It's About Children - Winter 2006 Issue by East Tennessee Children's Hospital


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It's About Children - Winter 2006 Issue by East Tennessee Children's Hospital

  1. 1. Board of Directors James S. Bush Chairman Dennis Ragsdale Vice Chairman Michael Crabtree Secretary/Treasurer Debbie Christiansen, M.D. Dawn Ford Steven Harb Lewis Harris, M.D. Jeffory Jennings, M.D. Bob Koppel A. David Martin Dugan McLaughlin Christopher Miller, M.D. Alvin Nance Steve South Bill Terry, M.D. Laurens Tullock Danni Varlan Medical Staff Lewis Harris, M.D. Chief of Staff David Nickels, M.D. Vice Chief of Staff Lise Christensen, M.D. Secretary Chiefs of Services John Buchheit, M.D. Chief of Medicine Alan Anderson, M.D. Chief of Surgery Administration Bob Koppel President Laura Barnes, R.N., M.S.N., C.N.A.A.,B.C. Vice President for Patient Care Paul Bates Vice President for Human Resources Joe Childs, M.D. Vice President for Medical Services Rudy McKinley Vice President for Operations Jim Pruitt Vice President for Finance A quarterly publication of East Tennessee Children’s Hospital, It’s About Children is designed to inform the East Tennessee community about the hospital and the patients we serve. Children’s Hospital is a private, independent, not-for-profit pediatric medical center that has served the East Tennessee region for almost 70 years and is certified by the state of Tennessee as a Comprehensive Regional Pediatric Center. Ellen Liston Director of Community Relations David Rule Director of Development Wendy Hames Editor Neil Crosby Cover/Contributing Photographer “Because Children are Special…” ...they deserve the best possible health care given in a positive, child/family-centered atmosphere of friendliness, cooperation, and support - regardless of race, religion, or ability to pay.” ...their medical needs are closely related to their emotional and informational needs; therefore, the total child must be considered in treating any illness or injury.” ...their health care requires family involvement, special understanding, special equipment, and specially trained personnel who recognize that children are not miniature adults.” ...their health care can best be provided by a facility with a well-trained medical and hospital staff whose only interests and concerns are with the total health and well-being of infants, children, and adolescents.” Statement of Philosophy East Tennessee Children’s Hospital 2 August 1, 2006 Dear Children’s Hospital, My daughter, Isabella, is a Neonatal Intensive Care Unit graduate, and we are very grateful for all that East Tennessee Children’s Hospital did for us. She was born on 1/25/05 and discharged on 4/25/05. Isabella was born at 27 weeks and weighed 1 pound, 5.7 ounces and was 12 3/4 inches long. We are blessed that she had none of the major complications that are associated with being an extreme preemie. In honor of her first birthday, we requested donations of scrapbook materials for the NICU and were able to donate over $700 of these items to the NICU. We can’t say enough good things about the care she received and the staff at the NICU. Many thanks, and we hope to be able to continue in our own small way. Tammie and Chuck Humphrey Maynardville Special thanks from Children's Hospital Children's Hospital would like to extend its appreciation to The Pool Place, Kingston Pike in Knoxville, for graciously allowing us to shoot our cover and patient story photos for the Winter 2006 It’s About Children magazine at their Christmas store. August 7, 2006 Dear Children’s Hospital, My name is Melissa Voorhies. My daughter, Riley Voorhies, was born May 19, 10 weeks early. We had to visit the Neonatal Intensive Care Unit, and they were great. My husband was deployed in Iraq when our little girl was born, so they [the NICU nurses] acted like my family and kept my spirits up when I was down. They did an awesome job. Riley got to come home one night before Daddy had to go back to Iraq. Now she is 11 weeks old and probably weighs over 8 pounds! Thanks you guys! Love, The Voorhies Family Knoxville “DearChildren’s”“DearChildren’s”1 On The Cover: Meggi Weeks is ready for Christmas! Read her story on pages 4-5.
  2. 2. 3 On January 1, 2007, the Children’s Hospital Auxiliary will change its name to Children’s Hospital Volunteers. All volunteers will automatically become members of the organization, which raises funds to support some of the important services throughout the hospital such as the Clothing Closet. Throughout the year the volunteers host various sales and coordinate an annual holiday greeting card sale, which is their largest fundraiser. The group recently made some adjustments in their by-laws, policies and procedures, including the name change, to strengthen the organization. HELPING CHILDREN IS ‘IN THE CARDS’ THIS HOLIDAY SEASON Children’s Hospital Auxiliary Annual Holiday Cards Now Available With the holidays quickly approaching, people throughout East Tennessee are starting to make gift lists and plan family get-togethers. The East Tennessee Children’s Hospital Auxiliary has an easy way to check one important task off that holiday “to-do” list – purchase the just-released 2006 Children’s Hospital Auxiliary Holiday Card, and help the area’s children at the same time. This is the 42nd year Children’s Hospital’s Auxiliary has sold holiday cards to benefit the hospital. Artist and Children’s Hospital Auxiliary member Jan Church designed this year’s unique holiday card especially for Children’s Hospital. Titled “Up on the Housetop,” this season’s card features a snowy rooftop scene with Santa’s sleigh overflowing with nostalgic holiday toys that stirs feelings of excitement and anticipation for the arrival of Saint Nick. The message inside the card is “Sending Good Wishes Your Way.” The Children’s Hospital Auxiliary’s holiday cards are $1 per card, can be sold in any quantity including box sets of 12 cards for $12, and personalization is available on bulk orders. The cards are appropriate for both business and personal use. Proceeds from the holiday cards will be used to support a variety of the Auxiliary’s programs at Children’s Hospital, all of which help to make a child’s hospitalization more comfortable. For more information or to place an order, send an e-mail request to or call the Volunteer Services Department at Children’s Hospital at (865) 541-8136. The Auxiliary Board of Directors also recently approved a $50,000 gift to Children’s Hospital from Gift Shop proceeds. The gift is being distributed as follows: $15,000 to the Fantasy of Trees, $15,000 to the Children’s Miracle Network Telethon, $11,500 to the laboratory for a Aggram Modular System, $4,185 to the library for partial funding for an annual subscription to CINAHL, $3,000 to Community Relations for portable signage for special events and $1,315 for the Open Door Endowment Fund. By Bethany Swann, student intern BulletinBoard V V Auxiliary changes name, gives gift to hospital V
  3. 3. Imagine being invited to a friend’s birthday party and not being able to eat the party food. Or going out to a restaurant and not being able to order off the regular menu. Or having to pack a lunch for school every day instead of ever buying a cafeteria lunch like your friends. For a child with gluten intolerance (also called celiac disease), this is a daily reality. Ten-year-old Megan Weeks – Meggi – has been living this way for just over a year, since her October 2005 diagnosis. Now a fourth-grader at Knoxville’s West Hills Elementary School, Meggi had experienced a variety of health issues since birth. A happy, energetic baby, she struggled with reflux as well as frequent ear infections that tended to progress to sinus infections and even pneumonia. By age 5 she appeared to have outgrown some of the early problems but was diagnosed with asthma. She began seeing pediatric pulmonologist Eduardo Riff, M.D., at Children’s Hospital for management of her asthma. When it did not improve and Meggi (now age 7) began to develop some digestive problems, Dr. Riff suspected a connection to her earlier reflux and suggested they have this problem re-examined. The Weeks chose to wait a little while to see if the problems would improve. Later, because Meggi was not showing improvement, her pediatrician, Gregory Swabe, M.D., of Knoxville Pediatric Associates, referred her to Youhanna Al-Tawil, M.D., pediatric gastroenterologist at Children’s to see if she still had reflux. Testing revealed stage two reflux. Dr. Al-Tawil prescribed medication and dietary changes, which helped but did not eliminate Meggi’s digestive problems. For the next two years, Meggi usually saw a nurse practitioner in Dr. Al-Tawil’s office. According to her mother, Alisa Weeks, “I didn’t think my child was seriously ill. At Dr. Al- Tawil’s office, we often saw children who were very seriously ill.” The family felt Meggi’s problems with reflux were minor and could easily be treated without seeing Dr. Al-Tawil, enabling him to devote more time to his seriously ill patients. But one time they were scheduled instead with Dr. Al-Tawil, and he was concerned that Meggi continued to have so many problems. He ordered a battery of new tests – six vials of blood were drawn in the Children’s Hospital Laboratory, according to Meggi – to check for celiac disease, diabetes and a host of other potential problems. Because of these tests, Meggi was diagnosed with gluten intolerance and was immediately started on a gluten-free diet. The family worked with (and continues to work with) Mary Sue Walker, Ph.D., R.D., L.D.N., a clinical nutrition specialist in Dr. Al-Tawil’s office, to learn about and practice the gluten-free diet. Within two weeks of her dietary changes, her stomach aches and other digestive problems had improved, her migraine headaches had decreased in frequency and severity, and she felt substantially better overall. Only her asthma continued to be a problem. Gluten is a protein that is found in wheat, rye, barley and possibly oats (until recently, oats were a definite no-no for the gluten-intolerant, but recent studies suggest it may be OK, although the Weeks family keeps oats on their banned list for now). Gluten is found in many unexpected places – not just food but also cosmetics such as lipstick and school supplies such as Play-Doh. “At first, it seems like gluten is found in everything, but there are many things that it is not in. I often say it is in almost everything, but there isn’t anything we cannot have,” Mrs. Weeks said. The keys to living gluten-free are avid label reading and becoming familiar with products and brands. Once you learn what is safe, you can cook anything, Mrs. Weeks said. Because Meggi was diagnosed in October, the holidays were fast approaching, and that required some significant adjustments. “Thanksgiving is actually easy,” Mrs. Weeks said. “It’s just the bread and stuffing that need adjusted, and last year we had crustless pies. Christmas is harder because of all the parties and social events – they are wonderful to attend, but we must prepare our own food for each occasion. It’s already a busy time, and this makes us even busier.” (The Weeks have shared some gluten- free holiday recipes on the next page.) When Meggi was first diagnosed, the Weeks household went completely gluten-free. That meant that everyone – mom Alisa, dad Bill and big sister Ali (age 14) – only ate what was safe for Meggi. After about three months, they relaxed the household rules a bit. One day Bill was preparing to go grocery shopping and asked if anyone wanted anything in particular. Meggi said, “Get Ali some Pop-Tarts.” They were all surprised that Meggi would be comfortable having something in the house she couldn’t eat, but Meggi said she was ready. Ali returns the 4 MeggiMeggi
  4. 4. 5 favor by being sensitive to Meggi – “Ali won’t eat something Meggi can’t have in front of her without asking Meggi if it’s OK,” Mrs. Weeks said. Gluten intolerance is a genetic disorder, and Mrs. Weeks believes she is the parent who carries the affected gene. She has not been tested because she follows the gluten-free diet so strictly that the test result would not be accurate. But she’s confident she’s the carrier for a very simple reason – she had for many years experienced digestive problems of her own with a different diagnosis, but the problems ended and she ceased to require medication when she began following the gluten-free diet. Like Meggi, Mrs. Weeks follows the diet at all times, and all family meals are gluten- free. Mr. Weeks and Ali opt not to follow the diet outside of the home. Purchasing gluten-free products is both difficult and costly, although in just the past year it has become easier because new federal laws about food labeling require the eight major allergens to be listed on labels of products that contain those allergens. Because wheat, one of the eight allergens, is also off-limits to those with gluten intolerance, this new labeling system has proven very helpful to families such as the Weeks. Many foods must be cooked from scratch; gluten-free convenience foods (such as baking mixes and frozen items) currently are available only in a limited supply, although such products are increasing in number. Many gluten-free items cost more than their gluten- containing counterparts. The Weeks shop at such specialty stores as EarthFare, where a store employee took them on a tour to show them how to find the special shelf labels identifying gluten-free products; Go Nutrition, which also uses a special labeling system; and Nature’s Pantry, which stocks all gluten-free items together in one aisle. Food City in Bearden and Kroger in Knox Plaza are two major grocery stores that have begun to carry a number of gluten-free items, but they do not yet offer a labeling system to make it easy to identify the safe products. Restaurants pose an entirely different challenge because there are no labels to read and the responsibility is placed in someone else’s hands. The restaurant chains Outback Steakhouse, Carrabba’s Italian Grill, Bonefish Grill and P.F. Chang’s China Bistro all offer gluten- free menus and knowledgeable staff, so these are where the Weeks typically eat out. Of course they are not inexpensive, nor are they fast. Some other chains – both fast food and casual dining – offer gluten-free menus on their websites, but employees in the individual restaurants typically are not well-trained in gluten- safe food preparation, so the risk of cross contamination is a problem. After going so long on a gluten-free diet, Meggi can tell when she has eaten something that does contain gluten — she is much attuned to the symptoms. She also clearly remembers how poorly she felt just a year ago, so she is careful and conscientious to stick to her diet. The Weeks are thankful for a great deal of support from their extended family (all family functions are now gluten-free), several friends and the Celiac Support Group, sponsored by Dr. Al-Tawil’s office (visit for more information). Meggi remembers some friends who came to see her shortly after her diagnosis. They brought her a bag of non-food gifts with a note that said, “There’s more fun things to life than food!” It’s a sentiment Meggi believes in. They are also thankful for Dr. Al- Tawil and Dr. Riff and their office staff members; their pediatrician, Gregory Swabe, M.D., of Knoxville Pediatric Associates; and Children’s Hospital. “It is an amazing place of positive, caring, patient people,” Mrs. Weeks said. “Children’s Hospital has been wonderful. Everyone is extremely kind to all of us when we go there.” What is gluten intolerance? Gluten intolerance (also called celiac disease) is a digestive disorder that damages the small intestine and interferes with absorption of nutrients from foods containing a protein called gluten. What are the symptoms of gluten intolerance? Symptoms vary from person to person — one person might have diarrhea and abdominal pain, while another person may be irritable or depressed. In fact, irritability is one of the most common symptoms in children. Symptoms can include: • Gas •Recurring abdominal • Delayed growth bloating and pain • Chronic diarrhea •Pale, foul-smelling, • Osteoporosis or fatty stool • Fatigue •Unexplained anemia • Bone or joint pain •Weight loss or gain • Muscle cramps •Behavioral changes • Seizures •Recurrent miscarriage • Missed menstrual periods (often because of excessive weight loss) • Infertility • Failure to thrive in infants • Tingling numbness in legs (from nerve damage) • Pale sores inside the mouth, called aphthous ulcers • Tooth discoloration or loss of enamel • Itchy skin rash called dermatitis herpetiformis. Source: The National Digestive Diseases Information Clearinghouse, a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The NIDDK is part of the National Institutes of Health under the U.S. Department of Health and Human Services. Old-Fashioned Pumpkin Pie 2 eggs One 16-ounce can pumpkin 3/4 cup sugar 1/2 teaspoon salt 2 teaspoons pumpkin pie spice 1 1/2 cups cream or nondairy substitute 1 cereal crust (recipe follows) In a large mixing bowl, beat the eggs slightly. Add pumpkin, sugar, salt and spice. Stir together. Add the cream and mix thoroughly. Pour into the unbaked crust. Bake in preheated 425° oven for 14 minutes. Reduce temperature to 350° and bake another 45 minutes or until knife inserted in the center of the pie comes out clean. Cool. Serve cold with whipped cream or whipped nondairy topping if desired. Makes 6 to 8 servings. Source: Bette Hagman cookbook, The Gluten-Free Gourmet, Living Well Without Wheat Cornflake Crust 2 cups Gluten Free Cornflake, crushed (4 rounded cups before crushing it) 1 teaspoon cornstarch 1/2 cup melted butter 1/3 cup sugar 1 teaspoon vanilla Put all the ingredients together in a food processor, and mix until all flakes are crushed. Pat on two 9” pie plates, sprayed with Pam, and bake 8 to 10 min. at 350°F. Makes 2 crusts. Old-Fashioned Sugar Cookies 1 1/2 cups sugar 1 1/2 cups potato starch flour 1 cup Butter Flavor Crisco 2/3 cup cornstarch 4 egg yolks 2/3 cup tapioca flour 1 teaspoon dried orange peel or vanilla 2 teaspoons baking powder 1 teaspoon salt In a large mixing bowl, blend the sugar and shortening. Add egg yolks and flavoring. Mix flours, baking powder and salt together and add to the first mixture. This will seem crumbly, but work the dough with your hands until you can form balls. Roll out dough on wax paper to about 1/8-inch thick. Cut into desired shapes and transfer to greased cookie sheets. Bake in pre-heated 375° oven for 8 to 10 minutes. When cool, frost if desired. Makes 6 dozen 2-inch cookies. Note: Don’t be afraid to handle this dough. It does not toughen with handling. Source: Bette Hagman cookbook, The Gluten-Free Gourmet, Living Well Without Wheat Rice Bread Stuffing 1 large onion, minced 1 cup diced celery 6 T (3/4 stick) butter or margarine 1 to 1 1/2 tsp poultry seasoning 2 T minced parsley 6 to 8 cups gluten-free bread, 1 to 1 1/2 cups chicken broth crumbled ** Salt to taste Sauté the onion and celery in butter until clear; add the poultry seasoning and parsley. Pour this mixture over the bread in a large mixing bowl. Stir until blended, then add the broth, a little at a time, until the dressing is as moist as you prefer. Add salt to taste. Makes enough to stuff a 10-12 pound turkey. Seasoned Bread: If you are baking your gluten-free bread near the holiday season, try putting the 1 to 1 1/2 teaspoons poultry seasoning directly into the dough for at least one loaf before you bake it. Try adding some dried minced parsley, also. This seasoned bread will make excellent stuffing. **The Weeks family uses Bob’s Mill gluten-free bread mix for this recipe, making the bread in a bread machine and adding the seasonings to the bread mix. Source: Bette Hagman cookbook, The Gluten-Free Gourmet, Living Well Without Wheat Gluten-Free Recipes
  5. 5. 1960s tree lighting at Miller’s Department Store on Henley Street each December. The nightly tree lighting began in 2004 at the event’s 20th anniversary in honor of the Knoxville tradition. Local television and radio personalities will join a hospital patient to light the tree each evening. Fantasy visitors will also have the opportunity to win a beautifully decorated seven-foot tree or one of five $500 gift cards donated by Target Stores of Knoxville. The raffle tree will be surrounded by a variety of electronics, children’s toys and games, holiday goodies and much more, valued at $5,000. Raffle tickets are only $5 each and will be available at the Fantasy of Trees beginning Wednesday, November 22, at 9 a.m. They will be sold through 4 p.m. on Sunday, November 26. Winners will be drawn immediately after ticket selling ends on Sunday afternoon. Since 1985, Children’s Hospital has received overwhelming community support for its annual Fantasy of Trees fund-raiser. Again this year, hundreds of businesses and individuals have participated in the Sponsor Program, which is invaluable to the success of each year’s show. Special events at the Fantasy of Trees include: Gala Preview Party Tuesday, November 21, 7-11 p.m. Dance the night away at the season’s first and most festive party! Enjoy cocktails, an evening buffet, a private preview and sale of designer trees and holiday accessories, and shopping in the Holiday Marketplace. Festive attire is requested at this black-tie-optional event. Tickets are $150 per person and must be purchased in advance. Call the Volunteer Services and Resources Department at (865) 541-8385 to purchase tickets. The gala is 6 In 2006, it’s time for “O Christmas Treats” at the Knoxville Convention Center from November 22 to 26 for the 22nd annual Fantasy of Trees. The convention center’s exhibit halls will be filled with sweet holiday treats in a magical winter wonderland, featuring more than 300 designer- decorated items, entertainment, holiday shops and activities for children. Fantasy of Trees visitors can stroll through an enchanting winter forest of holiday trees, as well as enjoy looking at holiday accessories, room scenes, fireplace mantles, swags, door designs, table centerpieces, topiaries and “Adopt-A-Trees,” created and donated by local students. Guests can also marvel at an array of delicious creations in the Gingerbread Village, crafted with a variety of edible building materials by area bakers, chefs and children. Each day entertainers from throughout East Tennessee will perform at the Fantasy Theater. Singers, dancers and other entertainers will help visitors celebrate the season by sharing their talents each day. While enjoying the trees, decorations, activities and entertainment, visitors also can shop at the Holiday Marketplace, where they will find holiday items ranging from children’s gifts and toys to clothing and accessories to holiday decorations. A family-oriented event, the Fantasy of Trees offers activities and fun for children of all ages, including favorites such as the beautiful 30-horse carousel and visits with Santa. This year several new activities are featured, including Christmas Plates (children can decorate a small holiday plate); Coaster Art (kids can color, paint and create holiday pictures on tiles for decorating their house); and Gingerbread Chef Wands (children can decorate their own magical gingerbread chef wand). New holiday boutiques have been added for adults, making it easy to shop for everyone on your Christmas list. Each evening the Fantasy of Trees will light a Christmas tree commemorating the nostalgic 22nd Annual FFaannttaassyyooffTTrreeeess to kick off holiday season November 22-26
  6. 6. sponsored by the Cazana Family and Commercial and Investment Properties Company. Babes in Toyland Parade Wednesday, November 22, 7 p.m. Don’t miss the first and only indoor holiday parade of the season as children from area child care centers show off their colorful costumes while parading to the sounds of a marching band. The parade’s grand finale features Santa Claus and indoor “fireworks” provided by Pyro Shows, Inc. The parade is broadcast live on WVLT-TV Volunteer News at 7 p.m. and is sponsored by Dollywood. Santa’s Senior Stroll Friday, November 24, 9-10 a.m. Seniors and walkers of all ages can enjoy a one-mile walk through the splendor and sparkle of this year’s Fantasy of Trees. Tables will be set up at the end of the walk with information on health topics of interest to seniors. Best of all, seniors 55 and over get a half-price admission of $4 to enjoy all of the Fantasy of Trees when they arrive during Santa’s Senior Stroll. (This discount cannot be combined with any other discounts.) Santa’s Senior Stroll is sponsored by Baptist Senior Health Centers and Knoxville Coca-Cola. Kris Kringle’s Kiddie Party Friday, November 24, 10:30-11:15 a.m. and 11:30 a.m.-12:15 p.m. Join us for a free party just for preschoolers at the Fantasy Theater, expanded to include two fun sessions this year. Your little ones will enjoy children’s activities and entertainment from Music-N-Motion, have photos made with Shoney Bear, enjoy snacks and receive a holiday gift. The party is sponsored by Knoxville Pediatric Associates. The funds raised at the Fantasy of Trees this year will purchase a variety of equipment for a new surgery suite at Children’s Hospital. Over the past 21 years, the Fantasy of Trees has raised nearly $4 million for the hospital. This spectacular holiday event would not be possible without the more than 148,000 volunteer hours that make the Fantasy of Trees a reality year after year. Children’s Hospital would like to thank everyone who has helped make this event a success, ensuring Children’s Hospital can continue to provide the best in pediatric health care to all of East Tennessee’s children. For more information about the 2006 Fantasy of Trees, visit our Web site at 2006 Fantasy of Trees co-chairs Stephanie Jeffreys and Linda Redmond and assistant co-chair Sarah Beth Carlon (l-r). 2006 Fantasy of Trees Major Event Sponsors 7 Show Times Wednesday, November 22 9 a.m. to 9 p.m. Thursday, November 23 Thanksgiving Day 3 to 9 p.m. Friday, November 24 9 a.m. to 9 p.m. Saturday, November 25 9 a.m. to 9 p.m. Sunday, November 26 Noon to 6 p.m.
  7. 7. 8 Scott Brice, M.D. Age – 35 Family – Wife, Sarah Brice; children Luke (7), Anna (4) and Janie (1) Name of Pediatric Practice – Knoxville Pediatric Associates, Clinch Avenue office Personal Interests – running, biking and all sports Academic Background/Prior Experience B.S. – Wofford College, Spartanburg, S.C., 1993 M.D. – University of South Carolina, Columbia, S.C., 1998 Internship – University of Tennessee, Knoxville, 1998-99 Residency – UT-Knoxville, 1999-2001 Other – Practiced pediatrics from 2001-06 in Greenwood, S.C. Why Pediatrics? I enjoy watching children and adolescents grow physically and developmentally. Pediatrics gives me an opportunity to work with patients and their families. Greatest Influence – My father. He has always been a source of encouragement for me. He has a great passion for his work and maintains a positive attitude. His integrity is without question. Those are all qualities of his that I have tried to emulate. Philosophy – Each child is a special and unique gift and, as such, should be treated with care and respect. Proudest Moment as a Pediatrician – I don’t have any particular moment that stands out. I’m proud to have the opportunity each day to do something I enjoy. Rob Schaerer, M.D., F.A.A.P. Age – 30 Family – Wife, Nikki; son Calvin (2) and a baby on the way Name of Pediatric Practice – Loudon Pediatric Clinic, Loudon Personal Interests – songwriting and music performance, golf, cooking and the Big Orange Academic Background/Prior Experience B.S. – University of Tennessee, Knoxville, 1997 M.D. – University of Tennessee, Memphis, 2001 Residency – University of South Florida, Tampa and St. Petersburg, 2001-04 Other – Board certification from the American Board of Pediatrics, 2004 Why Pediatrics? Every day allows me the opportunity to care for and encourage our next generation. Their innocence, energy and honesty are refreshing, amidst a busy world and hurried days. Greatest Influence – An unsuspecting patient at St. Jude Children’s Research Hospital, whose gleaming eyes showed me my future during a tour prior to medical school. Philosophy – Always let our patients and their families know how much we care, maintain a fun and friendly office environment, and never stop learning. Proudest Moment as a Pediatrician – Being asked by close friends to care for their children. Pediatrician Profiles
  8. 8. 9 There is no such thing as a “typical” day in a hospital. Day in and day out, patients enter our doors for care, but each child is unique, and each experience is different. However, within each day at Children’s Hospital, there are some common threads. One common thread is the training and experience of the hospital’s staff — no matter what situation arises, our staff is skilled and prepared to meet the challenge. For the next several issues of It’s About Children, we will profile some of our staff and highlight all our clinical areas. We hope it will give you a glimpse into life at Children’s Hospital. SURGICAL SERVICES Children’s Hospital meets a wide range of pediatric surgical needs, from common outpatient procedures such as tonsillectomies to more complicated procedures, such as reconstructive surgery and neurosurgery. Children’s Hospital’s Surgical Services includes Outpatient and Inpatient Surgery (both located on the hospital’s Fourth Floor), and Anesthesia, Post-Anesthesia Care Unit (also known as the PACU, “wake up” room or recovery room) and the Operating Rooms (all located on the hospital’s Sixth Floor). These departments work together to make sure each child’s surgery and recovery is as quick and painless as possible. The physicians, nurses and other surgical staff are trained in pediatric care. Depending on the individual department’s function, staff in the Surgical Services departments include R.N.s, L.P.N.s, patient care assistants (PCAs), transporters, unit secretaries, surgical technologists, sterile processing assistants, nurse anesthestists (C.R.N.A.s) and anesthesia technicians. Liza Graves Graduating with a degree in Physical Education and playing basketball at the University of Tennessee may have been an unlikely starting point for Pediatric Nurse Liza Graves. Graves wasn’t sure what career she wanted to have when she graduated, but she knew it wasn’t teaching or coaching. But shortly after graduation Graves found her home at Children’s Hospital; a friend suggested she consider a job at Children’s, and 25 years later, she’s still here. Graves first worked as an emergency tech while going back to school to earn a Bachelor of Science in Nursing from UT. After receiving her BSN, she moved into Surgery, where she plans to stay until she retires. As an operating room nurse, Graves primarily works with neurosurgery and plastic services but is able to assist with all types of surgeries and is on- call at times. One of Graves’ favorite memories is of a patient in the Hematology/Oncology Clinic, which formerly was part of the Emergency Department. “All of the children really touch your heart, but one in particular, Brad, will always have a special place in mine,” Graves said. “He considered himself a ‘country boy,’ and the rest of the patients were ‘city slickers,’ as he called them.” Traonna Smith Traonna Smith chose to work as a patient care assistant/transporter at Children’s Hospital for many reasons, but most importantly because she loves working with children. “I entered into this field because I’m a people person, and I enjoy helping people,” Smith said. Smith is a certified PCA/transporter in the PACU who is constantly improving her knowledge and skills through various training. She participates in in-services, CPR training and NetLearning (online employee continuing education programs). It’s Smiths’ primary task to assist the PACU nurses with patients during the recovery period, and then transport the patients back to their rooms when they are awake enough to leave the PACU. It is important to Smith to do her best to comfort and care for “the little ones,” as she likes to call her young patients. Tracey Jackson When Tracey Jackson began thinking about what career she wanted to pursue, she knew she wanted a profession that would keep her interest and continuously challenge her. Nursing was a perfect fit. Jackson graduated from nursing school ten years ago with an Associate of Science Degree in Nursing. While continuing to complete her degree, Jackson worked as a medical assistant. Critical care was Jackson’s first interest and she began working as an ICU nurse at St. Mary’s Medical Center. “I loved it, but I couldn’t get a schedule that was suitable for home,” Jackson said. The desire for a more flexible schedule led Jackson to apply for a position at Children’s Hospital. Although pediatric nursing was not an area Jackson ever expected to be in, she was hired in 2000 and now it is her “home.” Jackson enjoys being able to have fun while working hard in an environment of “teamwork” to provide the best care possible for Children’s Hospital’s patients and families. “I work with a wonderful group of people, including management… I can’t imagine doing anything else,” Jackson said. One of Jackson’s favorite memories is of the first critically ill child she cared for. Jackson worked with this patient through a long and stressful recovery and became very attached to him and his supportive family. “It was rewarding for me to see him go from being so critical to recovering without complications at all,” Jackson said. Jackson now works as a Shift Leader on 4East Inpatient Surgery. She maintains and increases her skills and knowledge through Net Learning and annual competency skill days. Amber Wilson Amber Wilson, a unit secretary for Outpatient Surgery, chose a career in pediatric health care because of her love for children. Wilson wanted to take part in providing health care for children and helping in every way that she could. “Every child who comes in is as special as the next. They all need lots of love and special care,” Wilson said. Wilson chose Children’s because she knew it would be a wonderful place to work; prior to her current position, she worked as a pharmacy technician in the Children’s Hospital pharmacy. “The people who work at the hospital are angels. I believe you have to be an angel to take care of sick kids,” Wilson said. By Amandalynn Thomas and Bethany Swann, student internsLiza Graves with Jay Lucas, M.D. Amber Wilson Tracey Jackson Traonna Smith lifeA day in the of Children’s Hospital
  9. 9. Children’sNews... 10 In August, leaders from Holston Valley Medical Center in Kingsport announced a reinvigoration of children’s services within the Holston Valley Regional Children’s Hospital and Center. The centerpiece of the sweeping initiative is a groundbreaking alliance with Children’s Hospital, the pediatric referral hospital for the region and the only state-designated Comprehensive Regional Pediatric Center in East Tennessee. Because of this new alliance, 17 board-certified pediatric specialists will establish an office and begin seeing patients at Holston Valley. “Every year, 2,500 children from our region are referred to Children’s Hospital for expert care that, until now, has been unavailable in Northeast Tennessee and Southwest Virginia,” said Dr. Richard Salluzzo, Wellmont Health System’s president and chief executive officer. “Now, instead of asking children and their parents to drive two hours or more for care, we’re bringing the pediatric specialists to these children. Working with the outstanding pediatricians, neonatologists and pediatric specialists already on the Holston Valley staff, these physicians will deliver comprehensive pediatric care that is unmatched in our region.” Specialists in pediatric endocrinology, pediatric gastroenterology, pediatric hematology/oncology, pediatric neurology, pediatric pulmonology and pediatric surgery will make regularly scheduled visits to see patients at Holston Valley. The specialists’ office will be located within the hospital, and appointments will be available by referral from a pediatrician or family-practice physician. “At Children’s Hospital, we are committed to making sure every child gets the medical attention necessary when faced with illness or injury,” said Bob Koppel, president and CEO of Children’s Hospital. “For many years, Children’s Hospital has seen children who have been referred to us from Upper East Tennessee. This alliance with Holston Valley will allow us to assist even more children as we bring our talented and dedicated pediatric subspecialists to Upper East Tennessee and allow us to see children where they live and help them with unique medical needs. We are excited about the opportunities that this brings to help the children in this area live happier, healthier lives.” Dr. Stephen Combs, a board-certified pediatrician and president of the Holston Valley medical staff, said “Through the new relationships we’ve announced, Holston Valley is affirming its commitment to the children of our region. As a pediatrician, I can think of no better investment for any hospital than an investment in the health of our children. “I know I speak for all the physicians of Holston Valley and East Tennessee Children’s Hospital when I say I’d move mountains to make life better for just one child,” Dr. Combs added. “How wonderful it is, then, that the alliances we’ve formed and the programs we’ve developed will ease the pain and restore the smiles of countless children in our community.” Children’s Hospital forms alliance with Holston Valley Children’s Hospital and Children’s Hospital Home Health Care were awarded a renewal of their three-year accreditation following a successful survey by the Joint Commission for the Accreditation of Healthcare Organizations (JCAHO) during the week of August 21. The JCAHO surveyed Children’s Hospital (including the Children’s Hospital Rehabilitation Center in West Knoxville) as well as Children’s Hospital Home Health Care in Farragut over a four-day period. The JCAHO is a private, not-for-profit organization that seeks to improve the quality of health care through the accreditation of health care organizations. It began hospital inspections in 1918, and today, the Joint Commission surveys hospitals, health care networks, long-term care pharmacies, laboratories and organizations specializing in long-term care, ambulatory care, behavioral health and home care. In its preliminary report, the Joint Commission survey team recommended a three-year accreditation — the longest period offered by the JCAHO — for the hospital and Home Health Care. The surveyors were extremely complimentary of our organization, staff and the care we provide to our patients and families. The Children’s Hospital Laboratory had a separate, successful survey in August. 2006 Joint Commission survey a success Dr. Stephen Combs (left), President of the Holston Valley Medical Center medical staff, and Children’s Hospital President Bob Koppel (right) at the Holston Valley press conference with Tony and Cari Crawford and their children, Jake and Gracie. Both Crawford children were born prematurely at Holston Valley and have frequently sought pediatric specialty care at Children’s Hospital.
  10. 10. 11 The quest for quality Children’s Hospital has a history of providing a high quality of health care to our patients. But exceptional quality requires exceptional effort. At Children’s, the quality of care is a priority throughout our medical center. For that reason, Children’s Hospital places a great deal of emphasis on instilling a “culture of quality” in physicians and employees. According to Laura Barnes, M.S.N., C.N.A.A.,B.C., Vice President for Patient Care Services, with employees, it begins with the hiring process. “We hire the right people with the right skills and goals,” she said. Then it continues with the new employee orientation process, with all areas of the hospital working continually to mentor the new employees with the goal of improving patient care. Although the employees providing leadership and support in quality improvement at Children’s Hospital are Quality Management Department Director Alzena Abernathy and her staff, all hospital staff members play a role in quality improvement. Quality issues can be identified by anyone – a physician, a nurse, a tech, a housekeeper, anyone who observes something that could be done better or more safely. They report their suggestion, and if it is approved for action, a team is selected to implement the plan. The suggestions most frequently pertain to quality and safety for our patients, but enhancing safety for our staff is also a priority. At Children’s Hospital, quality improvement goes beyond casual observation of something that can be improved. Children’s Hospital constantly is monitoring quality in a number of ways, looking for trends, new services, equipment or processes available elsewhere. Departments develop their own quality improvement (QI) plans annually to help them continuously search for areas to improve. One key element of the quality initiative at Children’s Hospital was the establishment earlier this year of the CSI team. CSI – not the network TV series – stands for Children’s Safety Initiative. The CSI team members, representing all hospital departments, meet monthly to review safety and quality issues and report to their peers. They provide education opportunities, poster presentations and other activities to help hospital staff remain up-to- date on policies, standards and expectations. The Joint Commission for the Accreditation of Healthcare Organizations, which surveyed Children’s Hospital in August, encourages hospitals to have ongoing readiness by doing surveys on an unannounced basis (the hospital knows only the year in which the survey will take place, but not the day or even the month). Barnes said the goal of the JCAHO’s new unannounced surveys is, “Instead of preparing for the next survey, you are preparing for the next patient.” When the JCAHO surveyed Children’s Hospital in August of this year (see page 10 for information on the survey), one question the surveyors frequently asked employees was, “What have you done to improve care over the last year?” The Medical Staff members of Children’s Hospital also are very integral to the QI program. They are involved in QI processes, in examining how we deliver care to make sure it is of the highest quality, and serving on various Medical Staff committees that monitor the quality of care rendered to our patients. The committees have a variety of functions (including Trauma, Infection Control, Pharmacy/Therapeutics, Acute Care, Department of Medicine and Department of Surgery) and they all include QI. They all report monthly to the Medical Staff QI Conference, currently chaired by John Little, M.D., pediatric otolaryngologist. Dr. Little said the community might be unaware of the degree to which Children’s Hospital works to enhance quality. “We watch for national alerts and trends from other hospitals, especially children’s hospitals, and we act on them to prevent problems here,” he said. “We also encourage and solicit input from hospital staff and the Medical Staff to identify problems or potential problems. “We try to be proactive, not reactive,” he added. “We work to prevent things from occurring or recurring when possible. It’s better to learn from other hospitals’ problems or mistakes, rather than responding only when they occur at our institution. That’s why when we receive national alerts, we take preventive measures” to avoid similar problems at our medical center. The hospital also actively “benchmarks” itself, which is something of a report card where we compare ourselves to other hospitals, particularly to other children’s hospitals. In neonatal care, Children’s Hospital uses the Vermont Oxford scale, which examines a wide variety of neonatal indicators at various NICUs. We’re also part of BENCH, which stands for Benchmarking Effort for Children’s Hospitals. This is a group of about 30 children’s hospitals across the country that benchmark against each other and learn best practices from each other. Locally, Children’s participates in Knoxville Area Healthcare 21 initiatives, where area hospitals share practices and work together to develop best practices. One example of an initiative from Healthcare 21 was the development of protocols for ventilator care to decrease ventilator-associated pneumonia. In addition, this group advanced the development of Rapid Response Teams (RRTs) to identify and address changes in patient status before the patients reach a critical state. All area hospitals have implemented the teams. (See sidebar for more information on the Rapid Response Team at Children’s Hospital). Both of these Healthcare 21 projects have been recognized by the state for improving patient safety. The hospital’s Board of Directors is ultimately responsible to ensure that the QI process is thorough and complete. The Quality Management Committee of the Board meets quarterly to hear reports about the processes and results of QI and make recommendations for improvement. The board also provides for resources and support necessary for the implementation of plans, helps to evaluate plans’ effectiveness and identifies 8-10 QI priorities annually for the hospital. Rapid response teams provide better care for patients Rapid response teams (RRTs) represent one way Children’s Hospital is working to provide the best care possible for each patient. In the past if a patient’s condition reached a critical state, a staff member alerted a “code team” to race to the bedside and care for the patient (a “code” is a life-threatening event for a patient). Since December 2005, rapid response teams have been available at Children’s Hospital to intervene BEFORE a patient requires emergency care. If a staff member is concerned and thinks a patient may be developing a problem, or if that staff member needs assistance in evaluating a patient, the rapid response team is called to assess the patient and begin basic interventions to slow or even prevent deterioration in the patient’s condition. The rapid response team then notifies the patient’s physician, reports its assessment of the patient’s condition and receives additional orders from the physician. At Children’s Hospital rapid response teams are composed of a nurse from the Pediatric Intensive Care Unit and a Respiratory Care professional. Each team member brings extensive expertise in pediatric critical care to the bedside with the goal of preventing emergencies. The teams are available 24 hours a day, seven days a week not only for response but also to provide education and support to other hospital staff. The availability of the teams is reassuring to nursing staff members, who know that if they feel the need for additional help with a patient, it is readily available. Hospitals around the country, such as Children’s, that have implemented RRTs have seen a decrease in their rates of life-threatening events (“codes”). by Meghan Alcorn, student intern
  11. 11. Safe Sitter Dates: December 9, January 6 and 20 Time: 9 a.m. to 3 p.m. Safe Sitter is a national organization that teaches young adolescents safe and nurturing babysitting techniques and the rescue skills needed to respond appropriately to medical emergencies. Instructors are certified through Safe Sitter nationally. Participants must be ages 11-14. This course is $18 per person. CPR Dates: December 4 and January 15 Time: 6:30-9 p.m. This class will teach caregivers cardiopulmonary resuscitation and choking maneuvers. This class also gives general home safety advice and tips. This course is $18 per person. Class size is limited, so preregistration is required. All classes are offered in the Koppel Plaza at Children’s Hospital, unless otherwise noted. For more information or to register for any of these classes or to receive our free Healthy Kids parenting newsletter, call (865) 541-8262. Additional classes are being scheduled for 2007. Announcements about upcoming classes can be seen on WBIR-TV 10 and heard on area radio stations. Or visit our Web site at and click on “Healthy Kids Education and News.” Children’s Hospital’s Healthy Kids Campaign, sponsored by WBIR-TV Channel 10 and Chick-Fil-A, is a community education initiative of the hospital’s Community Relations Department to help parents keep their children healthy. 12 Estate Planning... knowing when NOT to do-it-yourself Include Children’s Hospital in your estate plans. Join the ABC Club. For more information, call (865) 541-8441. Please send the free brochure titled “Personal Information Record.” Name______________________________ Address__________________________________________ City___________________________ State_______ Zip_____________ Phone#(______)___________ Please call me at the phone number below for a free confidential consultation concerning planned giving. Please send me more information about deferred giving. I have already included Children’s Hospital in my estate plan in the following way: __________________________________________________________________________ Please send me information about the ABC Club. Children’s Hospital Development Office • (865) 541-8441 Americans are a self-sufficient group. We take pride in our homes, with many people doing repairs or enhancements themselves. Home improvement stores sell the needed materials and offer classes and self-help books on topics ranging from building a deck to landscaping your yard. But there is also a time you should not “do-it- yourself” – when you are preparing your will. That is the time you need the advice and counsel of your lawyer. No preprinted form, “Will Kit” or computer software can take into account all of your individual needs; only your lawyer can do that. Here is a brief list of some things you can accomplish with your will: • Name the person(s) you trust enough to carry out all your instructions after you are gone – your Executor, sometimes called your Personal Representative. • Specify whether your Executor is required to post a bond and file reports with the probate court. • Document your wishes about a guardian to take custody of your minor children. • Instruct the guardian(s) how to use your money for their benefit: ° Should they sell everything and put the proceeds in a trust to provide living and educational expenses? ° You can give a specific asset – home, securities, land. ° After all other bequests, you can leave some or all of the remainder to a charity. ° You can name someone special to be honored or memorialized by your gift. Perhaps this list gives you an appreciation for the task and helps you understand why the cookie cutter approach of a “Will Kit” cannot meet all your needs. This is why your lawyer is so important to the process. Your lawyer can prepare a document that precisely accomplishes each of your wishes. Remember the amount you spend on legal fees is small compared to the comforting security of a sound plan and the great peace of mind you will have when your will is complete. We have a complimentary Personal Information Record booklet that will help you gather the information your lawyer needs to begin working on your will. Please use the form below and the business reply envelope in this issue to request your copy. Or you can call Teresa Goddard, Senior Development Officer, or David Rule, Director of Development, at (865) 541-8244. ° What type of expenses do you wish to cover and what would you prefer not to spend money on? ° Are there certain items of sentimental value you would like the guardian to keep and give to your children when they reach a certain age? ° If there is money left after raising and educating your children, should it be turned over to them when they reach a certain age? If so, what age? And how should it be divided? ° Do you have special needs children who will require support into adulthood or perhaps for the remainder of their lives? • Specify how you would like to dispose of everything you have accumulated over your lifetime: ° Your home and any other real property ° Your personal property – clothing, furnishings, china, family memorabilia, artwork, vehicles, firearms, quilts, etc. ° Your cash and investments • Name the people you wish to benefit and specify what each person is to receive. • Name the charities you wish to support and specify the amount going to each. ° You can list a certain dollar amount. Upcoming Community Education ClassesUpcoming Community Education Classes
  12. 12. CCAALLEENNDDAARR OOFF EEVVEENNTTSS 13 JAMMIN’ IN YOUR JAMMIES Jammin’ in Your Jammies is an annual event designed to “cure those winter blues” and give young families a weekend of affordable fun. The event will take place January 26-28 at the Holiday Inn Select, Cedar Bluff, and all the proceeds from the event will benefit Children’s Hospital. A family of four can enjoy an overnight stay beginning with registration at 5 p.m. on Friday and concluding with a scrumptious Saturday morning brunch, OR they can register at 5p.m. on Saturday and conclude their weekend with a Sunday morning brunch. In the evening, families may participate in many activities, including games, a pajama contest, dancing to music, and swimming in the indoor pool. The Jammin’ event wraps up the following morning with brunch. The cost is $125 for a family of four, and additional guests in a family are $25 each. This price includes one hotel room for one night, dinner, snacks, breakfast and all of the entertainment and games. Star 102.1 radio will provide music for the event. Call (865) 541-8608 for more information or to register. DANCE MARATHON University of Tennessee students will dance the night away at the 2007 Dance Marathon February 23-24 at the Tennessee Recreational Center for Students (TRECS). Dance Marathon is completely run by students and is the largest philanthropy on the UT campus. Each year Dance Marathon raises around $100,000 for the Hematology/Oncology Clinic at Children’s Hospital. Students will enjoy live music from local bands and learn a Dance Marathon dance to perform at the end of the 14-hour celebration. Dance Marathon also features a children’s carnival for Children’s Hospital Hematology/ Oncology patients. Before the event each year, prospective dancers raise funds for Dance Marathon. For more information, call (865) 541-8745 or visit STAR 102.1 RADIOTHON The sixth annual Star 102.1 Radiothon will take place March 1 and 2 at West Town Mall. Marc, Kim and Frank from Star 102.1’s morning show will host the live event from 6 a.m. to 6 p.m. each day and encourage listeners and those who stop by to make a personal pledge to help Children’s Hospital. Another way to help is to place a bid during the Radiothon silent auction, which will feature a variety of items from local and national companies and retailers. All funds donated will benefit Children’s Hospital Home Health Care and fund the CarePages service on the Children’s Hospital Web site. Call (865) 541-8457 for more information. “CUTEST LITTLE BABY FACE” CONTEST The 17th annual “Cutest Little Baby Face” contest will kick off March 10 at Belz Factory Outlet World in Pigeon Forge. The contest is open to children ages 6 and younger, with Gary Woods Photography in Sevierville taking photos of participating children. Contestants may pre-register by completing a registration form at the outlet mall or by calling the Children’s Hospital Development Department at (865) 541-8745. The entry fee for pre-registration is $5, and registration at the event is $7. The fee includes a 5x7 portrait of the participating child taken by Gary Woods Photography. Pictures will be taken on March 10 and 11. Voting will take place at Belz on March 23 and 24; $1 donation to Children’s Hospital will count as 100 votes. The child with the most votes wins and will be announced on March 24 during the “Baby Face Parade.” B97.5 CHARITY BREAKFAST Join B97.5 for a delicious breakfast, entertainment and silent and live auctions benefiting Children’s Hospital. Local and national celebrities will provide entertainment for the event. The spring date and location are to be announced. Tickets are $10 at the door for adults and children ages 13 and over; $5 for children ages 8-12; and free for children ages 7 and under. By Amandalynn Thomas, student intern U P C O M I N G E V E N T S T O B E N E F I T C H I L D R E N ’ S Mark your calendars now for several upcoming events to entertain families and benefit Children's Hospital. Thanks to the generous people of East Tennessee who host and participate in these events, Children's Hospital can continue to provide the best pediatric health care to the children of this region. CCAALLEENNDDAARR OOFF EEVVEENNTTSS It’s time to buy a Children’s Hospital license plate! The Children’s Hospital specialty license plate is in danger of being abolished by the state due to low numbers of plate holders. The minimum number to maintain a specialty plate formerly was 500 license plates, but the state increased the minimum in 2005 to 1,000. Currently, only 800 Children’s Hospital plates are registered. Children’s Hospital must reach and maintain at least 1,000 active registrations (plates) by July 1, 2007, or our plate will be abolished. If this happens, the hospital will have to wait three years before it can pursue another specialty plate through a lengthy process. If you have purchased one of the plates, we hope you’ll renew the plate when it comes due. This is an easy way to help Children’s Hospital on an ongoing basis. If you have been thinking about purchasing the hospital plate, there has never been a better time! The plate is available continuously through each County Clerk’s office, and the cost of the plate is $35 in addition to each county’s renewal fee. Fifty percent of the revenue generated from the specialty plates directly benefits Children’s Hospital. If you have any questions about the specialty Children’s Hospital license plate, contact your local County Clerk’s office or the Development Department at (865) 541-8467.
  13. 13. 14 Has childhood obesity become more common in recent years? If anyone took a minute to look around at our day-to-day lives, most would answer “Yes” to that question, and that response would certainly be correct. The extent of this growing issue and its dangerous health consequences may be less obvious and a harder topic for us to understand. Statistics from the Centers for Disease Control and Prevention are alarming. In the 1960s and 1970s, four to five percent of children and teens in this country were overweight or obese. In the 1999-2002 survey, that rate had risen to 16 percent. When the number of children who are “at risk” for obesity (those who are borderline overweight) is included, the rate rises to a staggering 30 percent. In addition, the obesity epidemic is reaching younger and younger children; current information indicates that 10 percent of children ages 2-5 are now overweight. Dr. David Nickels, pediatric endocrinologist at Children’s Hospital, shares surprising statistics and results about the increasing rate of childhood obesity and its relationship to Type 1 and Type 2 diabetes. QQ:: The increasing rate of obesity in children and teens is alarming. What are the medical concerns for these children and teens? AA:: The real worry is the danger to health that comes along with this early obesity. Type 2 diabetes, high blood pressure, sleep apnea and stress on the heart leading to early heart failure or heart attack are all much more common in children, teens and young adults who develop obesity in childhood years. My biggest concern now CChhiillddhhoooodd OObbeessiittyy is that because of this new severity in the obesity epidemic, we are seeing more Type 2 diabetes onset in children and adolescents before they reach young adulthood. QQ:: There is much more information available about Type 1 diabetes, but what about Type 2? What are the symptoms and consequences of Type 2 diabetes? AA:: Formerly, Type 2 diabetes was known as “adult onset diabetes,” and that has definitely changed in recent years. Type 2 diabetes is a serious chronic health problem that results in many life- threatening complications, such as kidney failure, blindness and early onset of heart attack and stroke, and will shorten the lives of many children. It has been suggested in recent years that at the current rate of increase in obesity, this generation of children will be the first in history to have shorter overall life expectancy than their parents. QQ:: What is the difference between Type 1 and Type 2 diabetes? What are the main causes of each? AA:: With Type 1 diabetes, which is not related to weight, the pancreas loses the ability to produce insulin because of an attack by the immune system against the pancreas cells that make insulin. The insulin-producing cells are eventually all lost, and without insulin, the rest of the body cannot take up glucose from the bloodstream and metabolize it. Therefore, blood glucose levels rise higher and higher. People with Type 2 diabetes develop high blood sugars for a different reason, primarily because the body becomes less responsive to the insulin that is being produced. The pancreas still can produce insulin, but because of obesity over time, the body tends to become resistant to the normal effects of the insulin. As this worsens, blood glucose eventually rises. In children and young adults, the pancreas initially tries to compensate for this resistance to insulin and tries to produce extra insulin to keep blood sugar levels down. It may be able to do this for a while but eventually this becomes hard on the pancreas and stresses the pancreas cells, which then start to fail. As insulin levels then become lower in the face of insulin resistance, blood sugars rise, and diabetes develops. Although there are some genetic influences on who develops insulin resistance and at what age, the single biggest risk factor is obesity. Because so many young people become overweight at earlier and earlier ages, we are seeing this process of developing Type 2 diabetes occur in these adolescents, sometimes even as young as nine or 10-years-old. QQ:: As a physician, why do you think obesity is on the rise? AA:: The reasons are clear – children and teens are eating more unhealthy foods more often and getting less physical activity. Hours spent in front of the TV, video games and computer screens add up and take their toll. Children who watch the most TV have the highest obesity rates. Surveys also tell us that only five percent of school children have daily physical education. Most who have any P.E. in school only have it once or twice a week. Children also play outside less and rarely walk to school.
  14. 14. QQ:: What other factors contribute to the Type 2 diabetes onset problem? AA:: Nutritional issues are a major factor in the increase in Type 2 diabetes in children. Over-consumption of highly processed, high calorie foods and high sugar drinks while watching TV or doing homework can result in children consuming more calories than they need. Fast food intake, and restaurant food intake in general, is at an all-time high, and this almost always results in higher calorie intake on average than if children ate meals prepared at home. Intake of soft drinks and other high sugar drinks is up and milk intake is down significantly over the last 30 years. The problems are not just in the home setting. Schools often rely on vending machine sales of soft drinks and high calorie snack foods, candy and chips for income, and they often resist efforts to remove these machines from schools. Finally, constant daily exposure to advertising for unhealthy foods, drinks, and fast food marketing aimed directly at children with prizes, games and cartoon characters is increasing. QQ:: What can parents, teachers, health care providers and the community do to help? AA:: The problems are not going to be fixed overnight. However, small steps made by all of us on a daily basis can have a very powerful effect. Here are several ideas to get families started in making changes: Limit television and other “screen” time with your children, starting at a very young age. An hour or two a day is plenty. No matter what children end up doing when the TV or video game is turned off, it almost always involves burning more calories than watching TV or playing video games. 15 Increase outdoor playtime by 30-45 minutes per day, every day. Take family walks more often. Parents and grandparents must take the time to actively play with their children, and they must resist the use of the TV or video games as a “babysitter” for an unlimited time each day. Improve your family’s eating habits with a few simple changes. Work on reducing high sugar drinks and highly- processed, high-calorie snack food in your household, such as snack cakes, candies and chips. Eat out less often, especially fast foods, and prepare meals with more “unprocessed” foods such as fruits, vegetables, whole grains and low-fat dairy. Avoid higher calorie frozen convenience foods at home. Start early. Children who learn from an early age how to live healthier will be more likely to avoid obesity. We all know that changing habits later in life is much harder. Prevention of obesity in children will be more effective than trying to get children who are already obese to lose weight, and prevention efforts must start at birth. Finally, talk as often as you can with community leaders and school officials about the importance of making changes that will encourage healthier living. Incorporating brief exercise breaks in the classroom, removing vending machines with unhealthy foods and drinks, and limiting advertisement of unhealthy foods and drinks aimed at children could be important changes that will help all children live healthier lives. Health care providers can begin educating parents about these healthy lifestyle goals beginning even during well baby exams in infancy. Previous efforts by the American Academy of Pediatrics to push safety and injury prevention education by pediatricians have been effective, and similar campaigns can work for obesity prevention. This needs to be a priority for all pediatricians and family practitioners. Obesity rates in children, teens and subsequently adults can be lowered, and our children’s prospects for healthier lives can be increased. We owe them our best efforts in these areas. We all have busy schedules and lots of demands on our lives, which can make these efforts hard to achieve. But when we think of the potential consequences to our children and grandchildren, it is hard to think of anything that could be more important. Compiled by Janya Marshall, public relations specialist PPeeddiiaattrriicc EEnnddooccrriinnoollooggyy DDeeppaarrttmmeenntt aatt CChhiillddrreenn’’ss HHoossppiittaall ttoo ttaakkee ppaarrtt iinn ddiiaabbeetteess rreesseeaarrcchh The Pediatric Endocrinology Department at Children’s Hospital, under the direction of Dr. David Nickels, has received certification and authorization from the Type 1 Diabetes TrialNet coordinating center at George Washington University to begin enrollment in the Natural History Study. The Natural History Study is part of an international network of clinical trials under Type 1 Diabetes TrialNet. Launched in March 2004, TrialNet is a collaborative network of 18 international clinical centers along with affiliated diabetes researchers in many other locations. The program is dedicated to testing new approaches to understanding, treating and preventing Type 1 diabetes. This study will screen relatives of people with Type 1 diabetes for autoantibodies associated with the development of the disease. “We know that children, siblings and other first- degree relatives of people with Type 1 diabetes have increased risk of getting the disease,” Dr. Nickels said. “The risk of getting Type 1 diabetes is about 1 in 300 for the general public; however, this risk increases to about 1 in 20 for first-degree relatives.” To be eligible for a no-cost screening test in the Natural History Study, volunteers must meet one of the following criteria: • between one and 45 years of age and have a first-degree relative (child, parent or sibling) who has Type 1 diabetes. • between one and 20 years of age and have a second-degree relative (cousin, aunt/uncle, niece/nephew or grandparent) who has Type 2 diabetes. Children’s Hospital’s Pediatric Endocrinology Office is currently enrolling patients and first-degree family members for the Natural History Study. Phase 1 includes an initial blood test. After the sample results are returned, participants will either be sent to Phase 2 for further testing or will be told they do not carry the autoantibodies associated with Type 1 diabetes and will be released from the study. Also, TrialNet has now begun enrolling subjects age 12 years and older with newly diagnosed Type 1 diabetes in treatment studies looking at two different medication regimens. These regimens may help stop or slow the autoimmune attack on the pancreas and preserve some of the residual insulin production that is often still present temporarily at the time of diabetes diagnosis. Patients interested in participating in these treatment/intervention studies can be initially screened for eligibility at Children’s Hospital, and if qualified, would travel to the University of Florida for enrollment. For more information or to participate in the studies, call the Children’s Hospital Pediatric Endocrinology Office at (865) 971-7400 or visit the TrialNet Web site at By Janya Marshall, public relations specialist David Nickels, M.D.
  15. 15. Children’s Hospital 2018 Clinch Ave. • P.O. Box 15010 Knoxville, Tennessee 37901-5010 We always try to stay current with friends of the hospital. If for any reason you should receive a duplicate issue, please notify the hospital at (865) 541-8257. NON-PROFIT ORGANIZATION U.S. POSTAGE PA I D PERMIT 433 KNOXVILLE, TN The 25th annual Children’s Miracle Network Telethon to benefit Children’s Hospital is quickly approaching. This year’s telethon has been moved to Sunday, January 28, and will be broadcast live from 3:30 p.m. to midnight on WBIR-TV. This year’s telethon again offers viewers the convenience of donating to Children’s Hospital online during the broadcast. Those watching the broadcast on WBIR-TV can log on to and click on “Make A Donation” on the left side of the home page to make their contribution. Last year’s 24th annual CMN broadcast raised more than $1.8 million for Children’s Hospital. This total represents the tremendous generosity of the people of East Tennessee and their ongoing commitment to Children’s Hospital. The success of this year’s Children’s Miracle Network telethon is crucial in helping Children’s Hospital grow. Funds raised during the telethon will be used to purchase new and sophisticated medical equipment for various hospital departments. Support from the community throughout the telethon helps ensure that each child who comes to Children’s Hospital, now and in the future, is able to receive the care he or she needs. Children’s Hospital is a charter member of the Children’s Miracle Network. In 1983, the hospital participated in the first telethon that raised $95,487 in East Tennessee, all of which remained at Children’s Hospital for the direct benefit of its patients. Since its inception, the telethon has raised more than $23 million for our pediatric medical center. For more information about the Children’s Miracle Network broadcast, or if you would like to volunteer at the telethon, call (865) 541-8441 or visit By Amandalynn Thomas, student intern t e l e t h o n d a t e h a s c h a n g e d Children’s Miracle Network Telethon is January 28