Handprints - Spring 2004 - Children`s Hospital Oakland

Transcription

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A C H I L D R E N ' S H O S P I TA L & R E S E A R C H C E N T E R AT O A K L A N D P U B L I C AT I O N
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HandPrints
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inside:
spring 2004
thinking
big • PAGE 10
sugar breakdown,
research breakthrough
beyond
borders
CHILDREN’S PLAN TO BRING
OBESITY UNDER CONTROL
• PAGE 16
SCIENTIST FIGHTS PREVENTABLE
BLINDNESS
FIRST EVER DRUG THERAPY
FOR RARE DISEASE
• PAGE 20
2
CHILDREN’S HANDPRINTS
calendar
OF
events
table of contents
5
M AY
Auntie Anne’s, Costco Wholesale,
Rite-Aid and WalMart Children’s
Miracle Network Balloon campaigns
underway.
3
4
HEALTH FACTS
5
THIS AND THAT
One of a Kind Children’s draws on experts from many specialties to
provide unique care to kids with little-known disease.
Getting Into Character Movie star Juilet Binoche gets a science
lesson from a Children’s researcher.
12-14 Children’s Circle of Care
National Leadership Conference
and Gala in Washington, DC.
510-428-3885, ext. 2789
7
Notes That Heal Stressed? Area musicians want to soothe your day.
7
Springtime Gala at Oakwood,
hosted by the Grateful Families
Program, Oakwood Athletic Club,
Lafayette. 510-428-3885, ext. 5344
or www.gratefulfamilies.org
10
10
16
20
18
RESEARCHER PROFILE
Beyond Borders A Children’s researcher found the path to her
career in the mountains of Nepal. Her work could help cure the
leading cause of preventable blindness in the world.
22
CHILDREN’S HOSPITAL & RESEARCH CENTER
FOUNDATION
Honoring Decades of Support The Walk of Honor recognizes
those who have walked the talk by supporting healthcare for kids.
Commitment, a Trust and a Legacy A family’s investment helps
sick kids, supports leading-edge research, earns them a tax break and
a lifelong income.
5 Rubber Ducky Derby, hosted by
14 10th Annual Northern California
PHYSICIAN PROFILE
What Makes a Good Physician Great When oncologist Caroline
Hastings, MD, can’t ‘fix’ things, she can still make them better.
for Children’s Hospital. Nor Cal
Lawmen vs. Northern Valley Lions,
7:00 p.m., Diablo Valley College.
925-429-2758
Children’s Hospital Branches at
Oakland Children’s Fairyland.
510-428-3355
FEATURE
Sugar Breakdown, Research Breakthrough An experimental
drug therapy may lower the physical and psychological toll of a rare
genetic condition.
18
JUNE
3-4 Tax-Exempt Planning for the
5 Semi-pro football game benefit
FEATURE
Thinking Big You’ve probably already heard plenty about the
problem of childhood obesity. Experts at Children’s are ready to tackle
solutions.
26 Elegant, private reception
Professional Advisor, 8 a.m. to
4:30 p.m., Research Center library.
Presented by Children’s Hospital &
Research Center Foundation.
510-428-3362
IN THEIR OWN WORDS
Never Just Another Patient It takes a strong family to get through
childhood cancer, but after fighting repeated relapses, Adriana
emerged with an uncommonly sturdy spirit.
22 Residential Pacific Mortgage
hosted by Mark and Rebecca Pine
at their Alamo home for members
of the Children’s Circle of Care.
510-428-3885, ext. 2789
DEAR READER
Letter from the President
25
20
Golf Invitational for Charity hosted
by Marriott and Sodexho, benefiting Children’s Miracle Network.
510-428-3885, ext. 2983
15 Lombardy Branch Annual
Garden Cocktail Party in Lafayette,
benefiting the Center for Child
Protection. 925-254-6959
w w w. c h i l d re n s h o s p i t a l o a k l a n d . o rg
NEW SERVICE
Old Friends, New Neighbors New clinic provides specialty services
in Marin County.
SPRING 2004
dear reader:
This is our history: For almost a century we have delivered the best healthcare possible to all children who
needed it.
3
HandPrints
A C H I L D R E N ' S H O S P I TA L & R E S E A R C H C E N T E R AT O A K L A N D P U B L I C AT I O N
Children’s HandPrints is a publication
of Children’s Hospital & Research
Center at Oakland, 747 52nd Street,
Oakland, CA 94609; 510-428-3000.
Written, designed and produced by:
This is our passion: To unlock the mysteries of the
body so that we can prevent and cure human disease.
This is our essence: People you trust caring for
children you love.
This is our wisdom: Our patients are kids today, but
they will teach, cure, build and lead your communities
tomorrow.
Communications Dept. at
Children’s Hospital & Research
Center at Oakland
665 53rd Street
Oakland, CA 94609
Phone: 510-428-3367
Fax: 510-601-3907
Tony Paap
President and Chief Executive Officer
Mary L. Dean
Senior Vice President, External Relations
This is our vision: To make sure that your kids, your
neighbors’ kids, your colleagues’ kids, and their
friends, and their kids, and grandkids and great
grandkids…are healthy.
Tina Amey
Receptionist
Debbie Dare
Graphic/Print Designer
Susan Foxall
In this issue of HandPrints, I invite you to read about
the ways in which we uphold our legacy, sustain our
mission and accomplish our vision.
Operations Manager
Nina Greenwood
Marketing Manager
Cyril Manning
Senior Writer
Bev Mikalonis
Media and Community Relations Director
Tony Paap
President and Chief Executive Officer,
Children’s Hospital & Research Center at Oakland
Vanya Rainova
Publications Manager
Editor
Neile Shea
Senior Web Designer
Gary Turchin
Writer
Contributing Writers:
Leanne Aboumrad
Lisabeth Kirk
Cynthia Romanov
Cover portrait:
Elena Dorfman
4
health facts
A
*
When it comes to obesity in the United
States, the public health outlook has
declined dramatically—and with startling
speed. In just 20 years, the prevalence of
obesity has skyrocketed across the nation.
Obesity Trends:
The prevalence of obesity in
each state soared between
1991 and 2002.
[Center for Disease Control data]
*
No data
<10%
10-14%
15-19%
20-24%
>25%
1991
2002
t
*
* *
*
READ ABOUT HOW RESEARCHERS AND
CLINICIANS AT CHILDREN’S ARE FIGHTING THE EPIDEMIC IN THINKING BIG ON
PAGE 10.
Caused by Chlamydia trachomatis,
trachoma is the leading cause of preventable blindness in the world.
READ ABOUT DR. DEBORAH DEAN’S
WORK TO DEVELOP A VACCINE AGAINST
THE BACTERIA IN BEYOND BORDERS
ON PAGE 20.
WEIGHING IN ON SSRIs
Children’s psychiatrist advises families to
carefully weigh the efficacy of SSRI-type
medications against concerns about the
drugs’ safety.
This spring, the Food and Drug Administration began warning
doctors against prescribing the antidepressant medication Paxil, as
well as most other drugs in the SSRI family, to patients younger than
18 years. Much of the controversy has stemmed from a British study
that indicated an increase of suicidal tendencies among some
patients taking SSRI-type antidepressants.
For families who rely on SSRIs to manage a child’s clinical
depression or other mental illness, this raises understandable
concerns. However, Children’s psychiatrist Herbert Schreier, MD,
cautions families to weigh the efficacy of these medications against
their concerns about the medications’ safety.
The significance of the suicide risk has been overstated, Dr.
Schreier says. For example, while the British study found increased
suicidality in 3.4 percent among children taking Paxil, it found the
same suicidality in 1.2 percent of patients who were taking placebos
only—indicating that only slightly more than 2 percent—a number
that was not statistically significant—of children may have experienced suicidal thoughts or behavior due to the medication. The
results are consistent with those found in other studies of drugs in
the SSRI family. In addition, there were no actual suicides among all
1,700 subjects participating in several SSRI studies. Finally, Dr.
Schreier points out, a 10-year epidemiological study conducted in the
United States found that areas with increased use of such medications had a decreased rate of adolescent suicides.
“SSRIs also have been found to be very effective treatments for
potentially debilitating conditions, such as anxiety, panic disorders,
post-traumatic stress disorder and obsessive compulsive disorder,”
Dr. Schreier adds. “It would be very unfortunate for parents to
withhold them because of recent negative publicity.” #
SPRING 2004
this
this
this
this
that ANDthat ANDthat ANDthat
AND
this
AND
this
this
this
5
this
this
that ANDthat ANDthat ANDthat ANDthat
AND
that
GRAND OPENING!:
Jack (left) and Julia (below left)
at the opening of the Jack &
Julia Center for Tuberous
Sclerosis Complex. Below,
clinic director Candida Brown,
MD, explains images of the
brain.
N I C K L A M M E R S / T h e O a k l a n d Tr i b u n e
ONE OF A KIND
In April, Children’s opened the Jack
philanthropic foundations. Their efforts,
& Julia Center for Tuberous Sclerosis
paired with the expertise of Children’s
not an uncommon genetic disease, but
Complex, the only clinic in the region
pediatricians from many different
unless it’s touched someone you know,
and one of just a few in the nation
medical specialties, will provide new
you’ve probably never heard of it. The
dedicated to the disease.
hope to more than 300 patient families
Tuberous sclerosis complex (TSC) is
condition—which causes benign tumors
The families of Jack Leal and Julia
that wreak havoc in vital organs, includ-
Steenman, the TSC patients for whom
ing the brain—can devastate physical
the new center is named, raised funds
and mental functioning, can strike early
and awareness through garage sales
in childhood or go undiscovered until
later in life. Worst of all, there is no cure.
Thanks to the financial support and
advocacy of two Bay Area families,
Northern Californians dealing with TSC
can finally get comprehensive care from
experts specializing in this complicated
condition.
and by making passionate appeals to
every year. #
GETTING INTO CHARACTER
Juliette Binoche, the AcademyAward-winning star of the films Chocolat
and The English
H O L LY W O O D :
Children’s
researcher Julie
Saba, MD, PhD (r)
guides AcademyAward-winning
actress Juliette
Binoche on how to
be a scientist.
Patient, recently
brought a bit of
Hollywood glamour to the world
of cancer
research.
6
this
this
this
this
that ANDthat ANDthat ANDthat
AND
this
AND
this
this
this
this
this
that ANDthat ANDthat ANDthat ANDthat
AND
that
LIGHTS! CAMERA! ACTION!:
[ clockwise] A film crew lights up the
research institute to simulate daylight;
Drs. Julie Saba and Bert Lubin, senior
vice president of medical research,
were joined by Binoche for a reception
at Children’s to build awareness and
financial support for Dr. Saba’s research
in pediatric cancers, as well as other
types of medical research.
Binoche, who plays a research scien-
created to lift the spirits of
tist in her forthcoming film Bee Season,
patients, families and staff
consulted with real-life researcher Julie
at Children’s.
Saba, MD, PhD, while shooting scenes
for the movie in a Children’s laboratory.
The actress got an intimate view of
Healing Notes features
violinist (and program
founder) Donny Lobree and
Dr. Saba’s investigation of how particular
local harpists Mitch Landry
genes affect the life and death of cancer
and Diana Rowan. They
cells. It seems Dr. Saba’s character
perform several times a
coaching made quite an impression;
month in the Outpatient
the experience inspired Binoche to
Center atrium and in
make a special appearance at a recep-
hospital waiting rooms.
tion to raise awareness and financial
Sometimes the musicians play lunchtime
support for Children’s. #
concerts in the cafeteria and bedtime
L E T T H E M U S I C P L AY ! : Mitch
Landry and Donny Lobree play notes
that sooth and heal.
lullabies for young patients.
N O T E S T H AT H E A L
The sweet song of a violin. The
Lobree hopes that the soothing
about it. It changes their energy, and
power of the music has a ripple effect
hopefully they bring that to the rest of
soothing strum of a harp. A gentle
throughout the hospital community.
their day.” #
melody weaving through corridors and
“When people hear something
into waiting rooms around the hospital.
beautiful, it affects them, even if they
This is the music of Healing Notes,
don’t have the time to stop and think
SPRING 2004
7
of your child having the illness are less than
one in a million. It is an aggressive type of
leukemia, but new treatments promise a high
success rate. Physicians explained to us the
treatment that they wanted to use, and we read
about the rare but possible complications. The
doctors answered our questions over and over
again until we understood the medical inforAs parents of four children we have had our
mation.
share of tending to colds, flu, ear infections and
We checked in to the hospital, bracing for a
the common bumps and bruises of childhood.
two-month stay. I know “checked-in” makes it
But the black
sound as if we were in a hotel room during a
bruises that marked the body of our
vacation; that is exactly what Adriana
daughter Adriana and did not
made it feel like. She was busy checking
IN THEIR
go away were far from comout the hospital equipment, introducing
mon. I consulted a home
herself to the nurses and insisting on
WORDS
remedy book, but I also made an
going to the playroom, as if we were on
B Y LEANNE a field trip. Adriana looked so good and
urgent appointment with our
ABOUMRAD
pediatrician.
her spirits were so high, it was hard to
Our journey began with a poke of
accept that her life was so fragile.
Adriana’s fingertip on that visit in 2000. The
I felt numb for days. Adriana looked at me
results of her blood test were off the charts,
and said, ‘“Mom it must be bad because you
literally. We were referred to a blood lab for a
look terrible.” I knew then that I had to pull
more comprehensive work-up. When we
myself together for her sake. I asked my
returned home, Adriana hopped on her bike
husband to bring me shampoo so that I could
and rode away.
wash my hair for the first time in a week. I also
I was serving dinner when the phone rang.
asked that he bring a bag of Adriana’s favorite
The person on the other end of the line
games, music and books to keep her busy.
instructed us to take Adriana to Children’s
Hospital & Research Center at
Oakland immediately. She told us we
might have to spend the night there.
At the hospital, more blood tests
revealed our daughter had leukemia.
All of a sudden the world around us was
spinning at an impossible speed but we
had to keep up; there was a lot to learn,
understand and accept.
What type of leukemia?
A test of Adriana’s bone marrow confirmed the initial diagnosis and revealed
Adriana had acute promyelocytic
leukemia (APL). One of the first things
you learn about APL is that the chances
Never
Just
Another
Patient
Own
8
At the time, the hospital had not yet
completed the construction of its new
Blood and Marrow Transplant (BMT)
unit—a special unit with an air-filtration
system where kids whose immune
systems are weakened by chemo can
move about safe from germs. So our
once-energetic daughter was soon
like a very bad dream with no end.
Explaining the loss of Adriana’s full head
of hair to our younger daughter seemed
like a mild concern. We were so happy to
finally get to go home.
Adriana returned to school after a
summer of healing. Pediatric oncologist
Jim Feusner, MD, and the oncology
a new set of terms to learn and complications to consider. We feared the worst.
Halfway through our ordeal, our
insurance changed and our new provider
asked us to go elsewhere for a transplant.
We almost fell apart. We were convinced
there wouldn’t be the same rapport or as
much heart put into caring for Adriana.
The passion and enthusiasm of Adriana’s Children’s Hospital
role models have rubbed off on her.
Q U E E N O F A L L T R A D E S : Adriana as a Brownie, Girl Scout, a baseball fan, hip teen-to-be, and tile artist; siblings Reena and Anthony.
confined to her hospital room. She
underwent her chemotherapy and was
dependant on blood products, many
antibiotics and IV hydration.
Just two weeks into treatment
Adriana started having complications; in
fact, she had almost every complication
on the list. During that time, I most
fully appreciated the advantage of being
in a hospital just for kids. There was
almost no department at Children’s
Hospital whose specialists did not participate in securing Adriana’s health.
Cardiologists addressed her high blood
pressure. Gastroenterologists helped her
with her severe nausea. Radiologists and
infectious disease doctors were called in
to figure out the source of her inexplicable, long-lasting fevers. A dietician set up
a special diet for Adriana to help her
pancreatitis. An ophthalmologist examined her when she was color blind for a
few days. The 12-week ordeal seemed
team kept a very close eye on her. They
ordered monthly blood tests as well as a
bone marrow aspirate and a polymerasechain-reaction test (PCR) every six
months to monitor her for relapse.
One year after our discharge, a PCR
test showed the return of DNA mutations associated with APL in the blood.
A second test did not assuage our fears; it
confirmed them by showing even more
mutations, meaning that a relapse was
more than likely. Dr. Feusner and the
director of the Blood and Marrow
Transplant Program at Children’s, Mark
Walters, MD, advised that we consider a
bone marrow transplant as a way of staying one step ahead of an imminent
relapse. The procedure, they explained,
involved taking special, immature cells
(called stem cells) from a donor’s bone
marrow and giving them to Adriana. In
her body the stem cells could grow to
become healthy blood cells. Now we had
Timely tests would have had to be rerun
and time was of great concern because of
the type of leukemia our daughter had.
Going to another hospital could have
made a difference of a cure. But staff at
Children’s Hospital assured us that we
could stay. They said they would bill the
insurance company for most of the transplant and that the hospital would cover
the remaining cost. They lived up to
their motto of “no child turned away.”
Adriana’s 12-year-old sister, Reena,
became her bone marrow donor. For a
transplant to be successful, donor stem
cells should genetically match the
patient’s cells as closely as possible.
Adriana’s sister was a perfect match.
Adriana’s transplant was a textbook case.
Although she did have to endure more
chemotherapy and treatments with blood
products and antibiotics, there were no
complications. We stayed at Children’s
Hospital for two months. We were happy
SPRING 2004
however, involved another prolonged
hospitalization. This time, we stayed in
the new BMT unit where kids are able to
leave their rooms and mingle in the hallways and the playroom, which is open
24 hours. Unfortunately, Adriana was so
sick and weak that she rarely got up to
walk. The Infectious Diseases department was called upon again to study her
charts to see why her fever was reaching
106 degrees. The hospital blood bank
worked to secure much-needed and
to return home as a family of six and
enjoy the simple things in life.
Adriana had to miss a year of school
before her immune system became
strong enough for her to go in crowds.
She often baked cookies and brought
them to her doctors and nurses at her
monthly clinic appointments.
Determined not to give in to sickness,
Adriana ran—and was elected—for class
office at school, earned her Girl Scout
Bronze Award, learned to snorkel in the
ocean and even snowboarded.
Eighteen months after her transplant,
a relapse shocked us. Adriana’s sister’s
donor cells had been 98 percent in
charge six months earlier, but the aggressive APL had its own agenda.
It took two rounds of chemotherapy
to get Adriana into remission. Some
treatments were administered in the
Outpatient Center Day Hospital, which
meant that Adriana was often able to
get treatment and go home for family
dinners. The final round of chemo,
hard-to-find white blood cell donations
so Adriana’s body could fight a deadly
infection. A physical therapist came to
Adriana’s room to help her get back in
shape. Friendly faces popped inside the
room, and people offered to do anything
that could bring us comfort at a very
difficult time.
In hope for a lasting cure, Adriana
had to face a second transplant. We
changed our insurance to lift any worry
that we might have to go to someplace
other than Children’s. We were at our
darkest moment of fear for our
daughter’s health.
Dr. Walters suggested that this time
Adriana’s older brother, Anthony, be the
donor. They took stem cells from his
bloodstream. In preparation for the
transplant, Adriana had to endure fullbody radiation. The new rounds of
chemotherapy and radiation placed so
much stress on her body that she ended
up in an isolation room in the Intensive
Care Unit, fearing heart failure. The
9
efforts of the entire staff made it possible
for her to return to the BMT unit. Tears
came to my eyes to see her enjoying
music lessons from Child Life staff. She
loved working on projects with the Art
for Life artist-in-residence in the playroom and participating in creating the
tile art that decorates the newly
redesigned hospital entrance.
With nine months of agony during
Adriana’s third bout with leukemia
behind us, we were able to go home joyously. Every month Adriana is feeling
better and better. Her “new” immune
system is fighting her body. She has a
mild graft vs. host disease that Dr.
Walters is treating. That means greater
hope for a long-term cure because the
immune system is also fighting the
cancer.
We celebrated Adriana’s 11th birthday by letting her have a slumber party
with her friends. She still bakes cookies
for her nurses, who seem like family. She
also bakes cookies by the hundreds for
charity events that benefit kids. A food
drive Adriana ran using hospital pillow
boxes collected more than 3,000 food
items. In March of this year, Adriana got
an award from the Red Cross and the
Oakland Fire Department for
Outstanding Acts of Kindness for her
community service. The passion and
enthusiasm of the Children’s Hospital
role models, around whom Adriana
spent four years, have rubbed off on her.
We don’t know what the future will
bring, but we live at peace, knowing that
we, as well as our care providers at
Children’s, have done the best we can.
I’m grateful to all of the hospital staff not
only for the expert medical care they
provided, but for the way they made us
feel—as if we were their top priority,
never “just another patient.” #
10
Thinking
i
BG
Doctors and scientists at Children’s have an
ambitious plan to bring child obesity under control.
by
Cyril Manning
When Julie Blair brought her 9-year-old daughter, Janelle
to their pediatrician last year, she wasn’t
worried about a specific medical problem. Instead, she
was looking for general advice about managing Janelle’s
weight. “It wasn’t a huge problem,” says Blair. “But I
knew she didn’t look like most of her friends.”
I L L U S T R AT I O N S B Y N E I L E C . S H E A
SPRING 2004
11
Janelle was about 25 pounds over
Fifteen percent of U.S. children— and nearly 30
the ideal weight for her age, which easipercent of children in Oakland—are overweight.
ly put her on track for high blood pressure, heart problems, diabetes risk and
other serious health issues down the
should address this issue, we realized it
obesity has overtaken smoking as the
road. Among other tests, Janelle’s doctor
didn’t make sense to deal with just one
number one cause of preventable deaths
measured her cholesterol and found that
small aspect of it,” Dr. King says.
in the country, and that today’s kids are
it was dangerously high. He recomgaining weight twice as fast as their parmended that the family eat more
ents did at the same age. According to a
healthly, and referred mother and
HEALTHY KIDS, NOT SKINNY
recent poll, Californians now see obesity
KIDS
daughter to a unique nutritional counas
a
bigger
risk
to
children
than
unsafe
Indeed, there are many reasons why
seling program at Children’s Hospital &
sex
or
drug
or
alcohol
use.
children—and
Americans in general—
Research Center at Oakland.
“The
problem
has
roots
that
are
are getting fatter. Cheap, quick meal
Until recently, tracking cholesterol
very deep in our society,” says Janet
options loaded with extra calories are
in children Janelle’s age was unheard of,
everywhere, from the
and the health risks associprocessed foods in grocery
ated with high cholesterol
aisles to the much-maligned
levels, such as heart attack
yet unfalteringly popular
and stroke, were of little
fare of fast-food chains. In
concern to pediatricians.
Joey’s mom packs a
addition, advertising for
That’s not the case today.
“Big
Grab”
bag
of
sugary sodas and snacks is
Weight-related “adult” medFritos
corn
chips
in
his
lunch.
not only ubiquitous, but is
ical problems are increasingAccording
to
the
also targeted directly at
ly common among Janelle’s
nutrition information on the bag,
children. As Children’s
peers—a trend many
how many friends should Joey
endocrinologist Cathy Egli,
experts see as foreshadowing
share his chips with?
MD, puts it,
a generation of teens with
“Our bodies have adapted
cardiovascular disease.
over thousands of years
There’s little chance you
to protect us against
haven’t heard at least some
starvation, but we’re not
of this already. Child obesiKing,
PhD,
a
Children’s
research
protected
against
excess. When we have
ty has been making a steady stream of
scientist
who
also
chairs
a
federal
panel
availability of more and more, we take
headlines ever since the U.S. Surgeon
responsible for revising the nation’s
advantage of it. Our diets have become
General declared it an epidemic in
nutrition guidelines. “Countering
‘super-sized,’ and so have we.”
2002. Fifteen percent of U.S. chilobesity is going to require thinking
It doesn’t help that kids are moving
dren—and nearly 30 percent of chilbig.”
less, as well. Although the time kids and
dren in Oakland—are overweight.
At the core of the hospital’s response
teens spend watching TV has remained
Among Children’s patient population
to the epidemic is a new, wide-ranging
about the same over the last ten years,
the issue is even more urgent; in 2002,
program led by King called Healthy
their combined TV, video game and
25 percent of patients were overweight
Eating,
Active
Living
(HEAL).
The
computer “screen time” has grown
and 40 percent were considered “at risk”
effort
integrates
obesity
treatment,
prephenomenally. Over the same period,
(see “Who’s overweight and who’s
vention, research and outreach. “When
physical education has practically
obese”, page 14). As recently as this
we thought about how Children’s
disappeared from many schools. The
March, separate studies concluded that
Portion
Distortion Quiz
There are 2.5 servings in one
“big grab” bag, so Joey should
share with one and a half friends!
12
NOT COVERED
Despite health implications, most insurers don’t cover weight
management.
Ten-year-old Miguel may be
one of the “fat kids” in his
school, but his round cheeks
frame an irresistible smile, and
his family has always seen his
30 extra pounds as harmless
baby fat. His pediatrician saw
otherwise; Miguel’s weight and
family history put him at risk for
diabetes, so the doctor referred
the family to a group nutrition
counseling session at Children’s
called Fit Families.
There, Miguel and a handful
of other kids learned about
nutritional choices and getting
active from Children’s dietician
Karen Amorde-Spalding, MS,
RD, CSP. By the end of the
class, Miguel had a list of things
he was going to do to be
healthy—such as always eating
breakfast, drinking milk and
water instead of soda, and
practicing his karate. And mom
got shopping and cooking tips
that would help improve the
family’s diet.
Attending such as a session
is a luxury many families can’t
afford. Fortunately, Miguel’s
family didn’t pay a penny. That’s
because Alameda Alliance for
Health, a non-profit health plan
serving the county’s Medi-Cal
population, pays the full cost of
Fit Families for its members.
That kind of reimbursement
is not the norm. “Until a weight
problem impairs other aspects
of a person’s life, insurers generally consider obesity to be a
lifestyle choice—which means
it’s not covered,”says Debbie
Nielsen, director of Managed
Care at Children’s.
The idea of lifestyle choices,
of course, misses the mark
when it comes to kids. “Part of
the problem is that the health
insurance industry is generally
geared toward adults,” says
Nielsen. “Reimbursement rates
are guided by Medicare which
doesn’t include any model for
things that affect children in a
unique way.”
Nielsen says there is a growing awareness in the managed
care industry that weight issues
need to be addressed. “The
problem is that no intervention
has been studied thoroughly
and proven effective. In the
absence of that, companies are
approaching the issue in the
same way they deal with smoking cessation: providing some
limited benefit with regard to
health education, but stopping
short of paying for services as if
they were medical treatments.”
So, why does Alameda
Alliance cover the full cost of
Children’s nutrition education
programs for its members?
Elizabeth Edwards, director of
education at the HMO, says the
company sees obesity prevention as a matter of principle.
“The potential health outcomes
for people who reduce their risk
of developing type 2 diabetes,
heart disease, cancer and
depression are clearly in line
with our mission,” she says.
“We believe that education
empowers people to improve
their own health.” #
problem is worse in poor and urban
areas, including many Oakland neighborhoods.
It’s enough to overwhelm parents
concerned about their child’s weight.
But families shouldn’t have to face the
issue on their own—that’s why
Children’s offers several programs to
help families such as Julie Blair’s.
Although her family began eating more
healthy and became more active as
soon as their pediatrician spotted
Janelle’s high cholesterol levels, attending Way To Go Kids, a six-week group
counseling program offered through
Children’s Division of Clinical
Nutrition, gave them the support and
knowledge to embark on a long-term
lifestyle change—not just a temporary
diet.
“That is exactly the point of the
program,” says Karen AmordeSpalding, MS, RD, CSP, director of
Clinical Nutrition. “We aren’t concerned with making kids skinny, we
want to make them healthy.” To that
end, the Way To Go Kids sessions are
led by a pediatric dietician who helps
families better understand nutrition
and their own eating habits, as well as
come up with creative ways to get
active.
“It’s really a family issue, not a
child issue,” says Amorde-Spalding.
“We make a point never to single out
the child. The whole idea is to instill
healthy habits that the whole family
can work on together.”
For Janelle and Julie, that approach
has proven successful: Janelle has lost
weight. “At first, Janelle kind of had
the attitude that she already knew this
stuff, because we had already seen
SPRING 2004
another dietician and we had talked
about her weight,” says Blair. “But
simply hearing, ‘This is what you can
eat and this is how much you can eat,’
doesn’t compare to getting food choices
and portion sizes out in front of parents
and kids, the way this program does.
Now, sometimes when I’m buying or
ordering the wrong type of food she’ll
catch me and say ‘Mom, we shouldn’t
have that—remember?’”
Children’s offers other weight
management
services as
well—including singlesession Fit
A typical cheeseburger 20
Families interyears ago had 333
ventions based
calories. How many calories do
on the Way To
you think are in today’s
Go model, indiaverage fast-food cheeseburger?
vidual nutrition
counseling, and a
Portion
Distortion Quiz
13
unique preventive pediatric cardiology
clinic for children with advanced,
weight-related medical problems. In
addition, Children’s endocrinologists
treat about 100 children whose type 2
diabetes is related, at least in part, to
their weight. Each of these services
predates the creation of HEAL, but
collectively their expertise contributes
to the strength of the new, broader
program.
PREVENTION IS KEY
Even the most successful programs
for treating overweight children are
limited in the impact they can have.
Today’s typical burger has 590 calories—
75 percent more than 20 years ago.
14
Waiting lists are often long, and most
insurance plans won’t cover the cost of
weight management services such as
Way To Go Kids despite strong
evidence that such interventions can
reduce long-term healthcare costs.
(One notable local exception is
Alameda Alliance for Health.)
Getting access to treatment can be a
problem for families, and a system that
relies solely on treatment options is
equally frustrating for doctors, nurses
and other care providers. “The key to
solving the obesity problem is not treatment, but prevention,” says David
Breland, MD, of the Children’s Teen
Clinic.
Together with Lydia Tinajero-Deck,
MD, a Children’s urgent care physician,
Dr. Breland will run the HEAL program’s monthly preventive clinic for
kids who are at risk of being overweight. The clinic, which opens its
doors in July 2004, is the centerpiece
of the HEAL program. It will accept
referrals from community physicians
and other Children’s clinics; provide
medical care and counseling; coordinate
personal follow-up with nutritionists,
kinesiologists and psychologists; and
when necessary, send patients to experts
in cardiology, endocrinology, psychiatry
and other specialties.
“When it comes down to it,
primary care is all about prevention,”
says Dr. Breland. “As a physician, it can
Who’s overweight and who’s obese?
It’s fairly simple to define what’s overweight and obese for adults.
Professionals rely on a measurement called Body Mass Index, or BMI.
BMI is a mathematical formula based on weight and height.
Although BMI isn’t an accurate measure of fat for muscle-bound
athletes, it works pretty well for most adults. In general, adults with a
BMI of 25 to 29.9 are considered overweight, while adults with a BMI
of 30 or higher are considered obese.
The term “obese” is generally not used to describe children,
however. Desirable BMI varies with gender and age. Because of this
variance, kids’ BMI scores are considered relative to their peers.
Children and adolescents whose BMI score is higher than 95 percent
of people their age and gender are considered overweight; those with
a BMI between the 85th and 95th percentile are considered “at risk of
overweight.”
Although children are generally not referred to as obese, the public
health issue is commonly referred to as an “obesity epidemic.”
Calculate your BMI:
BMI = Weight in Pounds
(Height in inches) x (Height in inches)
be frustrating to deal with problems
after they’ve become very serious. What
we really need to do is change lifestyles
earlier. The HEAL clinic will screen for
medical conditions that go along with
weight problems—such as heart and
respiratory distress, insulin resistance
and type 2 diabetes, high cholesterol
and sleep problems. We will also screen
for the motivation to change, not just
in the kids but in the family as well.”
In addition to screening patients,
the clinic will work with Children’s
dieticians to provide nutritional
“We don’t need new lab research to show us the benefits of fruits and vegetables. We need reserach that emphasizes real-world solutions.” – J A N E T K I N G , P H D , I N T E R I M D I R E C T O R , T R A N S L AT I O N A L R E S E A R C H
x 703
training; with kinesiologists and
physical therapists to promote exercise;
and with psychologists and psychiatrists
to help children deal with the psychological and social burdens of being
overweight.
BEYOND LAB RESEARCH
Dr. Breland has high hopes for the
clinic’s success, but knows that it isn’t a
complete answer to the problem. “The
issue is almost never just about the
child’s eating habits,” he says. “It
includes the school—is there physical
education? Are there soda vending
machines? It includes the family—are
the child’s parents overweight? Does the
family sit down together for meals? And
it even raises issues about ethnicity and
culture—for example, we know that
rates of obesity are greatest among
SPRING 2004
Hispanic boys and African-American
girls. There are many questions we need
to ask in order to address this issue.”
In the lab, researchers in Children’s
Nutrition and Genomics program
explore how genes, lifestyle and nutrition interact. They are finding that
while diet can contribute to the risk of
developing a number of diseases, the
extent of those risks depends in part on
an individual’s genetic makeup. But the
focus of much of the research under
HEAL isn’t your typical test-tube
science; instead, HEAL will employ
translational research, aimed at understanding how knowledge from the lab
and clinic can be applied in the real
world.
to the community in a way that makes
a lasting difference.”
Such research projects are already in
the works. Dr. Tinajero-Deck and her
Urgent Care colleague Victoria Agnos,
MD, are embarking on
two projects with the support of the
hospital’s Office of Multicultural Health
and Children’s Research Center. One
project will evaluate the effectiveness of
Sports For Kids, a program that aims to
promote activity and exercise among the
students in several Oakland schools.
The researchers also hope to introduce a
bilingual, culturally sensitive nutrition
education class in some of those
schools, and measure whether it further
improves outcomes. The
second planned
project will evaluate
whether school gardens and nutrition
workshops increase
A 16-ounce Vanilla Frappuccino
fruit and vegetable
Blended Crème from Starbucks has
consumption among
480 calories. How long would a
participants.
100-lb child have to ride her
“There are many
bike to burn those calories?
people and organizations out in the
community doing
innovative things to
fight child obesity,”
says Dr. TinajeroDeck. “But to be
sustainable, these projects need to be
“We don’t need new lab research to
studied and validated. If we can look at
show us the benefits of fruits and
a project scientifically and say, ‘yes, this
vegetables,” says Dr. King. “We need
works,’ or if we can provide data that
research that emphasizes real-world
can help refine these programs so that
solutions. You can’t just do nutrition
they work even better, then the
research and expect the government to
programs will have a much better shot
enforce whatever you’ve found to be
at success.” Dr. Tinajero-Deck says it’s
best for people’s health. Our challenge
crucial that care providers go into the
as scientists is to apply our knowledge
community to address the obesity issue.
Portion
Distortion Quiz
15
“We can’t wait for the families to come
to us, because by that time it’s too late,”
she states.
Ultimately, going into the community is exactly what HEAL aims to do.
“It’s not enough to get funding to set
up a program, gather some data, and
then leave,” Dr. King says. “What
would happen to the kids in that
community when the funding for that
research dries up?” To prevent that from
happening, Dr. King and her colleagues
in the HEAL program are building
partnerships with community organizations from the public schools and local
university programs to community
health centers.
“The problem with many of us
trained researchers is that we often read
scientific papers and write our grants all
by ourselves,” Dr. King says. “But we
can’t afford to be isolated in an ivory
tower; we have to spend time in the
community and build partnerships with
outside groups. We have to be ready to
get our hands dirty.” #
Depending on how fast she rides, she’ll
need to bike 1 to 2 hours to burn off
those calories.
16
by Vanya Rainova
June 10, 2002
at her tiny
Kendra says that people who don’t know her sometimes stare
ures.
body, her disproportionately large head and unusual facial feat
speak loudly as if
Occasionally, she adds, they approach her with “baby talk” or
t and articulate
she can’t hear or understand. Kendra, who is a very intelligen
17-year-old woman, often feels embarrassed for these strangers and worries
would make them
that letting them know how wrong their perception of her is
feel terribly awkward.
Dr. Paul Harmatz
examines Kendra
March 19, 2004
also draws intricate
Claudio’s command of the Nintendo machine is enviable. He
oonist. Claudio has
robots and monsters. At age 10, he dreams of becoming a cart
two weeks at the
not had any antibiotics for about a year. He used to spend
a year.
hospital, taking intravenous antibiotics at least three times
c
d
a
e
c
March 21, 2004
nd of the
Eight-year-old Isabella’s face brightens the stark white backgrou
of clear liquid,
Children’s Day Hospital. An IV line connects her arm to a bag
a limousine
but in her imagination Isabella is already living tomorrow when
her to Disneyland.
will pick her up from her family’s Bay Area hotel and take
any of the fast
Her doctor, Paul Harmatz, MD, reminds her she can’t take
l the mermaid.
rides – her neck is too fragile – but she will get to meet Arie
SPRING 2004
Isabella with
Ariel the
mermaid.
Claudio with
his mom,
Sonia Costa
e
s
The lives of Kendra, Claudio and
Isabella are in many ways as different as
one can imagine. They share neither culture nor language. They’ve grown up in
South Dakota, Portugal and the
Dominican Republic respectively. But the
stories of their childhoods converged at
Children’s Hospital & Research Center at
Oakland, where they participated in a clinical trial of the first-ever drug treatment for
a disease that could claim their lives by the
time they reached 20.
Kids with Maroteux-Lamy syndrome,
or mucopolysaccharidosis (MPS) VI,
lack an enzyme that is required for the
breakdown of a complex sugar
(glycosaminoglycan) into simpler mole-
17
cules. Without the enzyme, this sugar
remains in the cells, accumulates in the
tissues and causes severe damage. Because
this sugar is normally found in connective
tissue, the disease affects the skeleton, the
heart valves, the spleen, the liver and the
cornea, to name a few. Kids born with this
genetic disorder have short stature, joint
stiffness, respiratory problems, cardiac
insufficiency, and vision and hearing loss.
The physical and emotional challenges they
face are enormous.
“You have to adjust to the world,”
Kendra’s mom, Betsy Gottsleben, says,
“because the world’s not going to adjust to
you.” There is no approved drug treatment.
Bone marrow transplantation may result in
a cure, but the risks are
huge and chances of survival, slim.
In October 2000, a Novato-based drug
company called BioMarin Pharmaceuticals
announced that it was ready to begin
testing the safety and efficacy of an enzyme
replacement therapy for MPS VI. The
therapy relies on a synthetic enzyme, called
Aryplase, that mimics the body’s own
mechanism for breaking down glycosaminoglycan. The company selected
Children’s Hospital as the only site for
Phase 1 of the trial. The synthetic enzyme
was well tolerated by all six patients and
results suggested that it broke down the
sugars that otherwise accumulated in the
patients’ tissues.
Early in 2002, Claudio and his mom,
Sonia Costa, arrived at Children’s for the
Phase 2 study that enrolled 10 patients in
two sites, one in Oakland and one in
Australia. (Kendra participated in that
phase as well.) Their 20-hour trip from
Lisbon to Oakland pales next to the length
of their journey to a hope for a better,
longer life for Claudio.
“Claudio was about 18 months old
when we noticed something was wrong,”
Sonia remembers. “He had many respiratory infections, an umbilical hernia and his
legs weren’t stretching out, which doctors
told us was because of wearing diapers. But
later, his facial features changed, too.”
At age 6, Claudio was diagnosed with a
different form of MPS, type I, which
wreaks similar havoc on a child’s body and,
unlike MPS VI, doesn’t spare the mind.
The life expectancy is even shorter: 10
years.
Sonia had her doubts—Claudio’s
mental development, she thought, equaled,
if not exceeded, that of his peers—but she
accepted the diagnosis. “The day you learn
your child may not live past 10 changes
your life forever,” Sonia says. “A lot of
things become insignificant. It is easy to
distinguish the truly important things in
life.”
From their living room in Lisbon, the
family mined for healthcare information
[ C O N T I N U E D O N PA G E 2 7 ]
18
ONCE A WEEK, oncologist
Caroline Hastings, MD, takes a plane to
work. But despite the remote location of
her off-site practice in Reno, Nev., Dr.
Hastings has missed only three clinics in
the last 12 years, one after she had each of
her children. “Up until I was out to
here,” she says, extending her arms wide,
“I was boarding airplanes.”
In 1992, Dr. Hastings drove to Reno,
borrowed space in a pediatrician’s office,
and hung an oncologist’s shingle. At
first, her practice was modest: she
held a clinic once a month and had a
trickle of patients, one or two a visit.
Dr. Hastings put her stethoscope
aside and tried a second hat: marketing.
“I went to meet all the pediatricians in
Reno and Carson City in their offices and
gave talks and hosted dinners,” Dr.
Hastings recounts. “I never did anything
like it before; I was always a very shy
person. Now one of my favorite things is
to reach out to the community and do
some public relations work.”
The community reached back to
Dr. Hastings. As her practice grew (she
sees about 60 patients a month in her
weekly clinic), her colleagues at the
Washoe Medical Center, Reno’s most
comprehensive acute-care hospital, asked
her to move her office there.
“What’s nice is that the whole
Reno community has taken me in and
befriended me,” Dr. Hastings says. “They
completely trust me and they know how
to reach me. We have a continual
dialogue: when they need help, I’m there
to help them; when I need help, they’re
there for me. It’s wonderful to have that
kind of work environment that far away.”
Dr. Hastings attributes a lot of her
success in Reno to the relationships she
has nurtured. She says she plans to apply
this model of building personal bridges to
help the Children’s Hospital new specialty
clinic in Marin grow. (See Old Friends,
New Neighbors on page 26.) “It is fully
my intention to go out in the community
to meet physicians, tell them who we are,
what we do and what services we can
offer children,” Dr. Hastings states.
“Taking information directly to them in
an informal way, with personal contact,
helps.”
high number of relapsed leukemia.”
Though leukemia has a high remission
and cure rate, there are so many children
affected, that relapsed leukemia is actually
more common than a number of childhood cancers. In collaboration with the
international Children’s Oncology Group,
Dr. Hastings seeks new therapies and
approaches to this life-threatening disease.
“We’re trying to accomplish two
things,” she explains. “One is to cure
Good
What Makes a
Physician
As a result of Dr. Hastings’
community building,
children from the Reno area
are now routinely referred
to Children’s Hospital &
Research Center at Oakland
to receive the specialty
pediatric services they need.
But Dr. Hastings is not
only bridging remote
communities, she is also
straddling another line, that
between clinical care and
research.
Leukemia, and particularly relapsed leukemia,
claims the attention of what
Dr. Hastings calls her
‘thinking side.’ “Leukemia is
the most common cancer in
children,” Dr. Hastings
explains, “followed by a
JUST CHECKING:
Emily IDs her doctor,
Caroline Hastings, MD.
SPRING 2004
19
physician profile: C A RO L I N E H A S T I N G S , M D
more kids, the other is to maintain the
high cure rate and reduce the potential
side effects of chemotherapy and/or radiation. As time goes on, we do continue to
see increased cure rates (now approaching
90 percent in leukemia), but kids can be
left with
devastating
complications
related to
chemotherapy
by Gary Turchin
or radiation.”
For example, not all children with
acute lymphocytic leukemia (ALL)
require the same type of treatment,
explains Dr. Hastings. “We’re trying to
differentiate between subtypes and determine who needs more intensive therapy
and who needs potentially new therapies
or radiation. We’ve learned that maybe
we can back off from the treatment in
some cases.”
One such group is boys with
leukemia who relapse in the testes, a
condition Dr. Hastings has studied
extensively. This form of relapse occurs in
about 2 percent of boys treated for ALL,
and studies indicate that when the relapse
happens late in the treatment, the boys
have an excellent prognosis.
“This is our leap of faith: we are
going to eliminate testicular radiation for
this group of boys, thereby preserving
fertility and pubertal development, while
hoping to maintain the same end result, a
Great
high cure rate,” Dr. Hastings says.
Based on this hypothesis, Dr. Hastings
has written the protocols for a study
where she, along with her Children’s
Oncology Group colleagues, will explore
this new approach. “It’s very gratifying to
contribute to the knowledge base in this
area,” she states. “To study something,
to improve a treatment, then actually
use it on your patients, and see positive
outcomes.”
As excited as she is about the science
of oncology, Dr. Hastings is the first to
acknowledge that having the heart for
being a pediatric oncologist is just as
important as having the mind for it. Dr.
Hastings encounters most families at a
time of crisis. Few things can be more
trying for parents than caring for a child
with a life-threatening illness. That is
why Dr. Hastings’ work requires patience,
sensitivity and emotional wisdom, a
lesson she learned early in her career.
Dr. Hastings’ first patient as an
attending physician, Michael, had a type
of leukemia that he was unlikely to
survive. Dr. Hastings grew very close to
him and his family during the course of
his treatment. In a way, this experience
was a sad one; Michael did not survive
his leukemia. But it was also a blessing in
disguise—it taught Dr. Hastings that her
role as a physician extends beyond applying her clinical competence to include
being a compassionate, trusted, emotionally present companion to families during
some of the most difficult, most
emotional, most intimate moments in
their lives.
“Michael and his family taught me a
lot by allowing me to participate in the
process of his dying and their grieving,
which I realize was so intimate and
personal,” Dr. Hastings says. “It strength-
ened my commitment to being an
oncologist. Even thought my interest in
oncology initially had been purely intellectual, I now realize that the emotional
side of what I do is just as important to
me.”
The day before Michael died, he
asked his mom to take him to Toys-R-Us.
He walked up and down every aisle carefully, slowly. He looked at everything and
finally he picked something out. ‘I want
to give it to my sister,’ he said. “That was
all he wanted, something special for his
sister. It’s so moving to see how selfless a
5-year-old can be, how ethereal in many
ways,” Dr. Hastings says.
Dr. Hastings postponed a ski trip to
Utah so she could be there for Michael
and his family in the last days of the boy’s
life. “As doctors, we are often uncomfortable with death,” she says,” because we’re
used to ‘fixing things.’ Having this family
tell me ‘you don’t have to fix anything,
you don’t have to say anything, we’re just
happy you’re here,’ taught me what
makes a good doctor a great doctor: the
ability to be there for a family as a trusted
friend as well as a healthcare provider. I
learned you don’t
have to say something to make the
pain go away, there
are times when
that’s not possible,
but you have to be
able to listen and
support them.
This has colored
the rest of my
practice.” #
20
Afghanistan
Pakistan
Iran
ALAIN MCLAUGHLIN
Arabian
Sea
LONG BEFORE SHE
BECAME a senior research scientist at
Children’s, Deborah Dean, MD, MPH,
made a journey to the Kingdom of
Nepal that changed the course of her
career. Just out of medical school, Dr.
Dean was working at an infectious diseases hospital in India. Taking a break
from her work, she set out for Nepal to
explore trekking in the majesty of the
Himalayas.
On that trek, she was struck by
more than the jagged beauty of the
landscape. “I got stuck in this little town
while I was waiting for an overland
bus,” Dr. Dean recalls, “and as I was
looking around I noticed there were all
these people who were blind.”
Nepal is mostly an agrarian society
living at high altitudes, and cataracts
from UV exposure are common. Yet Dr.
Dean learned from a colleague that
many of the people she saw were suffering from blinding trachoma.
“Here I was, working in an infec-
tious diseases hospital, and I’d never
heard of trachoma before. It really
piqued my curiosity.”
Caused by a parasite called
Chlamydia trachomatis, trachoma is the
leading cause of preventable blindness in
the world. There are more than 600
million people—or one tenth of the
world’s population—whose eyes are
infected with chlamydiae; 6
million are already blind or severely
visually impaired. In some parts of
third-world countries, more than 90
percent of the population is affected.
Chlamydia trachomatis has a variety
Nepal
trachoma is caused by repeated eye
infections that scar the underside of the
eyelid. The eyelashes then
turn inward,
India
scratching the surface of the eye and
allowing bacterial infection to occur in
the cornea (the clear part of the eyeball).
The infection eventually heals by
scarring over, resulting in blindness.
Dr. Dean refers to the series of random occurrences following her first
encounter with trachoma as a “kind of
serendipity.” She found herself attending
a meeting for a Nepalese non-profit
organization dedicated to investigating
blindness. There, she met two Nepali
ophthalmologists with whom she shared
her interest in learning more about the
disease. By the end of the conversation,
she had been invited to work in NepalSri
to help solve the problem of trachoma.
“It was kind of like being in the
right place at the right time to make
these contacts that you have no idea will
have such a major impact on your life
Indian
and your career,” she says.
That was 18 years ago. Dr. Dean
has
Ocean
been traveling between the United
States and Nepal ever since.
“Until I got married and had kids, it
really was a second home to me,” Dr.
Dean says of Nepal.
The biannual visits “home” are not
B
B
B
Lanka
Beyond Borders
Border
by Lisabeth Kirk
of strains. Some strains (the kinds most
Americans have heard of ) cause sexually
transmitted diseases (STDs), while
others cause eye infections. Blinding
merely social, however. They involve
collecting clinical samples from the
populations most affected by trachoma
in order to analyze them with the
SPRING 2004
China
21
researcher profile: D E B O R A H D E A N, M D , M P H
sophisticated laboratory technology
eliminated it from industrialized populaavailable at Children’s.
tions. Such a change in socioeconomic
Bangladesh Helping the Nepali people with the
status is not likely to occur any time
problem of trachoma has proven to be
soon in the developing countries where
Vietnam
no small feat, however, especially given
the contagion of Chlamydia trachomatis
Myanmarcircumstances of the
the environmental
is highest.
Laos
populations most affected by the
“It’s important to keep in mind that
disease.
if the entire planet were developed, we
“You’re talking about people who go
wouldn’t have this disease,” Dr. Dean
Bay of
down to the river to collect drinking
points out. Acknowledging that as an
Bengal
Thailand
and cooking water, and it’s
the same
unlikely scenario, however, leaves
river where the buffalo and the eleresearchers like Dr. Dean with the need
phants bathe,” Dr. Dean explains.
to eradicate the disease with scientific
Cambodia
“TheyAndaman
live in really close quarters with
methods.
pigpens, buffalo
“There has been no infectious
Sea pens and chickens
running around, all these animals… if
disease on the planet that has ever been
not in the house, then right in the front
eliminated by antimicrobial treatment,”
South
yard. The women use their hands to
says Dr. Dean of the current practice of
China
press dung around the patio to make it
treating trachoma patients with antibiSea
nice and smooth, and the women are
otics. She
and her colleagues are pubthe ones who cook the food. You can
lishing the first hard data to prove that
really see how the eye-hand-eye
transChlamydia trachomatis persists in spite
Malaysia
mission can happen.”
of antibiotic treatment.
While trachoma used to be endemic
“It’s not an issue of antibiotic resistin the Americas as well, the socioance,” Dr. Dean explains, which occurs
economic changes that correspond with
when an organism is unaffected by treatfirst-world development have virtually
Indonesia ment with antibiotics.
Instead, the issue with
Chlamydia trachomatis is one
of latency, in which the organism goes into a non-replicating, or latent, stage. As Dr.
Dean explains, “an organism
may be completely susceptible
to every antibiotic that it
would normally be susceptible
to, but if the organism isn’t
replicating, it won’t be killed.”
s
HANDS-ON SCIENCE:
Deborah Dean, MD, MPH,
swabbing the conjuctiva of a
Nepali villager.
Subsequently, effective treatment
requires the prevention of the initial
infection, which is why Dr. Dean has
been actively working on a vaccine for
chlamydial STDs. If the vaccine is
successful, it will allow her to then go
after the trachoma strains. “The STD
vaccine may affect all chlamydial
strains,” she says. “It may end up being
one vaccine, we just don’t know yet.”
Evidence suggests that to trigger an
effective autoimmune response against
Chlamydia trachomatis both antibody
response and T-cell memory must be
stimulated (B cells produce antibodies;
T cells regulate B cells). Therefore, Dr.
Dean and her colleagues hope to be
able to produce a two-fold result from
inoculation with their vaccine: to
stimulate antibodies and T-cell memory
of having seen the trachoma pathogen
before.
In spite of the challenges that this
complex parasite poses, Dr. Dean has
plenty of motivation. “The Nepali
people are really special,” she says.
“They care a lot about other people.
They really want to do good for one
another. We’re not like that. In our
society, we’re brought up to respect each
other and be nice to each other, but in
Nepal, they’re brought up to help
people.”
Perhaps that is why Dr. Dean has
always felt so at home there. Since her
first introduction to Nepal, her commitment to helping the Nepali people has
never waned. With her continued
research, Dr. Dean may one day be able
to return to her second home with a
vaccine to eradicate the disease. #
22
Honoring Decades of Support
On Sunday, March 14,
hundreds of friends and
donors visited the hospital for
the Walk of Honor grand opening celebration. Located in the renovated entry plaza
and newly built Emergency Department
waiting area, the Walk of Honor features
colorful displays, bricks, tiles, pencil-path
lights, a dedicated flag pole and an animated plasma screen recognizing thousands of
supporters spanning nearly a century.
The celebration was an opportunity for
benefactors to see their names prominently
displayed, proudly depicting their partnership with Children’s Hospital & Research
Center at Oakland. Additionally, it was a
chance for Children’s to show off its new
critical care facilities and new hospital
entry—known as the Western
Expansion—and to personally thank
those who have contributed to advancing
pediatric care at Children’s.
The Walk of Honor can be found
throughout the hospital’s main campus on
Fifty Second Street in Oakland, across the
street in its Outpatient Center atrium, and
at the Research Center on Martin Luther
King, Jr. Way in Oakland. With the input
of hospital pediatricians, medical-care
providers, members of the board of
directors and those from the community,
Children’s Hospital & Research Center
Foundation created a variety of colorful,
engaging and educational venues to
recognize donor generosity.
hospital visitors.
One of the most striking
new elements depicting the
community’s generous and
creative spirit is a tile mosaic.
The mosaic wall features ceramic
tiles hand-made by local artist
Ruth O’Day with the help of
Children’s Artists-in-Residence
Sarah Barrow and Kyle
McDonald, patients and
community volunteers. This
Children’s Circle of Care members, Alden and Barbara
McElrath, descendents of the family whose carriage
special exhibit is underwritten
house became the Baby Hospital in 1912 and the site
by The Art For Life
of the current hospital.
Foundation, a private foundation dedicated to funding the
the Charlotte Rose Coleman Frey
hospital’s Artist-in-Residence Program.
Ambassador’s
Desk, named in memory of
Just inside, the new Welcome Pavilion
a
special
14-year-old
by her parents and
is named in honor of one of the hospital’s
grandparents.
This
generous
family also
most committed donors, the East Bay
established
the
Pediatric
Intensive
Care
Neonatology Foundation established by
Fellowship
Endowment
in
Charlotte’s
physicians who have dedicated their promemory, which will fund a
fessional lives to our newborn patients.
critical care fellowship in perpetuity. #
Families arriving at the Emergency
Building Blocks Campaign
Supporters
The new entry plaza is decorated with
five brightly colored “pencil-lights,” which
are each dedicated. A named hospital flagpole and hundreds of bricks and pavers
inscribed with personal messages welcome
Legacy of Children’s Care: Donors who have remem-
w alk of
honor
w w w. c h o f o u n d a t i o n . o rg
Department are greeted at
Find your name in the Walk of Honor
Annual donors and those who have created a legacy
for Children's Hospital are included in the Walk of
Honor. Currently, gifts made in 2002 are included. Gifts made in 2003 will be listed this summer.
How to find your name:
Emergency Department waiting area. Miracle Makers:
Donors of $100 to $999 annually may find their
names prominently featured in an animated
presentation located in the new main entry.
Life Benefactors: Donors who have contributed
businesses, organizations, community groups and
Children’s Hospital Branches for their ongoing
dedication to raising support through special
events.
$100,000 or more in their lifetime are featured on
a dramatic photographic mural by world-famous
environmental artist Stephen Joseph.
bered Children’s Hospital in their wills and trusts
or created endowments, along with members of
Children’s Circle of Care, special supporters who give
$10,000 or more annually, are featured in a
display that photographically captures Northern
California.
Chairman’s Circle: Contributors of $1,000 or more
annually are recognized in the Miracle Makers
“Machine” – an upright pinball machine underwritten by Children’s Hospital Branches—located in the
Event sponsors: The “Mirrored City” recognizes
Building Block Donors: Supporters who dedicated
bricks, pavers, and stars have left their mark for
future generations to see. The Art for Life
Foundation generously underwrote the exterior
80-foot tile mosaic, created by patients and
community members.
For more information about the Children's
Walk of Honor, please contact Jim
Armstrong at 510-428-3885 ext. 5394 or
via [email protected].
SPRING 2004
Grateful Families Invite You
to a Springtime Gala
“I am delighted to be a supporter of
Children’s Hospital. Giving back is my way
to express gratitude for the outstanding
care my children receive here,” says Terri
Phelps, whose daughter had brain surgery
at Children’s last year.
As her way of saying thank you, Terri
has helped to establish the Grateful
Grateful Family Committee member Jeff
Haney (right), his daughter Jordana, and
Cole Paulson at the Walk of Honor
celebration.
Families Program, a group of volunteer
parents and grandparents interested in giving back by raising funds for the hospital.
The group’s first major undertaking is the
Residential Pacific Mortgage Springtime
Gala on May 22 at the Oakwood Athletic
Club in Lafayette.
“We’ve got a very dedicated and diverse
committee, and it feels good to be able to
involve the community in something so
near and dear to our hearts,” says grateful
parent Renee Christensen, Children’s
Hospital & Research Center Foundation
trustee and retired Bay Area regional marketing manager for Costco Wholesale.
Gala highlights include a raffle drawing
for a one-week stay for six people on the
luxury cruise ship, The World of
ResidenSea. One lucky winner and five
guests can choose to travel Europe in the
summer, the Greek Islands in the fall, the
Seychelles in the winter, or another exotic
location based on availability. Additionally,
the gala boasts delectable food, Big Band
music, unique auction items, and an award
celebration to honor nominated hospital
staff members for their outstanding commitment to children.
“It’s reassuring to know that we have a
hospital like this in our community, where
the value of investing in children is understood,” says Terri. “We invite you to join
us in saying ‘thank you!’”
At the gala, Grateful Families will present Thank You Awards to the following
Children’s Hospital staff, in recognition of
their outstanding contributions to the care
of our children: Ardath Brandley, RN,
Martin Chin, DDS, Sue Ditmyer, RN,
PNP, Sandy Donato, Mary Beth Felice,
MS, Bernice Gotelli, PBVM, Pam Koch,
RN, Peter Sun, MD, Bryant Toth, MD,
and Adina Vargas.
Tickets for the Residential Pacific
Mortgage Springtime Gala are $50 each.
Raffle tickets are $50 each and only 500
will be sold. To purchase tickets or for
more information on the Grateful Families
Program contact Dave Tureaud at 510428-3885, ext. 4085.
The Residential Pacific Mortgage
Springtime Gala at Oakwood has been
generously underwritten by: Residential
Pacific Mortgage, Oakwood Athletic Club,
Diablo Magazine, Quivira Estate Vineyards
and Winery, Grace Street Catering, Best
Beverage Catering, MAI Industries General Contractor, and Clay and Jody
Davis. #
KFRC Radiothon Raises
$405,000 in Pledges!
23
KFRC listeners who pledged their support!
Thanks to all of you, and most importantly, KFRC 99.7 for its partnership. #
Events of Hope
Recently, two community volunteer
On-air personalities (l-r) Cammy Blackstone,
Mike Krupicka, Sue Hall and Dean Goss
during the KFRC Radiothon for Kids.
groups hosted glamorous events to raise
money and awareness for regional
HIV/AIDS programs, including the Hope
Clinic at Children’s. Richmond-Ermet
AIDS Foundation donated $13,500 as a
result of its Help is on the Way for the
Holidays Cabaret. The Academy of Friends
have committed $40,000, raised at its
Hollywood to
Bollywood
Academy Awards
Gala in
February. These
events enable the
Hope Clinic to
reduce the incidence of mother-to-child HIV
transmission and improve the health and
well-being of children at risk of infection.
#
It took four days, 500 volunteers, 100
grateful families and many hospital staff
sharing their personal stories and anecdotes; the dedication and commitment of
the KFRC 99.7 team; and thousands of
To learn more about giving opportunities at Children’s Hospital, please contact Children’s Hospital &
Research Center Foundation at 510-428-3814 or visit www.chofoundation.org.
24
Commitment,
a Trust
by Cynt
Long-time Branches
create a legacy
that will carry on her
to Children’s
Like many parents, Orvie Pamp can date the milestones in
her life by how old her children were when the event occurred.
Thinking back to the very beginning of her association with
Children’s Hospital & Research Center at Oakland, she recalls,
“My son Gregory was about a year and a half. I had heard
about Children’s Hospital Branches from a friend, and wound
up joining Teak Branch.” How long ago was that? “Well, he’s
about to turn 34,” smiles Orvie. “So it’s been a lifetime!”
Long-term commitment came naturally to Orvie, who grew
up in a family that had a strong ethic of helping others, especially children. “My father was a Shriner who could not stand
to see a child in need,” she explains. “He passed that on. I was
raised to do whatever I could to help.”
As a young mother with two little boys, Orvie, a resident of
Oakland’s Claremont Pines district, was deeply impressed by
how the Branches demonstrated what women working together
could achieve for their community. “Here was a hospital founded by a group of women. The Branches were there right from
the start in 1912. I was proud to be a part of a group that had
accomplished so much,” Orvie says. “Alice Bullard, president of
the Branches when I joined, told stories about the ‘old days,’
when members did anything and everything that was needed by
the hospital, from serving as nurses’ aides during World War II
to taking shifts as waitresses in the hospital café, in addition to
raising money.”
Over the past three decades, Orvie’s service to Children’s has
w w w. l e g a c y f o rc h i l d re n s c a re . o rg
evolved as her life changed. She served four terms on the
Branches’ board of directors and, yes, waited on tables at the
hospital years ago. She chaired the Rubber Ducky Derby twice,
and was a leader in the Miracle Balloons campaigns. After losing her eldest son, Mitchell, to an accident at age 15, Orvie
became even more dedicated to Children’s. “I wanted to do all I
could to make sure that other parents would not have to go
through what we did,” she states quietly.
Today, Orvie is a member-at-large of the Branches board.
Together with her husband, Gerry Pamp, Orvie took her commitment to Children’s Hospital & Research Center at Oakland
to another level in 2003, with the sale of a piece of rental property the family owned in Oakland.
Gerry, a retired real estate investor, and Orvie knew that the
sale could result in a significant capital gains tax bite. Exploring
tax-saving strategies, the Pamps attended a seminar sponsored
by the Children’s Hospital & Research Center Foundation and
learned about how both they, and the hospital, could benefit
through creating a charitable remainder trust—a very appealing
option for a family with a long-standing commitment to
supporting pediatric healthcare.
The Pamps created their trust, transferred their property
into it, and then sold the property. They did not pay any
capital gains tax on the sale, and were able to take a sizeable
charitable donation deduction on their 2003 income tax return.
The proceeds of sale were reinvested in an income-producing
SPRING 2004
and a Legacy
thia Romanov
leader and her husband
r service
for years to come.
diversified portfolio, and Orvie and Gerry will receive payments
from this income for the rest of their lives. When they are gone,
whatever remains in the trust will go to the hospital, and their
estate will pay no taxes on the assets in the trust. “Gerry and I
saw giving to the hospital (through the charitable remainder
trust) as a very good way to benefit through saving on taxes,”
Orvie says.
“The Pamps made a very generous and visionary gift,” says
Emily De Falla, Vice President for Trust Services and Legacy
Planning at Children’s Hospital & Research Center Foundation.
“It is a perfect match of a life-long philanthropic interest with
family financial benefit. Through their charitable remainder
trust, the Pamp family has created a legacy that will expand and
continue Orvie’s history of service to Children’s Hospital
Oakland for many years to come. We are very
grateful.”
Orvie and Gerry protest that they are not unusually
generous. “I just tell our friends that we found a wonderful
way to help the hospital while helping ourselves,” Orvie says,
adding, “I’m glad we had the opportunity to do this.” #
25
HOW A CHARITABLE REMAINDER
TRUST WORKS
A charitable remainder trust (CRT) is perhaps one of the most
intelligent investment and estate planning strategies available today,
enabling investors to:
• Avoid capital gains taxes on the sale of appreciated assets;
• Receive an income stream or designate income to a loved one;
• Diversify investment portfolios;
• Receive a charitable income tax deduction;
• Reduce estate taxes; and
• Support worthy causes.
A CRT is a wonderful solution for those who wish to sell highly
appreciated assets such as stock, a family business or investment real
estate without paying capital gains taxes, and convert those assets
into an income source.
Before selling a highly appreciated asset, an individual transfers it
to a charitable remainder trust. The trustee, who is usually the original owner, sells the asset at full market value and is not required to
pay capital gains taxes. The trustee reinvests the proceeds of the sale
in assets that produce income. Then the designated income beneficiaries (again, usually the original owner or the owner’s children) will
receive lifetime income or a “payout” from the trust’s assets.
Depending on whether a charitable remainder unitrust or a charitable remainder annuity trust is established, the income/payout
received can be in the form of a fixed percentage of the trust’s assets
valued annually (typically 6 to 8 percent) or a fixed payment.
The original owners are entitled to a charitable income tax
deduction the year they create the trust. The deduction is based on
the fair market value of the asset, the payout percentage, the
investor’s age(s) and the applicable federal rate. If they are unable to
use the entire charitable deduction in the year of the transfer, it may
be carried over for the next five years.
At the end of the life of the last income beneficiary of the CRT,
the trust assets are distributed to the designated charity, such as
Children’s Hospital & Research Center Foundation. The remaining
trust assets may also be used to create an endowment fund at that
charity, thus establishing a meaningful legacy for the investor’s causes
of choice.
As an additional bonus, the original owner pays no estate taxes
on the CRT assets that are transferred to charity at the end of the
trust term.
For more information on charitable remainder trusts, call Emily
De Falla at 510-428-3362.
THIS IS NOT LEGAL ADVICE. ANY PROSPECTIVE DONOR SHOULD SEEK
THE ADVICE OF A QUALIFIED LEGAL, ESTATE AND/OR TAX PROFESSIONAL TO DETERMINE THE CONSEQUENCES OF HIS/HER GIFT. #
26
Old Friends, New Neighbors
Oakland specialists at home in Marin County
By Cyril Manning
In many ways, those who
physician who may have little
1100 Larkspur Landing Circle, Suite 150
live and work in Marin
experience with rare childhood
Larkspur, California
County are fortunate. After all,
illnesses or sophisticated childAppointments: 866-854-0550
this is a place that spans from
specific procedures.
www.childrenshospitaloakland.org/Marin
tidal flats on the fog-swept
“When a community is
coastline to the wooded slopes
underserved by specialists, kids
of Mt. Tamalpais, and is home
can miss out on the great outan upscale, educated community. But in
to redwoods and pines, grasslands and
comes that are available,” says Dr.
the past it has been underserved when
monuments of exposed rock, wide-open
Hoffinger. He points to a recent patient
it comes to specialty medical care for
ranch and dairy lands, and residential
from Marin as an example, a 17-yearchildren. We are changing that.”
suburbs known for their high incomes,
old girl who suffered chronic ankle pain
Dr. Hoffinger, along with colleagues
political activity and good education.
and repeated sprains. “It was apparent
from Orthopaedics, Cardiology and
But for too long, many Marin
that she needed surgical ligament
Psychiatry has served Marin for the last
families requiring specialized pediatric
reconstruction, but she had been told
two years in advance of the new clinic’s
medical care for their sick children have
that such a procedure wouldn’t be
opening. “Marin is fortunate to have
had to leave their community to find an
possible until she was done growing.
many extraordinary pediatricians,” he
expert. That’s no longer the case:
That simply wasn’t true. I scheduled a
says. “Children’s has already developed a
Children’s Hospital & Research Center
surgical procedure that is fairly standard
great relationship with many, and
at Oakland is officially opening the
for a pediatric specialist, and we saved
several area doctors have told me that
doors of a new satellite specialty clinic
her from several years of pain and
they find everything about Oakland’s
at Larkspur Landing, providing families
limited activity.”
system—from our transport team to
from Marin County and surrounding
The new clinic in Marin adds to
our intensive care services—to be very
areas with convenient access to worldChildren’s
existing network of satellite
easy to work with.”
class experts in 12 specialty services (see
locations,
which
was created to provide
With 54,000 kids in the county,
back cover).
communities
across
the Bay Area with
primary care doctors see plenty of
“Until now, Marin County has been
easy access to world-class care. To find a
children who need advanced care and
in a tough situation,” says Scott
location near you or to make an
follow-up. The scarcity of advanced
Hoffinger, MD, one of two orthopaedic
appointment, call 1-866-854-0550. #
specialists creates a problem for parents,
surgeons who provide
who must choose between leaving the
services at the Marin location. “This is
community for care and seeing a
Kendra, Claudio an
d
Christiane receive
enzyme replacemen
t
therapy transfusions
in
the day Hospital at
Childrens in 2002.
SPRING 2004
27
President and Chief Executive Officer
Tony Paap
Interim Senior Vice President and Chief
Operations Officer
David Bertauski
Senior Vice President and Surgeon-in-Chief
James Betts, MD
Senior Vice President, External Relations
until one day they read that BioMarin was
preparing to test a treatment for MPS I. The
trial’s lead investigator, Emil Kakkis, MD,
PhD, asked the Costa family to send medical
reports and requested a skin biopsy to confirm
Claudio had MPS I. He didn’t; his correct
diagnosis was MPS VI.
“I was shocked and conflicted,” Sonia
recounts. “We had studied and learned so
much about MPS I, made so many contacts
with people around the world, had finally seen
a light at the end of the tunnel, and then we
had to start from square one. At the same time
Claudio had a ‘better’ illness than we had
thought. He could live longer, his mind would
be ‘normal.’”
Almost two years later, Dr. Kakkis
connected the Costa family with Paul
Harmatz, MD, lead investigator of the MPS
VI trial. At the start of Phase 2, Claudio was
confined to a stroller (because of the
disease, his 8-year-old body could fit in one).
His joints were so stiff, he could hardly walk
further than three feet. Breathing was hard; he
had respiratory infections and pneumonias. He
slept connected to a machine that helped ease
his sleep apnea.
The results of the 48-week-long Phase 2
study revealed that the kids’ endurance during
walking had improved by an average of 139
percent or 211 meters. Two years into treatment, Claudio can now run.
“Watching these kids’ health improve has
been really exciting,” Dr. Harmatz says.
“Common colds used to mean long
hospital stays for them. But look at them
now,” he adds, waving in the direction of
Isabella.
Isabella is one of about 40 patients
enrolled in Phase 3 of the trial, now underway.
Children’s Hospital remains the only U.S. site.
Five other medical centers—in Brazil,
England, France, Germany and Portugal—
participate as well.
Isabella’s family learned about the trial
from Readers Digest. “When Isabella was first
diagnosed, we were hopeless,” Karla remembers. “You know it is a rare condition (MPS
VI occurs in one out of 250,000 births) but if
your child has it, that’s irrelevant. All that
matters is that your child is different, that your
child may not live. So it was amazing to know
that someone miles away is taking care of our
child by looking for a cure for this disease.”
After the completion of each trial, its participants have continued to receive the enzyme
weekly. Some have returned to their countries
of origin. Others, like Isabella’s family, are
seeking ways to stay in the United States as a
way of ensuring their children can receive
treatment. About six months after Phase 3
ends this September, BioMarin will apply to
the Food and Drug Administration for
approval of Aryplase.
“We’ve moved heaven and earth to get to
here,” Karla says. “We left everything. We are
away from home, away from family, but where
we are is the best place for our child. Right
now, I have the hope that Isabella is going to
be with me for many, many years.” #
Mary L. Dean
Interim Senior Vice President & Medical Director
Len Kutnik, MD
Senior Vice President, Research
Bertram Lubin, MD
Senior Vice President and Chief Financial Officer
Terry Rosenthal
Vice President, Legal & Risk Management
Marva Furmidge
Vice President, Ancillary & Support Services
James Jackson
Vice President & Chief Information Officer
Don Livsey
Vice President, Nursing
Nancy Shibata, RN
Vice President, Human Resources
Greg Souza
Children’s Hospital &
Research Center at Oakland
Board of Directors
Harold Davis, Chair
Pamela Cocks, Vice Chair
Arthur D’Harlingue, MD, Vice Chair
Robert C. Goshay, PhD, Vice Chair
Barbara May, Vice Chair
Edward Ahearn, MD
Jeffrey Cheung
Henry Gardner
Donald Godbold, PhD
Howard Gruber, MD
Scott Hoffinger, MD
Howard Jackson
Watson M. Laetsch, PhD
Alden McElrath
Masud Mehran
Linda Murphy
Betty Jo Olson
Tony Paap
Howard Pien
Mary Rutherford, MD
Peter Sheaff, MD
Harold C. Warner, PhD
Story requests, comments or suggestions
for Children’s Handprints may be
e-mailed directly to Vanya Rainova
([email protected]), or sent to 665
Fifty Third Street, Oakland, CA 94609.
people you trust caring for children you love
Elizabeth
Gleghorn, MD
Gastroenterology
Herb
Scheirer, MD
Psychiatry
Alison
Matsunaga, MD
Hematology/
Oncology
Howard
Rosenfeld, MD
Cardiology
James
Betts, MD
Pediatric Surgery
& Urology
Susan
Conrad, MD
Endocrinology
Joseph
Torkildson, MD
Hematology/
Oncology
Scott
Hoffinger, MD
Orthopaedics
Marilyn
Butler, MD
Pediatric Surgery
Our pediatric specialists now serving you at Larkspur Landing.
Working hand-in-hand with community pediatricians, we’re
providing comprehensive specialty services at our new
convenient location. Visit our new pediatric specialty clinic
located at:
1100 Larkspur Landing Circle, Suite 150
Larkspur, California
Phone: 866-854-0550
www.childrenshospitaloakland.org/Marin
Our pediatric specialists in Marin:
Howard Rosenfeld, MD
Cardiology
Peter Sun, MD
Neurosurgery
Karen Amorde-Spalding, MS, RD
Clinical Nutrition
Scott Hoffinger, MD
Monica Kogan, MD
Orthopaedics
Susan Conrad, MD
Endocrinology
Elizabeth Gleghorn, MD
Gastroenterology
Caroline Hastings, MD
Alison Matsunaga, MD
Joseph Torkildson, MD
Hematology/Oncology
Suzanne Davis, MD
Sheila Jenkins, MD
Neurology
James Betts, MD
Pediatric Surgery & Urology
Marilyn Butler, MD
Pediatric Surgery
Stephen Daane, MD
John Griffin, MD
Plastic Surgery
Herbert Schreier, MD
Psychiatry
Non-Profit Org.
U.S. Postage
PAID
Oakland, CA
Permit No. 3
747 Fifty Second Street
Oakland, CA 94609-1809

Handprints - Spring 2004 - Children`s Hospital Oakland

Transcription

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