General

Surgery may sound like a scary experience, especially for children and teenagers, but it’s often necessary to help make them feel better and get back to life as usual. Below, Dr. Patrick Javid, a pediatric surgeon at Seattle Children’s, answers some of the most common questions he gets asked by patients and families before surgery.

Every week at Seattle Children’s, we perform 250-300 operations on children ranging from 2 hours old to 20 years old. Let’s just say that our operating room (“the OR” for short) is a happening place. As a pediatric surgeon, operating on children to improve their health and fight disease is what I do, day in and day out.

Having an operation can be really scary. Let’s face it — the OR is an unfamiliar and intimidating place if you don’t work there every day. In an effort to give children (and their parents, of course) a better understanding of what it means to have an operation at Seattle Children’s, here’s a list of my “Top 10 Favorite Questions from Kids Before Surgery.”

Drum roll, please…

Do I really have to stop eating and drinking before surgery? What if I get hungry? And when can I have a popsicle?!?!

This is the notorious “NPO time” that you may have heard about. NPO stands for “nothing per os,” or nothing by mouth. We want your stomach to be empty when you go into surgery so that going to sleep with anesthesia is as safe as possible. In most cases, you will need to stop drinking clear liquids (things like thin juice or breast milk) 4 hours before your surgery start time and stop eating food 6 hours before the operation.

You might get hungry, but only for a short time. Kids who are undergoing outpatient surgery will be able to eat and drink as soon as they wake up from the anesthesia. For patients getting admitted after their surgery, their diet will depend on the surgery they need in the OR. We have graham crackers, popsicles, and even Teddy Grahams for your culinary enjoyment in the recovery room!

Is it normal to be scared?

As you lie down on the OR table, you may feel a little nervous. This is completely normal. Not many kids have seen the inside of an OR. But don’t worry — this is the time to relax, like you’re taking a nap. After getting you comfortable on the operating table, and with your nurse at your side, the anesthesiologist will have you breathe some flavored air from a mask. They will ask you to think of something that you really enjoy like a beach, or your favorite TV show, or even Elsa from Frozen. I know some kids who like to think about Russell Wilson and the Seahawks! And then, before you know it, you will be fast asleep for the rest of the surgery.

Can my teddy bear go into surgery with me?

Absolutely! Your teddy bear, your blanket, your special good luck charm — you can always bring a special item with you into the OR. In fact, if your special friend is a “stuffy”, we will make sure to put a wrist band on him or her, too. That way, nobody will get lost during the busy day in the OR!

Does falling asleep hurt?

The doctors and nurses on the anesthesiology team at Seattle Children’s have special training in giving anesthesia to children. Each year, the team cares for more than 22,000 children! They will make sure that it won’t hurt to fall asleep in the OR.

After lying down on the operating table, the anesthesiologist will have you breathe some flavored air through a mask. Popular scents include strawberry and everyone’s favorite — root beer! The air in the mask is an anesthetic agent that will put you into a deep sleep. As someone who has had a procedure under general anesthesia, you can take my word on it — falling asleep in the OR will not hurt. And you will be fast asleep before you even realize it!

Will I wake up during surgery?

No! Our anesthesiologists will make sure that you are fast asleep throughout the entire operation. You won’t feel anything, you won’t remember the surgery, and you will not wake up during the procedure. Just remember — all of our anesthesiologists here are pediatric anesthesiologists. So their job is to put children to sleep during surgery, all day, everyday. And they are really good at it!

Have you ever operated on the wrong leg?

No! And I hope this never happens to anyone. While “wrong site” surgery is obviously a scary thought, it is also very rare. At Seattle Children’s, we take several steps to make sure this will never happen in the OR.

For example, one detail you may see and hear before you head back to the OR is the Pre-Operative Checklist. Like airplane pilots before a take-off, we perform several checklists before any surgery at Seattle Children’s. Research has shown that checklists before an operation can help to catch mistakes — like operating on the wrong side of the body — before they ever have a chance to occur in the OR.

Another cool point to look out for is the surgical marking. Whenever we perform surgery on only one side of the body, we have to put a special mark on your skin where we plan to operate. This is another safety measure to make sure that we agree on the correct location of your surgery. For me, I use my initials. So I will place a big purple “PJ” on your right leg if that is the correct site for your surgery. But tell your parents not to worry — this will not be your first tattoo! The marking can easily be washed off after the procedure.

Why do some people have to wear a suit that makes them look like an astronaut?

In the OR, we have a very technical term for this outfit — the “bunny suit”! And it’s usually worn by a parent, not a child or a surgeon.

In most cases, a parent can accompany you to the OR with the team. But they have to dress up first in one of our OR bunny suits, a clean white overflowing body suit that is designed to keep germs on your parent’s clothes from spreading into the OR. Make sure to have someone snap a photo– it will be a funny memory for years to come!

Will it hurt when I wake up after my operation?

It’s true that surgery can be painful. But our goal is for you to wake up comfortably in the recovery room with excellent pain control.

When you wake up after surgery, you will be resting on a stretcher in our PACU — or Post Anesthesia Care Unit and it will feel like just a minute has passed. The PACU is a fancy way of saying “Recovery Room.” You will meet your recovery nurse here who will be with you while you wake up and will make sure that you are comfortable with enough pain medicine. We can give pain medicine through your IV so you don’t have to swallow a pill or liquid.

Will I know where I am when I wake up?

Your final stop after the operation depends on whether you are getting admitted to the hospital or whether you are going home. If you are going home, the recovery room nurse will take you back to the Pre Op Zone where you can now enjoy a delectable lunch of popsicles, graham crackers, and Goldfish, a perfect snack for a belly recovering from anesthesia.

Can my parents stay with me in the hospital?

Great question, and the answer is yes.

All of our patient rooms have a pull out couch next to the patient bed. The couch can easily fit one parent and usually both parents. Your parents are welcome to stay with you 24 hours a day, seven days a week. We even have a complimentary coffee cart that comes around each floor every morning for parents.

And a bonus question for all you techies out there: Can I check my email in the hospital after my operation?

Whenever I get this question, I have to remind myself that we didn’t even have email when I was a teenager! But the answer is yes. All of our patient floors have free Wi-Fi available to patients and families. So if you are admitted to the hospital after the operation and you have a laptop, tablet, or smart phone, you can use the Wi-Fi to check email, surf the web, and even do FaceTime. Pretty cool.

Resources:

• What to Expect
• Meet the Pediatric Surgery Team
• On the Pulse: Pediatric Surgery Stories

New data suggests that adolescents in the U.S. are chronically sleep-deprived. Doctors recommend the average teenager get between 8.5 to 9.5 hours of sleep on school nights, but a recent study conducted by the National Sleep Foundation found that 87 percent of high school students were sleeping far less.

That’s a real concern for parents and caregivers, as sleep deprived teenagers run an increased risk of physical and mental health problems, car accidents, as well as declining academic performance. But with homework and school start times as early as 7:30 a.m. in some parts of the country, is it even possible for teens to get the sleep they need?

“No, it’s not possible,” said Dr. Cora Collette  Breuner, a pediatrician at Seattle Children’s Hospital and co-author of a new American Academy of Pediatrics (AAP) policy statement that recommends all middle and high schools delay the start of class to 8:30 a.m. or later.

Read full post »

The 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.

The study included 24 patients, ages 12 to 25, who had been diagnosed with cancer or type 1 diabetes. Participants worked with trained counselors to learn four primary skills to improve their personal resilience and cope with the challenges of their illness: stress-management; goal-setting; cognitive restructuring (turning a negative into a positive) and benefit finding (extracting meaning from adversity).

“These skills are developed throughout life, but they are less likely to be strong at such a young age,” Rosenberg said. “We want these patients to grow up to be the adults they were supposed to be and to move on in their live with a new sense of meaning and purpose.”

Qualitative feedback from the participants was universally positive.

“Patients found PRISM helpful and said it should become a standard part of care soon after diagnosis,” Yi-Frazier said. “Many said they wished they’d been taught these skills earlier in their treatment.”

Helping patients thrive

While it is difficult to prove that coping skills have a direct impact on cancer survival rates, Yi-Frazier published a study in 2013 demonstrating that resilience is likely to reduce stress and improve glycemic control in adolescents with type 1 diabetes.

“We hope patients will continue to use the skills taught in PRISM so they might live healthier lives,” Yi-Frazier said.

Patients who cope with stress better may also be less likely to participate in risky behaviors like drinking or smoking.

“Anecdotally, we’ve seen that patients who can handle the stress of a serious illness are more careful with the life they’ve been given,” Rosenberg said.

This summer Rosenberg and Yi-Frazier will test the efficacy of the PRISM model in a randomized trial and hope to offer a similar intervention model to parents.

“There is more to being sick than cells and biology,” Rosenberg said. “At Seattle Children’s our goal is to take care of the whole patient – physically and psychosocially.”

Resources:

• New AYA Cancer Leader Helps Teens and Young Adults Balance Life with Cancer
• Seattle Children’s Cancer and Blood Disorders Center
• Seattle Children’s Adolescent and Young Adult (AYA) Cancer Program
• Seattle Children’s Endocrinology and Diabetes program
• Center for Clinical and Translational Research

Seattle Children’s Hospital has been named to Becker’s Hospital Review’s list of 150 great places to work in healthcare.

Seattle Children’s was chosen for its “robust benefits, wellness imitatives, commitment to diversity and inclusion, professional development opportunities and a work environment that promotes employee satisfaction and work-life balance.” Read full post »

‘Tis the season for mistletoe, gingerbread and carefully strung lights. It’s the most wonderful time of the year, but also a potentially dangerous one for children. And although festivities, candles and garland may make the holiday season more cheerful, with them come some serious safety concerns.

Tony Woodward, MD, MBA, medical director of emergency medicine at Seattle Children’s Hospital, says the most important thing to remember this holiday season is supervision.

“The holidays are a fun and exciting time, but there are a few more things inserted into the environment, like holiday plants, electrical cables, new toys and festive beverages, which are potentially dangerous,” says Woodward. Read full post »