Public Health Leaders Urge Vaccination Against Measles

Physician-in-Chief, University of Maryland Children’s Hospital

It is impossible today to turn on the TV or read the news without hearing about the current debate surrounding childhood vaccinations and the measles outbreaks in the United States.

As chair of the Department of Pediatrics at the University of Maryland School of Medicine, I took the opportunity to encourage parents to get their children vaccinated by participating in a joint statement with other pediatric and public health leaders from around Baltimore. Please consider the public health benefits of vaccinating your children, and talk to your pediatrician to get the answers you need to feel comfortable with this lifesaving decision.

A Little Hero Recovers from Heart Surgery to Run Like Superman


Editor’s note:
For 2-year-old Thaddeous McKenzie, the Baltimore Running Festival was just a fun day when he got to run fast with a bunch of other kids. For his mother, Jennifer McAnany, and others who formed “Team Thaddeous,” it meant a lot more.  

By Jennifer McAnany

(as told to Amy Katz)

I felt my son grip my hand tightly as he wiggled in anticipation of the race. He was restless, but only because he was excited to run in the Kids Fun Run at the Baltimore Running Festival. I looked down at him, beaming with pride. I could think only about how truly blessed I am to have a healthy child who is living life to the fullest and being a normal 2-year-old.

When I was pregnant with my son Thaddeous, I wanted the best care possible for my baby. Because of complications, I was already considered a high-risk pregnancy, so I went to see Dr. Geoffrey Rosenthal at University of Maryland Medical Center. At 20 weeks, doctors found a heart defect and diagnosed Thaddeous with Tetralogy of Fallot. In this heart defect, it is difficult for the heart to pump oxygen properly, causing the child’s lips, tongue, and fingers to turn blue from lack of oxygen. The most common treatment for TOF is usually open heart surgery, and this surgery usually must occur within the first few months of life. It was scary for me because we wouldn’t even know how bad the defect was until he was born.

The day Thaddeous was born was very nerve-racking for me. He was born at UMMC – where they were prepared to perform open heart surgery on him immediately, if he needed it. As soon as he was born, the nurses came and assessed him. I was thrilled when I learned little Thaddeous was well enough to be able to go home from the hospital with me when I was released two days later. He was monitored every couple weeks and seemed to be doing okay.

About 11 weeks later, when we went in for a genetics appointment with Dr. Julie Kaplan at Upper Chesapeake Medical Center (part of the UM Medical System), she noticed that Thaddeous was looking a little blue, demonstrating one of his heart-defect symptoms. They had to immediately transport us from Upper Chesapeake hospital to the UM Medical Center in downtown Baltimore. It was a horrible weekend because his oxygen levels would drop every so often and he wasn’t scheduled to have open heart surgery until Monday morning. This is when we started calling him our little Superman because he pulled through his surgery and came out of it as our little hero.

Thaddeous McKenzie recovers after surgery. He's now a healthy 2-year-old.

Thaddeous McKenzie recovering after heart surgery at University of Maryland Children’s Hospital. 

 

The full-heart repair was a success and Thaddeous recovered fairly quickly. He was doing great. So when I heard about the Children’s Heart Program Running Team in the Baltimore Running Festival on Oct. 12, not only did I sign up to run – I signed up our little Superman. He even had his own bib number. And then several family members and friends signed up. As “Team Thaddeous,” we raised money for the program to be able to help other young patients and families.

Ready, Set, GO! The buzzer went off to signal the start.

Thaddeous ran as fast as he could, trying his hardest to keep up with the other kids and pulling me along with him. He was having a blast in his Superman shirt with his cape blowing in the wind, and I felt so glad he is still on the mend.

He will still have to have yearly check-ups for the rest of his life, but he is living life like a normal 2-year-old. He has his hiccups at times but what 2-year-old doesn’t? He walks, he plays, he kicks the ball and does everything he wants to do. The sky is the limit for him now.

As we crossed the finish line, still hand-in-hand, I once again realized how thankful I was.  He wouldn’t be able to be here running this race beside me for the Children’s Heart Program if it wasn’t for all of his doctors, nurses, and everyone who helped him get where he is today. I did the race for Thaddeous and to give back to the program that had helped us. It was like everything came full circle, and I can’t thank everyone at the University of Maryland Medical System enough.

Go to the Team Thaddeous page to see more photos of Thaddeous or to make a donation to sponsor his team’s fundraising effort.

Team Thaddeous

Team Thaddeous after running to raise money for the Children’s Heart Program and, below, with Dr. Rosenthal (third from left).

 

Group picture with Dr. Rosenthal

 

Occupational Therapist Shares Joy of Watching Lives Change

Lila Nappi, OTR/L, an occupational therapist in the Department of Psychiatry at University of Maryland Medical Center, wrote a moving letter to her colleagues after the culmination of a project they had worked on for more than three years. Last November, 14 adults became the first graduating class of the Academy of Independent Living, a unique program developed by the Division of Community Psychiatry. To read more about the event, see the previous post, Life Lessons for Independent Living Within a Community.

Dear All,

I just wanted to take a moment to share a few thoughts I have had since the graduation.

This has been quite a pilgrimage we have been on and, given the season, I just wanted to thank each of you for the privilege.  It is days like 10/10/12 and 11/14/12  that make it possible for me to be very proud to work for an organization that supports programs that transform people’s lives, members, family and staff alike.

Consistently, I heard from members and staff that they took the risk of getting outside their comfort zone in one way or another and were all the better for it.  I am struck by how we have learned to lead by example from the top down.

One example of this is Jill pushing us all to dream big. And then having the audacity to set the example and invite Kay Jamison. (Editor’s note: refers to academy founder Jill RachBeisel, MD, and keynote speaker Kay Redfield Jamison, PhD) I hear through the grapevine she is sending the graduates an autographed signed copy of her book — simply a class act.

Not to mention her inspiration, which was palpable on Wednesday. I kept looking at our graduates wondering what they were thinking and feeling and so hoping this is a turning point in their lives. Again we all made the seemingly impossible, possible. I hope as a result you see the world a little differently. We did not let fear, obstacle or negativity stand in the way of our goals and as a result we met them with meaning and purpose for all of us.

I have worked very hard during my 25-year career to create joy at work but I have never known joy like this. And for that, I thank you. It is role fulfillment I could not have imagined.

Best wishes for a wonderful holiday season and look forward to seeing you in the new year.

Fondly,

Lila Nappi

Life Lessons for Independence Within a Community

By Anne Haddad

UMMC Publications Editor

A brass ensemble played “Pomp and Circumstance” as the 14 graduates proceeded up the aisle. Family and friends wiped away tears of joy. One graduate, Richard Turnage, 31, spotted his mother, Tangera Keene, and stopped just long enough for her to snap a picture.

The proud moment was the culmination of a unique community mental health program that Turnage and his fellow graduates completed – a nine-semester curriculum focused on the skills and experience they need to make the transition to independent living.

Bryan Baird, the student speaker at the graduation, reminded his fellow graduates of all they had done.

“We learned how to interview for a job,” he said. “We learned how to cook meals [and] how to open a bank account. We went to the library and took public transportation.”

“Most of these patients were very young at the onset of their illnesses, which include mood and cognitive disorders. That greatly interfered with daily life,” said Jill RachBeisel, MD, (pictured above, center) associate professor of psychiatry at the University of Maryland School of Medicine and director of community psychiatry at University of Maryland Medical Center.

“In their teen years, at a stage when most of us learn our social skills, they were just hanging on for dear life,” RachBeisel said. “We wanted to develop a holistic, structured program to teach these skills that the majority of adults take for granted.”

Reaching Stability, then Gaining Skills

Before members of the academy progressed to residential rehabilitation, mental health treatment had allowed them to achieve stability. But even with this stability, the patients still had gaps in their experience and knowledge that might thwart their attempts to land a job, rent an apartment, get along with their neighbors and bosses or even to emotionally navigate a large family get-together.

Keene said she sees a big improvement in her oldest son, Richard Turnage, who was in the academy’s first graduation class this year.

“He is much better with his cousins, nieces and nephews when we all get together now,” Keene said. “There’s a big difference.”

“I’ve learned to manage my anger,” Turnage said.

RachBeisel developed the Academy of Independent Living three years ago. The learning and living both happen within each of the 19 single-family homes UMMC owns or rents in West Baltimore neighborhoods. The homes are run by UMMC Community Psychiatry’s residential rehabilitation program, Harbor City Unlimited.

Presentations are made in a classroom setting, and students then go out into the community to practice what they have been taught, and in some cases, even rehearsed, such as ordering food in a restaurant.

A Real Graduation

In some respects, the first-ever commencement ceremony of the Academy of Independent Living felt like that of any school, which is what the graduates wanted. Most had never had the opportunity to wear a cap and gown. In their teen years, when they might have gone to the prom and finished high school, the struggle with severe psychiatric disorders consumed their emotional and physical energy.

Their keynote speaker, scholar Kay Redfield Jamison, PhD, (above, left) professor of psychiatry at Johns Hopkins University, is internationally known for her writings on managing life with severe mental illness.

The graduates wanted as much of the pomp and circumstance as they could get, starting with a formal dance a month before the graduation at the University of Maryland, Baltimore.

AIL Formal Dance

Stella’s Bridal Fashions and Value Village donated elegant gowns that retail for hundreds of dollars and Horton’s House of Tuxedos donated rental tuxedos or suits for the men. Elegant catered appetizers, cheeses, fruits and desserts were set on lovely tables. Everyone danced and celebrated. Staff noticed the students, in their formal attire, were standing taller and more poised than ever.

“Most programs have bits and pieces of this. But none that I know of is as comprehensive and organized as ours,” RachBeisel said. “Everyone would agree with the concept, but it is having the skill sets available in the staff to execute all of it. Our use of occupational therapists in the program has brought a skill set that can help train the existing staff to carry out this program moving forward.”

“Her collaborations with all staff have made it possible for members to participate in transformational opportunities for a population that is so frequently left in the shadows,” said Lila Nappi, OTR/L, director of occupational therapy in the Psychiatry Department.

In addition to teaching skills, the program allows the residents to develop relationships with neighbors and supports their transition back into the community. The academy embraces the mission of “recovery in mental health treatment,” RachBeisel said. Individuals learn to manage their illnesses so they can recover their lives.

Nappi and other occupational therapists such as Mark Karolkowski, OTR/L, and Chris Greseth, MS, OTR/L, (pictured below, on either side of Nappi) were among the staff who celebrated at the formal and at graduation. They were central to the development of the curriculum and training other staff to teach the students life skills to be able to live on their own, get and keep a job, and interact with coworkers and others. Read a letter Nappi wrote to her colleagues about the joy she felt watching the students graduate.

Free Holiday Concerts at UMMC

Three different groups will be performing holiday music at the University of Maryland Medical Center the week of December 17, most members of which are University of Maryland doctors or medical students.

The concerts, which are from noon to 1 p.m. through Dec. 21, are on UMMC’s first floor, feature the following groups:

The Not2 Cool Jazz Trio kicked off the week on Dec. 17. The Trio is led by trumpet player Michael Grasso, MD, PhD, professor of medicine and emergency medicine, who plays the trumpet.

On Dec. 18-20, The UMMC Chamber Players return for the 25th year in a row. Founded and directed by cardiologist Elijah Saunders, MD, clinical professor of medicine, the Players feature musicians and vocalists who play and sing a variety of holiday favorites. The group’s music director is Candy Carson, an accomplished musician and wife of Benjamin Carson, MD, a Johns Hopkins neurosurgeon.

Wrapping things up is Otitis Musica, a group of medical students who have performed with the UMMC Chamber Players in the past.


The UM Chamber Players perform various Christmas songs in the hospital lobby near Au Bon Pain on Dec. 18-20th 2012 as an annual tradition.

 

Mandatory Pulse Oximetry Screening for Newborns Takes Effect in Maryland

By Carissa M. Baker-Smith, MD, MPH

Assistant Professor, University of Maryland School of Medicine

Pediatric Cardiologist, University of Maryland Children’s Heart Program

A quick, painless and non-invasive test to determine the amount of oxygen in a newborn baby’s blood is a first step in screening infants for congenital heart defects. Beginning September 1, 2012, hospitals in Maryland must administer the test to all newborns.

Congenital heart disease (CHD) occurs in approximately 8 of every 1,000 children.  Infants born with congenital heart disease have structural defects of the heart. Approximately 25% of all CHD cases are critical and require intervention during the infant’s first month of life. Interventions can include the administration of special medications or even surgery. Pulse oximetry may be helpful in improving the detection of critical CHD (CCHD).

On September 1, 2012, hospitals across Maryland begin mandatory pulse oximetry screening for all newborns. The screening must be done by a health professional before the infant is discharged and within 24 to 48 hours after birth. All hospitals in Maryland will be responsible for creating and implementing pulse oximetry screening protocols.

Children who “fail” pulse oximetry screening will undergo further evaluation, and their primary care providers will work closely with pediatric cardiologists to make the correct diagnosis. Failing the pulse oximetry test means oxygen saturation is lower than normal without another explanation, such as infection or lung disease.

What is pulse oximetry?

Pulse oximetry relies on the use of a non-invasive, painless method for detecting the amount of oxygen in the blood.  Probes are applied to the palm of the hand and the sole of the foot. The protocol selected by the State of Maryland for screening  is published in the Journal of Pediatrics (Pediatrics 2011; 128; e1259). Children with oxygen saturation less than 90% automatically test positive and fail screening.  Children with oxygen saturation greater than 95% test negative and pass screening. Children with oxygen saturation between 90% and 95% will undergo repeat testing and evaluation.

What is the potential impact of pulse oximetry screening?

We anticipate that pulse oximetry screening will enhance detection of CCHD. Data indicate that for every 1,000 children born in Maryland, 2.3 have CCHD.  Currently, between 60% and 70% of these infants are diagnosed through prenatal screening, leaving approximately 30% who are not yet diagnosed by the time they are born. Combined with physical examination, pulse oximetry is reported to improve sensitivity for detecting CHD by 20%.

What is the role of the Children’s Heart Program?

The University of Maryland Children’s Heart Program offers a comprehensive panel of services designed to accurately diagnose and effectively manage and treat children with CHD and CCHD.  Pediatric cardiologists are available 24 hours a day, 7 days a week, to assist with the diagnosis of CHD.  Through consultation and telemedicine services, the Children’s Heart Program is ready to assist surrounding providers and families with the evaluation of infants with suspected CCHD.

For more information on pulse oximetry, please contact the Children’s Heart Program at 410-328-4FIT (4348).

Dr. Baker-Smith is a member of the Maryland State Advisory Council’s Committee for CCHD and the Newborn Screening for Critical Congenital Heart Disease multi-institutional group.

A Mission to Ecuador for Pediatric Heart Surgeon

By Meghan Scalea

UMMC Communications Account Leader

Sunjay Kaushal, M.D., Ph.D., associate professor at UM School of Medicine and director of pediatric cardiac surgery at UMMC, recently returned from a medical mission to Ecuador, where he performed life-saving heart surgeries on nearly 20 children who would have died without surgery.

 

Dr. Kaushal, a father of two, is a huge advocate for kids. This medical mission to Guayaquil, Ecuador, was his fifth trip with the International Children’s Heart Foundation (ICHF), a group dedicated to providing supplies, training and surgical resources to care for underprivileged children with heart disease in dozens of countries around the world.

According to the ICHF, 1% of the world’s population is born with heart disease, only about one-third is diagnosed, and even fewer receive life-saving heart surgery. Congenital heart disease is the most common birth defect in the world.

“There is a huge surplus of kids with congenital heart disease,” says Kaushal. “Traveling with this group allows me to provide free health care for children who wouldn’t otherwise be treated.”

Joining him in Ecuadorwas UMMC certified surgical technologist, Nicolette Dupuis, who supports Dr. Kaushal in his pediatric heart surgeries in the OR in Baltimore. This marked Dr. Kaushal and Ms. Dupuis’s third medical mission trip together. During their week inEcuador, they worked with cardiologists and intensivists from hospitals around theU.S. in the sparse operating rooms.

 “Part of our job while we were inEcuadorwas to teach the local medical professionals to do congenital heart surgeries like we do, but on a smaller level,” says Dr. Kaushal. “Our day began at 7:30 am, and we’d operate until 9:00 pm. We staffed the ICU 24/7 during the time we were there to make sure those children had the post-operative care they needed.”

Dr. Kaushal is the only board-certified congenital heart surgeon inMaryland, giving him a unique expertise in performing surgical procedures on babies just a few days old who were born with heart disease, children with congenital and acquired heart disease, and adults living with heart conditions they developed as babies, known as adult congenital heart disease.

Dr. Kaushal performs the most complex pediatric heart surgeries available today, including surgeries for babies with hypoplastic left heart syndrome, Tetralogy of Fallot and ventricular septal defect, and those in need of pulmonary valve replacement. He is also preparing to open a clinical trial that will use a baby’s own stem cells to regenerate the underdeveloped portion of their heart caused by hypoplastic left heart syndrome.

We invite you to learn more about what Dr. Kaushal and the Children’s Heart Program at UMMC are doing for children within the Mid-Atlantic region.

Arthritis and Joint Problems Sideline NFL Pros and Weekend Warriors Alike

Robert Sterling, MD

Robert Sterling, MD

By Robert D. Sterling, MD
Associate Professor of Orthopaedics

Ouch! As you can imagine when you see a player get sacked, years on the football field can take their toll! A 2008 University of Michigan study of retired NFL players found that, compared to the general public, these former football greats have a very high rate of diagnosed arthritis. Their joints are, plain and simple, just worn out. So of the older retirees in this study, almost 25 percent have had at least one joint replacement. The vast majority have had knees replaced. Hips replacements are less common.

So as some great athletes take to the field this Super Bowl XLVI weekend, some of us former “great” athletes may be wondering if that creaky knee or aching hip needs a possible replacement. When is the right time to see a doctor about it? Listen to your body, and it will tell you: If you are experiencing pain, swelling or stiffness in one of your joints, now is a good time to get checked out.

During your evaluation, we will get a full history of your complaints and examine your joints to figure out why you are having pain. This history and physical exam is often followed by an x-ray to look at your bones. The first steps we try for treatment of arthritis usually involve exercise, weight reduction, knee braces, and medications to help your pain.

Whether you want to get back on a field or just back to playing with grandkids, diagnosis and appropriate treatment of any joint pain should be the next step in your training program.

For more information or to make an appointment, contact the University of Maryland Department of Orthopaedics at 877-771-4567.

Stories From Haiti: “I Will Never Forget What We Were a Part of”

By Steven Louis, M.D.
Director of Orthopaedic Trauma
Good Samaritan Hospital
Hinsdale Orthopaedics

Editor’s Note: Dr. Louis and several colleagues were invited to be a part of the sixth University of Maryland Medical team to help earthquake survivors in Haiti. Below are excerpts of an e-mail Dr. Louis sent to the UM team after returning to Illinois.

It is difficult to put all of what has happened and all of what has and is still going through my head, down in plain words on paper.

When people ask me how was the trip, my first response was hell. It is a great way to let them all know right off the bat of the conditions down there, from the structural, economic, climate, transportation, security, social and political situations. They all perk up after I say this. Then I go into what great work was getting done and how rewarding it was to be part of it. I tell them that I have never worked so hard in my life, and that there is LOTS more work left!

I want you to know that my team and I will never forget what we were a part of down there. As I said to you when we were down there together, we appreciate the invitation to help out, and we are all ready to spend another taxing (but rewarding) week down there.

You guys, in partnership with Catholic Relief Services, have put together a real class act that has far-reaching potential to make a huge difference. It is our honor to have been a part of the team, and we hope to be a part of a future team.

Teaching Medical Students to Focus on the Patient

By Richard Colgan, M.D.
Director of Medical Student Education
Department of Family and Community Medicine

Editor’s Note: Dr. Colgan is the author of “Advice to the Young Physician: On the Art of Medicine.”

Medical students and residents at the University of Maryland School of Medicine and Medical Center are learning lessons from some great doctors — most of whom have been dead for hundreds of years.

Third-year students rotating through the Department of Family and Community Medicine’s Family Medicine Clerkship are being taught how to make the transition from technician to healers by learning about some of history’s greatest physician educators. These include Hippocrates, Maimonides, Osler, Schweitzer and others. Such tips as, “If you listen to the patient, they will tell you the diagnosis,” are emphasized to these soon-to-be doctors of medicine.

Students are taught that looking for the patient’s unique “story” or “poetry of life” will sustain them and help them to become better doctors. The art of medicine is best learned by working alongside a senior mentor, but these students are also looking back to some of the teachings of medicine’s greatest educators to help them learn how to improve their relationships with their patients.

In an age when science has advanced by leaps and bounds, high tech is being complemented by “high touch.” By looking to the past, we hope to teach students and young physicians what some of the giants of medicine have practiced: that, in the final analysis, what matters most is focusing on the patient. Or, in the words of Francis Peabody, that “the secret of the care of the patient is in caring for the patient.”