these scenarios is not dependent upon reducing the prematurity rate alone.   We need to be proactive and provide optimal care to both mother and baby, so that we can decrease the incidence of prematurity and improve the outcomes of those born early or with complex medical conditions. In short, we need to address the needs of the infant long before a mother’s due date.

In early February of next year, Children’s Hospitals and Clinics of Minnesota and Abbott Northwestern Hospital will open The Mother Baby Center in Minneapolis. It will be the first of its kind in the Upper Midwest, and one of only a few in the nation where mother-baby care is fully integrated. This new Center will bring together maternal and infant specialists, with the understanding that every pregnancy has the potential to be high risk.

With a proactive approach, the goal is clear: optimize care from conception to delivery.  This means the sharing of information across all nine months of the pregnancy whenever possible.  It means providing quick access to specialists when concerns for the health of either the mother or baby arise. It means collecting data to look at the root cause of prematurity in our own community.  It means collaborating in clinical trials that start at the first obstetrical visit and end in the pediatrician’s office at school age follow-up.  And it means continuing to incorporate the latest technologies and therapies on the Newborn Intensive Care Unit (NICU), while simultaneously measuring their effects and proving their validity.

While simple in theory, these are lofty goals that are difficult to implement and execute, but are well worth the effort.  As physicians we must continue to set the bar high and help moms achieve term delivery whenever possible, while at the same time improve the care for the babies that are born early.  In doing so, we’ll create a recipe for success that will provide enormous benefits to Minnesota babies and families.

Dr. Bendel-Stenzel is a neonatologist and co-director of clinical research for the Newborn Intensive Care Unit at Children’s Hospitals and Clinics of Minnesota in Minneapolis.

Mom finds comfort in cancer research team after rare diagnosis

This is a guest post by Kim Sondergard, whose son Tony was diagnosed with cancer when he was a few months old. The Sondergard family recently attended the 2012 PPB Family Meeting at Camp Courage.

My son Tony’s entry into this world was a bit bumpy.

He was born with a fever and pneumothorax (air pockets) in both lungs. Doctors and nurses tended to him for four days in the special care nursery. When he was fever-free and able to keep his body temperature within a normal range on his own, my husband and I were able to take our baby boy home. For four months, Tony was healthy.

He developed a cough and a fever, so we took Tony to his pediatrician. A chest X-ray showed what his pediatrician thought was a cyst. It was thought to be a congenital cyst and could be removed through surgery. Tony was admitted to Children’s Hospitals and Clinics of Minnesota, where he had surgery. From his nurses, to his pulmonary team, to the surgeons, to his anesthesia team – everyone rocked!

During our follow-up appointment with the surgeon two weeks later, we learned that the cyst that was removed was abnormal. Our baby had cancer. It was a rare form of childhood lung cancer called pleuropulmonary blastoma, or PPB. I didn’t know how to react.

Tony

The surgeon made an appointment for us to meet with Dr. Yoav Messinger, an oncologist who specializes in this type of cancer and is among the personnel at the International Pleuropulmonary Blastoma Registry. The PPB Registry is a collection of physicians, scientists and data analysts from many institutions, including Children’s, who have been working together for 20 years to evaluate PPB cancer cases.

Dr. Messinger gave us a deeper understanding of Tony’s cancer, and he explained the treatment options. Unfortunately, there wasn’t significant research on treatment options because this cancer was so rare. At the time of our meeting with Dr. Messinger, we also were introduced to Gretchen Williams and Dr. Jack Priest – also part of the PPB Registry.

Tony’s dad and I, as well as our relatives, provided the PPB Registry with DNA samples for a genetic study. They have found in many cases children with PPB carry the DICER1 gene. However, no one in his family, including Tony, carries this gene.

Tony

Dr. Messinger, the Medical Director of the PPB Registry, knows genetic testing needs to continue. “If we can determine in advance which children are at risk for PPB, we will do our best to try and diagnose PPB when it’s in the earliest, most curable stage.”

Two months after Tony’s diagnosis, a CT scan indicated another spot on his right lung. We decided at that time we’d proceed with chemotherapy. Dr. Messinger and Dr. Priest also recommended the spot be removed. Ultimately, we learned it was scar tissue – not cancer.

For an entire year, Tony underwent weekly chemo treatments. He also had CT scans every three months. None showed recurrence.

This past May, Tony celebrated his third year of being cancer free. Next month, he turns 5. He’s happy, active and healthy – all a parent wants for her child.

I would not have gotten through Tony’s diagnosis without the staff at Children’s and the PPB Registry. They were there step by step.

I believe in and support the continued research of the PPB Registry, so they can determine PPB’s cause and how to cure it. Not all kids diagnosed with PPB are as lucky as Tony.

Children’s takes steps to minimize radiation exposure

MRI Scanner

There’s often a lot of information in the media and medical journals about CT scans (known as Computed Tomography) and how they expose children to radiation. Most recently, The Lancet, a medical journal, published a study that reports that children who get multiple CT scans are at increased risk of leukemia and brain cancer.

We know children are more sensitive than adults to radiation exposure and that CT scans are one of the most common and significant medical exposures of children to radiation. We also know that although the risk of radiation from a CT scan is low, it’s not zero. There can be a slight increased risk of cancer later in life.

“We take this seriously, and we do everything we possibly can at Children’s to minimize the level of radiation exposure to our patients while preserving the quality of the images we need,” said William Mize, MD, a pediatric radiologist.

Here’s how:

  • Our scan settings are adjusted according to your child’s size and age.
  • We work under the ALARA (as low as reasonably achievable) principle. Some of the steps we take include limiting the area of exposure to include only the area of specific medical concern and shielding sensitive areas such as breast shielding during chest CT.
  • We don’t recommend a CT scan as a diagnostic test unless it’s necessary. When appropriate, we suggest other imaging tests such as an ultrasound or MRI (or magnetic resonance imaging) which do not use radiation.
  • We continue to re-evaluate our protocols and explore new opportunities for reducing radiation.

For many medical problems in children, the CT scan is invaluable. Often, it’s the only test that can provide the information needed to optimally treat children. There are potential risks and benefits to all medical treatments and procedures.

The CT scan is capable of viewing all the internal organs, which may lead to a diagnosis that was previously only possible with surgery. When we recommend a CT scan, the benefits to a child’s health from the information obtained outweigh the minimal risk associated with the low dose of radiation.

Where kids are concerned, rest assured that their safety and health are our top priority.

For more information about our procedures involving radiology, click here.

To read the Society for Pediatric Radiology’s response to The Lancet article, click here.