wonders small

Fall 2008

a Publication of Maria Fareri Children’s Hospital at Westchester Medical Center

The Comeback Kid Lacrosse Defenseman Matt McIntyre’s Journey to Make the Team

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Also in this Issue Tips for Avoiding Sports-Related Injuries When Should You Take Your Child to the ER? Our Research Promises a Healthier Tomorrow

Fall 2008 The Comeback Kid 3 Giving Back 5 Playing It Safe 6 Are You Worried About Your Child’s Weight? 8 Neurosurgeons Join MFCH Team 10 Kids Designing for Kids 11 Research Holds the Key to a Healthier Tomorrow 12 Ridgebury’s Got Talent 15 Bumps, Bruises, Aches and Pains 16 Talking to Teens About STDs 17 Improving Emergency Care in the Hudson Valley 18 Experiencing Neverland 19 Read Small Wonders online or sign up to receive it electronically at www.worldclassmedicine.com/smallwonders. Westchester County Health Care Corporation Michael D. Israel, President and Chief Executive Officer

Board of Directors Officers John Heimerdinger, Chair Helen Blackwood, First Vice Chair John Spicer, Vice Chair Joseph Tomaino, Vice Chair Mark Tulis, Treasurer Emmeline Rocha-Sinha, Secretary

Directors Richard Berman Gerard Bernacchia Claudia Edwards Renee Garrick, M.D. Herman Geist Susan Gevertz Jon Halpern

Mitchell Hochberg Michael Israel (non-voting) Patrick McCoy Alfredo Quintero Steven Rogowsky Michael Staib

Maria Fareri Children’s Hospital at Westchester Medical Center Michael Gewitz, M.D., Physician-in-Chief Gerard Villucci, Senior Vice President for Administration Charlotte Cady, R.N., Vice President, Nursing

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At Maria Fareri Children’s Hospital and Westchester Medical Center, we care for the most severely ill and injured newborns, infants, children and adults from the Hudson Valley region and beyond. Because of the strong partnerships we have forged with community hospitals in the region, with managed care companies, with local doctors, with our patients and within the hospital, Westchester Medical Center has become a major healthcare resource in the tri-state area. With more than 3.6 million people in the region, each day hundreds of sick or injured people need to rely on us…and they can.

A Message from Our Physician-in-Chief Being a major healthcare center for children means not only providing excellent medical care in an environment specifically comfortable for children and their families, but also providing an environment conducive to developing better ways to understand and treat the problems that beset them. This issue of our regular news magazine highlights developments in clinical programs at Maria Fareri Children’s Hospital at Westchester Medical Center. It also provides insight into some of the scientific research activities ongoing with our academic medical center partner, New York Medical College. At Maria Fareri Children’s Hospital, our specialists are investigating causes of and better treatment for conditions such as asthma, cystic fibrosis, brain tumors, vascular abnormalities, chronic fatigue syndrome and cerebral palsy, among others. Only through active scientific research today can tomorrow’s cures be developed and better treatment programs be realized. Our research programs depend on both local and national support. For example, the neonatal research effort, which you will read about in this issue, has received more than $5 million in support from the National Institutes of Health, the New York State Department of Health and the March of Dimes. Maria Fareri Children’s Hospital is also one of only 20 American Lung Association-designated Asthma Clinical Research Centers nationwide and one of just five focused on pediatric patients. Cardiovascular research has also garnered several important NIH research awards and other sponsored support. In fact, throughout our clinical program roster, from oncology to gastroenterology, to child advocacy, research programs that supplement the outstanding clinical care we provide are under way. I hope you’ll enjoy reading about these exciting endeavors. Also in this issue, you will be introduced to our new neurosurgeons: Dr. Michael Tobias and Dr. Avinash Mohan, and you will find tips and advice for handling emergencies, avoiding Fall sports injuries and helping your children to stay fit. As our hospital continues to grow to meet the needs of the children of the Hudson Valley and their families, we hope you will remain interested in our programs and in our unique facility dedicated to children’s healthcare. When a serious medical problem or an unexpected injury strikes a child in our region, knowing where to turn is critical. Together we can make the lives of our children healthier and safer. And that benefits everyone.

Michael Gewitz, M.D. Physician-in-Chief Maria Fareri Children’s Hospital at Westchester Medical Center Published by Westchester Medical Center, Department of Marketing and Corporate Communications 110 Executive Offices, Valhalla, NY 10595, 914-493-8024 Kara Bennorth, Senior Vice President, Marketing and Corporate Communications David Billig, Director, Media Relations Isabel Dichiara, Director, Community Relations and Outreach Leslie Mills, Director, Editorial Information Andy LaGuardia, Director of Communications, Maria Fareri Children’s Hospital Katherine Turiano, Marketing and Communications Specialist Ben Cotten, Gordon Tunison, Rebecca Finch, Digital Imaging Ellen Lane, Staff Writer The information in this publication is written by professional journalists and/or physicians. However, no publication can replace the direct care or advice of medical professionals and readers are cautioned to seek such help for personal problems. Comments about this publication should be emailed to millsl@ wcmc.com.

cover story

The Comeback Kid Yorktown’s Matt McIntyre Makes the Team After Recovering from a Bike Accident

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Matt McIntyre was taking advantage of a warm and sunny day last October by mountain biking on the trails in FDR State Park in Yorktown. While his father and brother stuck to the paved biking trails, Matt decided to take a ride on a very steep, dirt trail. He had only been on the trail for about a minute when he struck a rock and went flying over the handlebars. His bicycle helmet was split down the middle from the impact, and he had scrapes all down one side of his body. As he lay on the ground, the one symptom Matt recalls is that he felt like he couldn’t breathe. A couple of passersby called 911. “I thought I might have just been winded from the fall and the EMTs thought I had a broken rib because it hurt whenever I took a breath,” says Matt, who recently joined the Yorktown Volunteer Ambulance Corps.

Matt McIntyre

At the community hospital where he was taken, Matt’s injuries didn’t appear serious at first. Once a surgeon viewed his CT scan, however, it was determined that Matt had a lacerated liver. Recognizing the severity of his injury, hospital personnel asked Matt’s parents if they wanted to transfer him to Maria Fareri Children’s Hospital at Westchester Medical Center, the only accredited pediatric trauma center in the Hudson Valley. Here, pediatric trauma surgeons are immediately available 24 hours a day, seven days a week, as are pediatric surgical specialists and pediatric critical care specialists. “Once we arrived at Maria Fareri Children’s Hospital, we discovered that Matt had a grade 3 (out of 6) liver laceration, a dislocated shoulder and a shoulder fracture,” says Matt’s mother, Dr. Carol Karmen, Associate Chief of General Internal Medicine at Westchester Medical Center.

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cover story continued from page 3

Matt and his dad, Lawrence

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Because a lacerated liver results in hemorrhaging, it can be a life-threatening injury. Matt spent four days in the Pediatric Intensive Care Unit (PICU) where critical care specialists continually monitored him to determine whether the liver had stopped bleeding.

For Matt, the injury meant more than missing school. An avid lacrosse player since second grade, Matt had his heart set on trying out for Yorktown High School’s Junior Varsity Lacrosse Team. Yorktown is known throughout the region as a powerhouse school for both boys’ and girls’ lacrosse.

Fortunately, in Matt’s case, it did. If the bleeding had not stopped, Matt would have required surgery and might have needed transfusions. He then left the PICU and spent another three days in the hospital as an inpatient before being discharged.

“His biggest concern throughout recovery was whether he would be able to play lacrosse,” says Matt’s mom. “Dr. Jenkins wasn’t going to let him play if there was any danger but he knew how important the tryout was to Matt.”

“We transferred Matt because we knew Maria Fareri Children’s Hospital was the best trauma center in the area,” says Lawrence McIntyre, Matt’s father. “ The nurses in the PICU were fantastic, and Dr. Wallace Jenkins from adolescent medicine was very, very attentive in follow-up.”

After five months of not being allowed to participate in any sports, Matt was finally cleared for activity one-and-a-half weeks before lacrosse tryouts. “I was in terrible shape because I wasn’t allowed to do anything for months,” says Matt.

Giving Back

Somehow, however, he was able to train sufficiently to make the cut. In fact, he was the only freshman defenseman to make the team.

Sometimes, a thank you note just isn’t enough.

“We thought the whole experience at Maria Fareri Children’s Hospital was very positive,” says Matt’s dad. “It wasn’t just the care. The hospital design made it very comfortable for one of us to stay with him every night and there were pleasant surprises like the dog that came to visit and jumped up on his bed.” In fact, Lawrence McIntyre says, Matt’s only complaint with his stay at the Children’s Hospital was that it wasn’t just a little bit longer: “He was hoping to be there when the Rockettes came to visit, but he missed them by a few days.”

That’s how Matt McIntyre, a Yorktown High School freshman, felt after being treated for a lacerated liver and shoulder injuries at Maria Fareri Children’s Hospital at Westchester Medical Center last fall. “The doctors and nurses at Maria Fareri Children’s Hospital took such good care of me that I wanted to do something to give back to the hospital,” said Matt. “So, I called the Children’s Hospital Foundation and found out they needed help setting up for the ‘Go the Distance’ walk in April.” When Matt mentioned his plan to his teammates on the Yorktown High School Junior Varsity Lacrosse team, they offered to help as well. Fifteen team members turned out the day before the walk to unload trucks, set up tents, chairs, tables and signs for the event. “The kids were so pumped up and excited about helping,” said Dr. Carol Karmen, Matt’s mom. “It was great to see.” The group made such short work of setting everything up that Margie Ostrower, Director of Special Events for the Children’s Hospital Foundation, has asked if they would like to make it a tradition. For his part, Matt says, he would be happy to return next April.

Matt and his Yorktown High School Lacrosse teammates helped set up for the “Go the Distance” fundraiser in April.

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feature article

Playing It Safe Help Your Child Avoid Sports-Related Injuries

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Sports activities help kids stay fit, learn teamwork and build self-confidence. But playing a sport also carries the risk of injury. Each year, more than 775,000 children under the age of 15 are treated in hospital emergency rooms for sports-related injuries. In fact, sports injuries are the number one reason for children to visit emergency departments. Most injuries occur to ligaments, tendons and muscles, with only five percent of injuries involving broken bones. In young children, however, the growth plates, or areas where bones grow, are at greater risk of injury. “The good news is that many of these injuries can be prevented if parents use common sense and take precautions,” says Iris Schlesinger, M.D., a pediatric orthopedic surgeon at

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Maria Fareri Children’s Hospital at Westchester Medical Center. To reduce the risk of injury, players should: •W  ear the right gear and make sure it fits. “A child should wear all the protective gear that is sold for the particular sport,” says Dr. Schlesinger. Protective equipment includes items such as pads for knees, chest, shin, shoulder and neck, protective eyewear, mouth guards and protective cups. Kids should wear helmets for baseball, softball, bicycle riding, hockey, in-line skating and riding scooters and skateboards. Parents who are not sure how to fit a helmet properly should consult coaches or sporting goods experts. Bicycle stores are particularly good at fitting bike helmets for children.

• Start training well before the season begins. Young athletes should begin running and working out at least a few weeks before the season begins, gradually increasing intensity and duration.

•T  ake breaks. Rest periods during practices and games will help prevent injuries. • Get a pre-season physical. Get a thorough check-up before practice begins.

• Always warm up and stretch before playing. Pay special attention to the muscles that will get the most use during play. For example, a pitcher or swimmer should focus on warming up the arms and shoulders.

• Wear shoes that fit well. If possible, get a professional to measure a child’s feet and help pick out the best shoes for his or her sport.

• Play with children of the same age and size. Pushing young athletes to play above their level invites injury because older children tend to be stronger and more coordinated. • Do not play through the pain. Tell your child that it is OK to come out of a game if he or she is hurt. See a doctor for injuries and follow doctor’s orders for recovery. • Play safe. Follow the rules against headfirst sliding (baseball and softball), spearing (football), and body checking (ice hockey).

Special tips for bicycle and skating safety The fall is a great time to get out on bike trails as a family or visit skate parks in your community. To avoid injury, make sure you: • Get a bike that is the right size for your child. Do not buy a bike for the child to “grow into.” For more information on finding the right fit, go to http://www.aap.org/family/bicycle.htm • Do not push your child to ride a two-wheeler before he or she is ready (usually at about five or six). • Helmets should have CPSC approval; look for a label or sticker. • A helmet should be worn so that it is level on the head, not tipped backward or forward. The strap should be fastened securely. You should not be able to move the helmet in any direction. • Never allow children to ride skateboards, scooters or use in-line skates in or around traffic. • All skateboarders and scooter riders should wear protective gear. Wrist guards are particularly important. • Stick to designated paths, skate parks or skate rinks.

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feature article

Worried About Your Child’s Weight? Take Control and Help Them Get Moving

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Nicknames, teasing and jokes — overweight children get more than their share of all three. But childhood obesity is no laughing matter.

It may be hard to tell if a child is too heavy, given that children’s bodies are always changing. Children often gain weight as they approach puberty.

The percentage of children who are overweight or obese in the United States has more than tripled since 1980; 18 percent are now obese and 31 percent are overweight. And the consequences are frightening.

To make that determination, most doctors rely on Body Mass Index (BMI), a number calculated by dividing a child’s weight in kilograms by height in meters squared.

Overweight children are at risk for diabetes, joint problems, depression, high blood pressure and heart and liver disease, says Richard Noto, M.D., Chief of Pediatric Endocrinology at Maria Fareri Children’s Hospital at Westchester Medical Center. “This is the number one health problem in the United States today and it has the potential Dr. Richard Noto to bankrupt the country if we don’t do something about it,” he says, adding that parents, schools and physicians must work together to turn things around. Pediatric cardiologist Usha Krishnan, M.D., concurs, “This is a very, very big problem and it begins in infancy, not adolescence or adulthood.”

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BMI is then compared to results for children of the same sex and age. Generally, children in the 95th percentile or higher — meaning the child’s BMI is higher than 95 percent of other children — are considered obese. Children with BMIs in the 85th percentile or higher are considered overweight. So, what’s to blame? There are two main culprits: too many high-calorie foods and not enough exercise. Contributing factors include Dr. Usha Krishnan working families with little time to cook; restaurant portions that are double what they were 20 years ago; and children who spend too many hours glued to the television or surfing the Internet instead of playing outdoors.

Genetics also play a part, but even children pre-disposed to being overweight can remain at a healthy weight with the right lifestyle choices — provided, of course, that those choices are made by the whole family.

Tips for Helping Kids Get Fit Want to help your child find a healthy weight? Make it a family affair.

“We do a lot of counseling to start with and explain that this is something the whole family must do. The onus should not be on the child,” says Dr. Krishnan. For younger children, physicians often try to hold a child’s weight steady so they will thin out as they grow taller. In teens who have already gone through puberty and the growth spurt, many physicians begin by cutting their calorie intake by about 50 percent.

•W  eight management is a family issue, not an individual issue. • Set a good example. You are your child’s best teacher when it comes to eating habits and attitudes about exercise. • Learn about good nutrition. Visit a nutritionist, read books or check out websites that deal with nutrition. Try the National Heart, Lung, & Blood Institute’s We Can!TM website at www.nhlbi.nih.gov/health/public/heart/obesity/wecan/

Dr. Noto says he emphasizes good nutrition, portion control and cutting back on sugary drinks and highcarbohydrate foods, both of which cause glucose levels to spike and appetites to increase. Later this fall, he will begin a 12-week, multi-disciplinary weight-loss program for children and teens that combines group meetings with nutritionists, exercise physiologists and a psychologist. For all ages, Dr. Krishnan and Dr. Noto both say, exercise is key. “Growing children should be getting 45 minutes of aerobic exercise every day and that does not mean standing around in the outfield at a softball game,” says Dr. Krishnan. “Riding a bike for 45 minutes; that’s real exercise.”

• Control portions. Don’t give children access to a whole box of cookies, for example. Divide boxes of treats into smaller portions and put the rest away. • Give children plenty of water. Low-fat milk is good, too. But offer fruit juices, which are high in sugar, in moderation. • Make family time more active. Play a game of Frisbee or volleyball in the backyard. Or go for a hike or bike ride. • Limit screen time. Try creating black-out hours when no one is permitted to use televisions, computers or video game systems. • Tell your children to go outside to play. • Avoid banning any food outright. Instead, allow treats like chocolate in moderation, not every day. • Keep healthy snacks like fruit around the house. • Read food labels and avoid foods with high fructose corn syrup as much as possible. • Transition to simpler, fresh foods from processed foods.

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staff profile

Two Neurosurgeons Join Maria Fareri Children’s Hospital

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Complex neurological disorders in children such as epilepsy, brain tumors, spina bifida and hydrocephalus often require a multi-disciplinary team of specialists to provide the most comprehensive and up-todate treatment. At Maria Fareri Children’s Hospital at Westchester Medical Center, the care of such children will now be overseen by two highly trained pediatric neurosurgeons: Michael Tobias, M.D., and Avinash Mohan, M.D., each of whom was recently named Co-Chief of Pediatric Neurosurgery. “Both are gifted surgeons who treat their patients with compassion,” says Michael H. Gewitz, M.D., Physician-inChief of Maria Fareri Children’s Hospital at Westchester Medical Center. “ They will enhance the services we provide to children of all ages with congenital and acquired disorders of the brain, spine, spinal cord and peripheral nerves.” Dr. Michael Tobias

A native of New Jersey, Dr.Tobias received his undergraduate and medical degrees with honors from Brown University in Rhode Island. He completed a one-year internship in general surgery and a six-year residency in neurosurgery at Albert Einstein College of Medicine in the Bronx, and completed a fellowship in pediatric neurosurgery at LeBonheur Children’s Medical Center and St. Jude’s Children’s Research Hospital in Tennessee. For Dr.Tobias, there are two elements to providing the best patient care: surgical skill and attention to a child’s emotional well being. As Chief Resident in Neurosurgery at Albert Einstein College, Dr.Tobias sought to improve both sides of the equation by redesigning a shunt system used to treat children with hydrocephalus (excess fluid on the brain) and establishing a new curriculum for neurosurgery residents to promote better communication. He feels strongly that caring for children poses unique challenges, but that’s what makes the job so rewarding.When treating children, he says, medical specialists really have multiple patients to consider -- the child and his or her parents. Specialists also

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need to collaborate closely with the child’s pediatrician and be sensitive to the child’s emotional well being. “The way I look at it, treating children requires extra care. I like that I’m responsible for getting it right,” says Dr.Tobias. Dr. Mohan brings a wealth of experience to Maria Fareri Children’s Hospital at Westchester Medical Center. A native of California, Dr. Mohan received his undergraduate degree with honors from Johns Hopkins University in Maryland and his medical degree from Case Western Reserve University in Ohio. He completed his internship and residency in neurosurgery at New York Medical College, during which time he served for one year as a Research Fellow at the Skirball Research Institute, affiliated with NYU. He then did his fellowship in Pediatric Neurosurgery at Children’s Memorial Hospital, Northwestern University Feinberg School of Medicine in Chicago. In his new position, Dr. Mohan plans to establish multi-disciplinary, specialty clinics to treat conditions such as brachial plexus injury, epilepsy and tethered cord syndrome. “Because children are still growing and developing, the neurological problems they have can’t be treated in isolation,” Dr. Mohan says.“Depending on the condition, the pediatric neurosurgeon may need Dr. Avinash Mohan to work with a pediatric neurologist, neuropsychologist, physical therapist, plastic surgeon or urologist.” Dr. Mohan, who has co-authored 16 academic publications, also plans to continue doing research on pediatric brain tumors. He says there are many promising treatments on the horizon that may improve outcomes for children with these problems. At the end of the day, both surgeons say what inspires them most about their work is the kids themselves. “Kids are very resilient,” says Dr. Mohan.“With children, you can do a brain tumor operation one day and watch them playing Nintendo the next day. It is a very hopeful and heartwarming job.”

child life

Kids Designing for Kids Holiday Cards for Sale

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For the 12th consecutive year, Maria Fareri Children’s Hospital at Westchester Medical Center is proud to offer seasonal greeting cards designed by our patients and their siblings. The cards, which feature winter scenes, can be purchased blank inside or printed with “Happy Holidays.” Personalized greetings are also available. The cards were designed by children working in the art studio with certified art therapists. Since its inception, the greeting card fundraiser has raised more than $55,000 to support programs at Maria Fareri Children’s Hospital. The cards are on sale at

www.wordclassmedicine.com/cards. Check them out!

One of the 2008 Maria Fareri Children’s Hospital Holiday Cards (shown above) was drawn by Michelle, age 16, using colored pencils and water colors. She is pictured here in the Children’s Hospital Art Studio.

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special report

Research Holds the Key to a Healthier Tomorrow And It’s All Happening Right Here at Maria Fareri Children’s Hospital

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Preserving future fertility in girls and young women who need chemotherapy… Unraveling the mystery of why some young people suffer from fainting spells or chronic fatigue syndrome… Reducing the incidence of cerebral palsy in premature infants…

These are just some of the goals of ongoing research by clinical specialists at Maria Fareri Children’s Hospital at Westchester Medical Center. As the premier children’s healthcare provider in the Hudson Valley, Maria Fareri Children’s Hospital is committed not only to state-of-the-art care, but to ensuring that tomorrow’s children are healthier by preventing serious illnesses or finding better treatments for them.

Dr. Kutluk Oktay is pioneering the use of ovarian rescue and transplantation to preserve fertility in young girls receiving chemotherapy. “The key to the best clinical care is to make sure your physicians are dedicated to research and teaching,” says Allen Dozor, M.D., Associate Physician-in-Chief of the hospital and Chief of the Division of Pediatric Pulmonology. “Our job is to always think about children, to involve them and give them access to the most promising treatments available.” The following is just a sampling of the many ongoing research programs at Maria Fareri Children’s Hospital. For a more in-depth look at our programs, visit www.worldclassmedicine.com/MFCHresearch.

Preserving Fertility It is a bitter irony of medical science that the chemotherapy that saves the lives of so many children and young adults with cancer or rare blood disorders also robs them of their ability to have biological children later in life. Kutluk Oktay, M.D., Director of the Division of Reproductive Medicine and Fertility at Westchester Medical Center, says it should not have to be that way. To that end, Dr. Oktay is pioneering the use of ovarian rescue and transplantation to preserve future fertility.

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“In pre-adolescent girls, it is not possible to freeze eggs or embryos for future use,” says Dr. Oktay. “The only technique at this time is to take ovarian tissue and freeze it with the hope of transplanting it later.” Dr. Oktay, who performed the first ovarian tissue transplant nine years ago, says he has performed more than 60 ovarian cryopreservation procedures and five transplants to date and a few babies have been born as a result. With this technique, one or both ovaries are removed using minimally invasive laparoscopic surgery. The ovary is then sliced into slivers about the size of a dime. Each sliver is soaked and packed with an anti-freeze substance to prevent ice from forming and damaging the eggs during the freezing process. The eggs are then frozen and cryopreserved. When the young woman or child is an adult who wants to have children, the ovarian tissue is transplanted into the abdomen near the uterus or under the skin of the forearm or abdomen. Eggs can be extracted and fertilized through in vitro. Although ovarian transplantation is still experimental, Dr. Oktay’s study has shown that once transplanted, the ovaries behave as they did in their original position. They produce reproductive hormones, restore menstrual cycles, and produce healthy eggs.

Unraveling the Mystery For teens and young adults who suffer from unexplained dizziness, nausea, headaches, fatigue and fainting, the reseach lab of Julian Stewart, M.D., Ph.D, may hold the greatest promise for figuring out what ails them and how to treat it.

Dr. Julian Stewart studies how the nervous, vascular and respiratory systems work.

A pediatric cardiologist at Maria Fareri Children’s Hospital, Dr. Stewart has been studying how the nervous, vascular and respiratory systems work and interact for more than 10 years. He is the principal investigator in four National Institutes of Health research studies.

Teens and adults, ranging in age from 14 to 29, come to Dr. Stewart’s lab from all over the United States and from other countries to participate in studies on postural orthostatic tachycardia syndrome (POTS), which causes the heart to race and sometimes causes blood pressure to drop when patients stand upright; chronic fatigue syndrome, which leaves patients without the energy for ordinary activities; and syncope, or fainting. Although POTS sufferers exhibit common symptoms including dizziness, nausea, exercise intolerance, headaches, shortness of breath, abdominal pain and difficulty thinking, the cause of their symptoms can vary from patient to patient, says Dr. Stewart. For one group of patients, the problem may stem from respiratory abnormalities that trigger changes in the autonomic nervous system, which regulates blood flow and heart contractions. In another group, the culprit may be decreased levels of nitric oxide and increased levels of angiotensin, molecules that help regulate blood flow. “It is not clear yet how these symptoms correlate to how the body works, although we are getting closer to answers for certain groups of patients,” says Dr. Stewart. For his research, Dr. Stewart relies on a variety of measures. In some tests, he uses painless lasers to measure blood flow in the skin under a variety of conditions. By using the skin as a surrogate for the entire body, Dr. Stewart says, he is able to test how blood vessels respond to different chemicals and stresses without disturbing the overall circulation and heart rate. His work is at the cornerstone of understanding these increasingly prevalant problems.

Changing the Odds Today, four out of five children diagnosed with cancer survive, with cure rates reaching 90 percent for acute lymphoblastic leukemia, the most common form of childhood cancer. That is a far cry from the 1950s when a diagnosis of cancer was virtually a death sentence for a child.

One area of particular interest is high-risk neuroblastoma, a solid tumor of the sympathetic nervous system. Although cure rates for children with low and moderate risk neuroblastoma are about 90 percent, cure rates for high-risk neuroblastoma are only about 45 percent. High-risk neuroblastoma is currently treated with surgery to remove as much of the tumor as possible and high-dose chemotherapy followed by a stem cell transplant with stem cells taken from the patient’s own blood before chemotherapy. When stem cell transplant was added to treatment for high-risk neuroblastoma, it increased survival by about 10 percent, says Dr. Ozkaynak. COG is now investigating whether two back-to-back stem cell transplants would improve survival even further.

Fighting Pulmonary Arterial Hypertension If Rajamma Mathew, M.D., can determine what causes pulmonary arterial hypertension (PAH), someday doctors may be able to prevent or reverse this debilitating and deadly disease. But that is a long way off. At this point, Dr. Mathew, a pediatric cardiologist and researcher at Maria Fareri Children’s Hospital, is trying to pinpoint molecular changes that occur in animals that go on to develop PAH. “The goal would be to identify a molecule that can be used in screening to determine which patients are at risk for PAH,” says Dr. Mathew.

Dr. Rajamma Mathew is trying to pinpoint molecular changes that occur in rats that go on to develop PAH.

“Pediatric oncologists want to increase the cure rate to 100 percent for all kids at all stages of cancer,” says Mehmet Fevzi Ozkaynak, M.D.

“Pediatric oncologists want to increase the cure rate to 100 percent for all kids at all stages of cancer,” says Dr. Mehmet Fevzi Ozkaynak.

As part of the Children’s Oncology Group (COG), an international consortium of more than 200 leading children’s hospitals and research centers, Maria Fareri Children’s Hospital is involved in dozens of ongoing clinical trials at any given time. Current studies are examining the use of antibodies to fight specific cancers, immunotherapy to boost the body’s immune response and the use of tandem stem cell transplants to fight the most aggressive cancers. Researchers are also working to tailor chemotherapy regimens based on an individual’s risk, so that children do not receive too little or too much treatment.

Children born with certain heart defects are at risk of developing PAH, as are some newborns who were exposed to certain medications during fetal life, and some newborns who are unable to maintain adequate oxygen saturation at birth because of lung disease or other problems. Regardless of the underlying causes, the changes seen in PAH are constriction and thickening of small pulmonary arteries leading to elevated pressure in the pulmonary artery and subsequent right heart failure. Working in the laboratory, Dr. Mathew induces PAH in rats by injecting a plant alkaloid. She then studies molecular changes that occur before the development of PAH. For example, within 48 hours of receiving an injection, rats exhibit changes in the lining of the blood vessels in the lung, while PAH is observed 10-14 days later. Her work has led to numerous scientific publications and important insights that may result in new therapies for this problem.

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The Missing “Ingredient”

Breathing Easier

Despite dramatic advances in survival and overall health for premature infants, one thing has not changed in the last 40 years: About 12 percent of infants born between 24 and 28 weeks gestation (6th to 7th month of pregnancy) have cerebral palsy or CP.

Could medication for acid reflux help prevent asthma flare-ups?

CP is an umbrella term for movement disorders caused by damage to a specific area of the brain. The lifetime costs associated with CP average one million dollars per child. Edmund F. La Gamma, M.D., Chief of Newborn Medicine and Director of the Regional Neonatal Center at Maria Fareri Children’s Hospital, says thyroid hormone may be the missing ingredient needed to reduce the incidence of CP. That’s because thyroid hormone is critical to brain development, and premature infants cannot make sufficient quantities of the hormone to meet their needs. Only one-third of physicians currently treat preemies for thyroid hormone deficiency because no one knows the correct dose.

Dr. Edmund F. La Gamma says thyroid hormone may be the missing ingredient needed to reduce the incidence of CP.

In an effort to change that, Dr. La Gamma recently completed a National Institutes of Health international trial aimed at determining how much thyroid hormone is needed for optimal development in a premature infant. Using a continuous infusion of thyroid hormone, his research team was able to bring levels to above the median for newborns without interfering with the body’s own production of thyroid hormone. “We believe we have the correct dose now,” says Dr. La Gamma, who served as Principal Investigator on the study. “The next step would be to see if supplementing with that dose gets the longterm results we would hope for.” Dr. La Gamma has proposed a five-year study to test the effectiveness of thyroid supplementation at 18 centers across the country. Premature infants would be treated with thyroid hormone to correct the deficiency and examined at two years of age to determine if CP has developed.

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That’s just one of the questions that Allen Dozor, M.D., Associate Physician-in-Chief at Maria Fareri Children’s Hospital and Chief of the Division of Pediatric Pulmonology, and his research team hope to answer. One of the questions Dr. Allen Dozor and his research team hope to answer: Could medication for acid reflux help prevent asthma flare-ups?

As one of only 20 Asthma Clinical Research Centers designated nationwide by the American Lung Association (and one of only five pediatric centers), Dr. Dozor and his staff participate in about a dozen ongoing clinical trials at any given time. Since 1999, the center has received more than $1 million in grants and regularly participates in multi-center trials funded by the National Institutes of Health. Maria Fareri Children’s Hospital is also one of 115 centers accredited by the Cystic Fibrosis Foundation for its patient care, teaching and research activities. One study under way is examining the relationship between acid reflux and asthma. Since the gastrointestinal tract and respiratory tract have many connections, doctors suspect that reflux may be one trigger of breathing problems. This trial will enroll 300 children to test whether adding reflux medication to regular asthma therapy reduces the incidence of wheezing and severe asthma attacks. Another area of interest is cystic fibrosis, which is characterized by thick, sticky mucus in the airways that leads to chronic lung infections throughout life. Although fewer people suffer from CF than asthma, the stakes are higher for researchers because patients have a shorter life expectancy. Dr. Dozor and his colleagues are investigating whether increased levels of Vitamin D can help prevent lung infections in CF patients. Children with CF already receive Vitamin D supplements, but the minimum standards are based on bone health, not on the ability of Vitamin D to fight infection, says Dr. Dozor. “There are so many new treatments in the pipeline,” he adds. “Doctors and patients just have to take the time and effort to participate in clinical trials because lives are at stake.”

For a more in-depth look at our programs at Maria Fareri Children’s Hospital, visit www.worldclassmedicine.com/MFCHresearch.

donor spotlight

Ridgebury’s Got Talent Faculty Variety Show Benefits Maria Fareri Children’s Hospital Imagine an episode of “Dancing with the Stars” in which the winning entrants perform the Chicken Dance while talented dancers are booed off stage. Imagine sitting quietly in the audience as members of a Wind Ensemble take their places and carefully open their music cases revealing … kazoos. Those were just some of the scenes that tickled the funny bones of audience members at Ridgebury School’s Faculty Talent Show in Ridgefield, CT. The school, which has a history of coming together to support good causes, went all out last spring to stage a variety show to benefit Maria Fareri Children’s Hospital at Westchester Medical Center, where two of its students are undergoing treatment for cancer. “We had a second grader and a sixth grader being treated for different types of cancer at the Children’s Hospital this year,” says Merryl Polak, a fifth-grade teacher who spearheaded the event with music teacher Glen Lebetkin. “The parents of the children being treated have said such wonderful things about the place that we wanted to do something positive because the hospital does so many positive things every day.”

Every teacher and staff member in the school participated in the show, which Polak says took months to plan and rehearse. The show also featured skits on “A Day in the Life of the School Nurse” and a “Fantasy Teacher’s Room,” as well as a vocal number by the school’s singer-principal, Elizabeth Smith. “We like to do fundraisers for good, non-profit organizations to teach the children how to get involved,” says Lebetkin. “What could be better than combining a love of music and performing with doing something good for the community?” Both children who were treated at Maria Fareri Children’s Hospital are doing well. The sixth grader who suffered from non-Hodgkin’s lymphoma is now cancer free and in the maintenance phase of treatment. The second grader who is being treated for leukemia should complete treatment this winter. “Funds are vitally needed to sustain the excellent programs and services of Maria Fareri Children’s Hospital so that children like (the two from Ridgebury) continue to receive the important care they deserve,” said Nancy Fornasiero of Ridgebury PTA. The show raised about $5,000.

From left to right: Principal Elizabeth Smith and music teacher Glen Lebetkin; a scene from the “Hard Knock Life” skit; and “A Day in the Life of a School Nurse.”

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feature article

Bumps, Bruises, Aches and Pains Do You Know When to Take Your Child to the Emergency Room?

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Your child falls and hits the back of his head. A nice, big, goose egg pops up on the spot where he hit the pavement. But after the tears, he seems fine. Does he need to go to the emergency room? Should you call your pediatrician? “I usually tell parents that for emergent problems they need to go to the emergency room, but for many of the most acute problems, it is best to call your pediatrician,” says David Markenson, M.D., Director of Pediatric Emergency Medicine at Maria Fareri Children’s Hospital at Westchester Medical Center. As Chairman of the American Red Cross Advisory Council on First Aid, Aquatics, Safety and Preparedness, and a member of the American College of Emergency Physicians Committee on Emergency Medicine, Dr. Markenson has helped write the guidelines on emergency care for children published by both organizations. He is also a frequent guest on television news shows such as “Good Morning America,” “Live with Regis and Kelly” and the “Today Show.”

What Constitutes an Emergency? “An emergency is a severe illness or injury that you believe is threatening your child’s health and may cause permanent harm,” Dr. Markenson says. “It can be the result of an accident or medical or psychiatric illness.”

• Acting strangely or withdrawing from others and becoming less alert • Unconsciousness or lack of response when you talk to your child • A large, deep cut anywhere on the body or a cut to the head, chest or abdomen • A burn that is large and/or involves the hands, feet, groin, chest or face • Bleeding that doesn’t stop after applying pressure for five minutes If a child has swallowed a suspected poison or another person’s medication, Dr. Markenson recommends calling your poison control center at 1-800-222-1222, even if the child has no symptoms.

Serious injuries are usually the result of a car or bicycle crash, a fall, burns, choking, electric shock, poisoning, near drowning or a firearms accident. If your child is seriously ill or injured, it is safer to have an ambulance transport him or her to a hospital than to do so yourself.

In addition to learning CPR and basic first aid, every parent should research area hospitals and decide where they would want to take a child in the event of an emergency, Dr. Markenson says. “As a parent, you don’t want to wait until you need an ER to figure out where you want to go,” Dr. Markenson says. “For the best care, you want to take your child to a hospital that has a pediatric emergency specialist on duty who is backed by all the pediatric specialties.”

Symptoms that warrant a visit to the emergency room include: • Difficulty breathing or increasing effort with breathing • Confusion, loss of consciousness, headache or vomiting after a head injury

• Rhythmic jerking and/or loss of consciousness (a seizure). • Skin or lips that look blue, purple or gray • Increasing or severe persistent pain • Neck stiffness with a rash or fever

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Dr. Markenson says many people do not realize they have a right to tell the ambulance driver which hospital they want their child to go to within reason. Maria Fareri Children’s Hospital at Westchester Medical Center has a fully staffed Pediatric Emergency Department with access to more than 150 pediatric specialists in all areas of medicine.

Dr. David Markenson

feature article

Talking to Teens About STDs As a Parent, Do You Know What to Say and When to Say It?

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Parents can give three basic messages. First, sex is part of relationships and an expression of love. Second, everyone should respect their own bodies and their partners’ bodies. Third, although sex feels good, it can have immediate and negative consequences, including STDs. The best approach is to be straight-forward and open to questions, not lecturing. “Find out what they already know and get straight to the point: When we exchange body fluids, we exchange germs – just like the germs on our hands – and they can cause serious illnesses,” says Dr. Velez-Domenech. In terms of specific diseases, Dr. Velez-Domenech recommends starting with a discussion about Chlamydia and human papillomavirus, or HPV; both are common and sexually transmitted diseases. (For fact sheets on these

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“They should hear this from their parents – the most important people in their lives,” Dr. Velez-Domenech says. “Honestly, most kids know more than their parents think. They’re often just waiting for their parents to gain the courage to bring it up.”

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While information needs to vary by age and maturity level, parents really cannot start talking about sex too early, says Gilberto Velez-Domenech, M.D., Chief of the Division of Adolescent Medicine at Maria Fareri Children’s Hospital at Westchester Medical Center. A good starting point is around age 11, when many girls begin to menstruate and both boys and girls experience signs of puberty.

STDs and others, visit www. worldclassmedicine.com/ STDs.) HIV/AIDS is another priority because while rarer, it can have devastating health consequences. “Those are the three to emphasize initially,” he says, “but eventually it’s good to cover them all.”

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If the thought of talking to a teenager about sexually transmitted diseases (STDs) is cringe-worthy, consider this: About half of all newly diagnosed infections nationwide are in people ages 15 to 24.

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h One crucial message is that STDs often cause no symptoms. Chlamydia can lead to burning during urination and abnormal discharge, for example, but about three-quarters of infected women and half of infected men have no outward signs, according to the Centers for Disease Control and Prevention. Untreated, the disease can cause permanent damage to the reproductive system.

That’s why preventing and testing for STDs should be the focus, Dr. Velez-Domenech says. Abstinence is the best safeguard, of course, but a teenager who is sexually active needs to use condoms. “They’re not perfect protection, but they’re the best we have,” he says. Those teens also should be tested at least once a year and anytime they change or add sexual partners. They can go to a pediatrician, family doctor or local clinic. As for parents who can’t get past their embarrassment, Dr. Velez-Domenech encourages them to ask their teen’s doctor for help passing on information. “Young people need the facts,” he says, “and those facts need to be correct.”

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grant update

Improving Emergency Care in the Hudson Valley

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When it comes to emergencies, there’s only one chance to get it right.

That’s why Maria Fareri Children’s Hospital at Westchester Medical Center has been awarded a $100,000 grant from the R Baby Foundation to improve emergency care for infants, toddlers and children at community hospitals throughout the Hudson Valley. As the recognized experts in pediatric emergency care in the region, physicians at Maria Fareri Children’s Hospital will develop a model for community hospitals that includes: • The equipment needed to care for children including newborns • Continuing education for emergency room physicians, nurses and technicians • Guidelines for assessing when a child needs to be transferred to a children’s hospital, and steps to take for a speedy transfer • Real time access to consults with Pediatric Emergency Medicine specialists

“This grant recognizes that the highest level of care for pediatric emergencies is at a children’s hospital,” says David Markenson, M.D., Director of Pediatric Emergency Medicine. “It also recognizes, however, that conditions may require that a child be taken to the nearest hospital, and that may be the community hospital.” The goal of the program is to ensure that community hospitals are equipped and trained in recognition, initial stabilization and transfer or referral for pediatric emergencies. Once a successful model has been piloted, Maria Fareri Children’s Hospital will administer an Emergency Department Program to educate the public about those community hospitals that have met the guidelines for optimal pediatric emergency care. The R Baby Foundation was founded by in 2006 to organize and fund efforts to improve the outcomes of medical care for infants, particularly those who contract certain viral infections within the first month of life. Phyllis and Andrew Rabinowitz started the foundation after their daughter, Rebecca, died at nine days of age from a viral infection that was incorrectly diagnosed as a common cold.

Phyllis Rabinowitz of the R Baby Foundation presents representatives from Maria Fareri Children’s Hospital with a ceremonial check symbolizing the grant. New York’s CW11 covered the event. Pictured from left to right: John Fareri, Chair, Children’s Hospital Foundation Board of Directors; Margie Ostrower, Director of Special Events, Children’s Hospital Foundation; Brenda Fareri, Children’s Hospital Foundation Board Member; Michael Gewitz, M.D., Physician-in-Chief at Maria Fareri Children’s Hospital; Betty Ellen Berlamino, Vice President/General Manager, CW11, David Markenson, M.D., Director of Pediatric Emergency Medicine; Phyllis Rabinowitz, Irv Gikofsky, also known as Mr. G, CW11’s News at Ten weather expert; Michael Israel, President and CEO of Westchester Medical Center; and Gary Brudnicki, Executive Vice President, Westchester Medical Center.

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volunteer focus

Helping Kids Experience a Little Bit of Neverland Pet Therapy at Maria Fareri Children’s Hospital

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In the play “Peter Pan,” the Darling family entrusts “Nana,” a big, lovable Newfoundland dog to serve as nursemaid to their three children. While Nana can’t speak, she clearly has a rapport with her young charges. For patients at Maria Fareri Children’s Hospital at Westchester Medical Center seeking a little of that same TLC, Rober t Fries and his dog Kai are happy to oblige. Kai, a 129-pound all black Newfoundland is a cer tified, insured pet therapy dog who visits children at Maria Fareri Children’s Hospital once a week.

“Newfoundlands are ideal for this type of work,” says Fries, a retired music professor who taught at Oberlin College. “Nothing bothers them - walkers, crutches or machines that make all kinds of noises.” Indeed, during a recent visit Kai gamely entered all patient rooms where he was welcomed. Fries always asks parents if their child would like a visit from Kai before entering. The minute Kai enters a room everyone in it lights up, and there are giggles all around. Amanda, 11, who is blind, cannot see Kai as he enters her room, but can feel the heft of the large dog when he places his paws on her bed. She reaches over to pet Kai and a smile emerges. In another room, Grant, 13, needs the side rail on his bed lowered in order to touch and see Kai. Still, another patient with a room full of visitors gets a kick out of the way Kai eyes the unfinished pizza on her table. Alex, 18, says he has been in the hospital many times over the years and enjoys Kai’s visits. “When you’re in the hospital, it is nothing but doctors and nurses poking and prodding you all day,” he says. “So, this is really nice. It’s a change of scenery.”

Robert Fries and Kai

Fries has been volunteering as a pet therapist since 1999, having learned about pet therapy from the Por t Chester Obedience Training Club. Kai is the second dog he has used for the program, and he is currently training a puppy for future duty. “You add a little bit of normalcy to an abnormal place,” he says. After patient visits, Fries returns to those children who have requested rides in a little red wagon pulled by Kai. As they wheel through the different patient “neighborhoods,” the hospital around them is all but forgotten. Children love to ride in Kai’s red wagon.

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Upcoming Events NICU Reunion

Radiothon

Wednesday, September 17

Wednesday-Friday, October 15-17

The Regional Neonatal Center at Maria Fareri Children’s Hospital at Westchester Medical Center invites all NICU graduates and their families for a reunion celebration. 3pm to 5pm. For more information, call (914) 493-8486.

Fourth annual WHUD 100.7 Children’s Miracle Network Radiothon to benefit Maria Fareri Children’s Hospital at Westchester Medical Center. Three days of live broadcasting from the lobby of the hospital where stories of hope and miracles are told. Tune in!

sail4kids

Wine Tasting and Charity Auction

Join us for the sixth annual sail4kids fundraiser at American Yacht Club in Rye, NY. A lobster dinner, casino and live auction will entertain you at one of the most beautiful places on the Long Island Sound. Visit www.sail4kids.org for more information.

Sixth annual Wine Tasting and Charity Auction held at Trump National Golf Club, Briarcliff Manor, NY. Learn about the world of wine as you taste wines from around the globe. Fabulous food paired with the wine as well as a fantastic auction of food, wine, travel and leisure experiences.

Friday, September 26

Thursday, November 13

For more information on events benefiting Maria Fareri Children’s Hospital at Westchester Medical Center, contact Margie Ostrower, Director of Special Events, Children’s Hospital Foundation, at (914) 493-5414 or [email protected]. To learn more about giving opportunities, please contact the Children’s Hospital Foundation at (914) 493-2525 or visit www.worldclassmedicine.com/MFCH. Want to hear from us? Sign up for a free weekly children’s health-related email, called Advance Notice, at www.worldclassmedicine.com/MFCH.

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