On the Pulse

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Infectious Disease Epidemics May Not Influence Vaccination Rates

Doctor giving a child an intramuscular injection in arm, shallow DOFExperts have long believed that when the risk of a disease is high, people are more likely to accept a vaccine to prevent that disease. But recent research suggests that might not be uniformly true. Dr. Elizabeth Wolf, an investigator in Seattle Children’s Research Institute’s Center for Child Health, Behavior and Development, led a study that determined Washington’s recent pertussis (whooping cough) epidemic did not influence the number of infants who were vaccinated against the disease.

Pertussis is an extremely contagious bacterial disease that can lead to pneumonia, seizures, brain damage and death. In 2012, the United States experienced the largest pertussis epidemic since the 1950s. There were 20 deaths reported nationally, the majority of which were infants. Washington reported one of the highest incidence rates of pertussis. The state also has one of the highest nonmedical vaccination exemption rates from required kindergarten vaccinations.

“Vaccination rates are below public health goals, both locally and nationally,” Wolf said. “We need to better understand what factors might impact vaccine acceptance.”  Read full post »

‘Boot Camp’ Designed to Prevent ACL Injuries Keeps Derby Girls Rolling

Seattle Derby Brats WebWatch the derby girls from the Seattle Derby Brats, the largest junior roller derby league in the Northwest, whiz around the roller rink at high speeds, weaving meticulously between skaters and occasionally crashing to the ground, and it’s understandable why safety is a priority for the league. When the Seattle Derby Brats, reached out to Seattle Children’s Hospital’s Athletic Trainers Program, they were hoping to implement a program that would keep the girls safe at practices and matches. But what they got was much more than that.

Seattle Children’s athletic trainers provide an innovative type of customized care that not only treats injuries, but reduces them as well. For the derby girls, that customized care helped prevent a common injury they’re at greater risk for sustaining: tearing their anterior cruciate ligament (ACL). Read full post »

Camp Inside-Out Aims to Improve the Odds for Teens in Foster Care

Dr. Kym Ahrens (left) with Camp Inside-Out colleagues (left to right), Heather Spielvogle, Mavis Bonnar and Alexis Coatney.

Dr. Kym Ahrens (left) with Camp Inside-Out colleagues (left to right), Heather Spielvogle, Mavis Bonnar and Alexis Coatney.

This month, Dr. Kym Ahrens is going to camp with 24 teenagers.

Some people would call that an adventure; others, a challenge.

Ahrens calls it research.

Ahrens, an adolescent medicine specialist and researcher within Seattle Children’s Research Institute’s Center for Child Health, Behavior and Development, is studying whether an intensive, five-day “dose” of a specially designed camp can give teens in foster care the skills they need to steer clear of risky sexual behaviors.

It’s a big deal because teens in foster care are at much higher risk than their peers for unwanted pregnancies and sexually transmitted infections (STIs).

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Transplant Saves First ‘Bubble Boy’ in Wash. State Detected with Newborn Screening

This is a special guest post from JoNel Aleccia, staff writer at Fred Hutchinson Cancer Research Center. See the original article and photos here.

Rachel Dixon holds her son Ezra, who was born with severe combined immunodeficiency. SCID affects about 1 in every 50,000 babies born in the U.S. Nearly two months after having a life-saving bone marrow transplant from his brother, Judah, he's doing well. Photo courtesy of  Bo Jungmayer / Fred Hutch News Service

Rachel Dixon holds her son Ezra, who was born with SCID. Nearly two months after having a life-saving bone marrow transplant from his brother, he’s doing well. Photo courtesy of Bo Jungmayer / Fred Hutch News Service

Ezra Dixon was born April 7, four months after the state of Washington first starting screening newborns for the disorder commonly known as “bubble boy disease,” which leaves its patients at the mercy of common germs.

Some 22,610 babies were tested before him and more than 28,000 have been tested since, all negative, health records show. But Ezra is different.

The bald, blue-eyed boy is the only child in the state so far diagnosed with severe combined immunodeficiency, or SCID, detected through the program.

When staff at the Washington State Department of Health Newborn Screening Lab analyzed the drop of blood pricked from his heel shortly after birth, they found none of the T-cells that protect the body from infection, a certain sign of the rare disorder.

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Remembering Daniel and the Legacy He Left Behind

Daniel Mar

Daniel Mar

In my last post about “The Fault in Our Stars,” I made a comment about how most patients live, if not thrive after their cancers. I am deeply grateful for the readers who correctly commented that some patients also die.

There are no words to express how tragic, painful, or unjust, the death of a young person from cancer can be. I particularly appreciated these comments because they came a day after the death of one of my own, and very beloved, patients. I wrote this memoir the day he died. With his parents’ permission, I am sharing a few pieces of his story, his legacy, with you.

Remembering Daniel

Daniel Mar died early this morning at the age of 20. He was one of my first patients as an independent oncologist. For that alone, I could say he will not be forgotten. Daniel was a “patient” simply because he happened to have cancer; terrible cancer that ultimately took his life. But beyond that, he was so much more. He was an advocate. A son. A brother. A devoted friend. To me, he was my muse. My teacher. And, through it all, my friend.

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Researchers Combine Therapies to Find a Better Way to Treat Brain Injury in Infants

Complications that can arise around the time of birth may reduce oxygen and blood flow to a baby’s brain, causing hypoxic-ischemic encephalopathy (HIE), a leading cause of death or neurological impairment among infants. In the past eight years, cooling therapy (hypothermia) has become the standard form of care for HIE, as it’s been found to be effective in reducing brain injury, but doctors say it’s not enough – about half of affected infants still have a poor outcome.

For this reason, researchers have launched a nationwide study, called the Neonatal Erythropoietin and Therapeutic Hypothermia Outcomes in Newborn Brain Injury (NEAT-O), to see if using the hormone erythropoietin (Epo) in conjunction with cooling therapy may further reduce the risk of neurologic deficits in full-term infants (at least 36 weeks gestation) with HIE.

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Research in Sub-Saharan Africa Aims to Improve Lives of HIV-Positive Kids

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Dr. Mogomotsi Matshaba, a clinician and researcher at the Botswana-Baylor Children’s Clinical Center of Excellence in Gaborone, Botswana.

Seattle Children’s Research Institute’s mission to prevent, treat and eliminate childhood disease extends far beyond the Pacific Northwest or even the United States. Researchers like Dr. Jason Mendoza, of the institute’s Center for Child Health, Behavior and Development, are advocating for vulnerable patients all over the world. Mendoza recently led a global health research study in Botswana, published in the Journal of Acquired Immune Deficiency Syndromes, to find out if inadequate access to food, also called food insecurity,  might be associated with worse health outcomes of HIV-positive children in Sub-Saharan Africa.

Studying patients with the greatest need

HIV is a major public health problem in Sub-Saharan Africa. In 2012, there were 3.3 million children worldwide, under the age of 15, living with HIV. Of those, 2.9 million were in Sub-Saharan Africa. Botswana has one of the highest HIV rates of countries in this region, with 23% of adults (ages 15 to 49) infected. Additionally, from 2010 to 2012, 27.9% of people in Botswana did not have physical or economic access to enough nutritious food to maintain a healthy, productive lifestyle. Read full post »

Doctor Explains the Truth about Drowning: “It’s a Silent Killer”

lifejacket imageTemperatures are on the rise, which has families flocking to pools, lakes, rivers and oceans to beat the sweltering heat.

While a cool dip may sound like the perfect summertime activity for a family, it can also be a dangerous one. More than 1,500 children and teens die every year in the U.S. from drowning. In Washington state alone, an average of 25 children and teens drown every year, higher than the national average.

Fortunately, most water related injuries and deaths are preventable, if proper safety measures are taken. One important hurdle to overcome, however, is deciphering the difference between drowning fact and myth. Read full post »

The Fault in “The Fault in Our Stars”

I loved “The Fault in Our Stars.” Both the book and the movie. I read the book a few years ago during a flight. I cried so hard that I’m sure the other passengers were alarmed, if not downright uncomfortable sitting near me. This summer, I saw the movie with a girlfriend. Same thing – I went through a whole pack of tissues and left red-faced, swollen and physically dehydrated.

As we walked out of the theater, my girlfriend (also a pediatrician) turned to me and said skeptically, “I don’t get it, Abby. Why are you so emotional? Isn’t this what you DO for a living?”

The answer is yes. Taking care of teens and young adults with cancer is what I do. And, perhaps, that is why this book/movie hit me so hard. For one thing, we oncologists are often so busy thinking about chemotherapy and side effects, we don’t see the other side of cancer. We get to know our patients and families, but we see them in the contrived settings of clinic and the hospital – not at home, amongst their friends or on a trip to Amsterdam. We aren’t always privy to their witty internal monologues or their poignant observations about the injustices of life, the things that really matter to them, or the life lessons they’ve learned during their arduous journey with cancer.

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Study Helps Teens Cope with Stress of Cancer, Diabetes

blogpic1The teen years can be difficult– you’re fighting for your independence but still trying to develop an identity. And your 20s come with their own obstacles, like going to college, starting a career and living on your own. Can you imagine facing those developmental milestones while injecting yourself with insulin or enduring chemotherapy?

Dr. Abby Rosenberg, medical leader for Seattle Children’s Hospital’s Adolescent and Young Adult Cancer program and researcher in Seattle Children’s Research Institute’s Center for Clinical and Translational Research, and Dr. Joyce Yi-Frazier, research health psychologist at Seattle Children’s Research Institute, have seen teens with cancer and type 1 diabetes struggle physically and psychosocially. Adolescents and young adults with cancer are less likely to achieve social milestones like college, marriage, and employment and more likely to suffer from anxiety and post-traumatic stress. Likewise, teens with type 1 diabetes struggle to control their blood sugar levels and are more likely to be depressed.

“The teen and young adult years are a critical time of transition for anyone,” Rosenberg said. “When you add a serious illness to the mix, you are asking patients to do extraordinarily hard things. We want to help them integrate the experience into their identity so they are not only surviving, but thriving.”

An intervention model

To help patients, Rosenberg and Yi-Frazier worked together on the Promoting Resilience in Stress Management (PRISM) study. PRISM is an intervention model designed to teach patients resilience – the ability to maintain psychological and physical well-being in the face of stress – to buffer the impact of serious illness. Read full post »