children’s hospital boston

RECENT POSTS

Pioneer Of Mother-Baby Bonding Research Dies

Among childbirth advocates and educators, the death of Dr. John Hawks Kennell is truly notable.

(popularpatty/flickr)

(popularpatty/flickr)

An early researcher on the health benefits of immediate physical contact between a mother and her newborn, Kennell, a professor emeritus of pediatrics at Case Western Reserve University’s School of Medicine and a former chief resident at Children’s Hospital Boston, is also largely credited with launching the modern doula movement.

His pioneering studies (the most influential research was published in JAMA in 1991) found that women who have the continuous support of a doula, essentially a trained round-the-clock companion during labor and delivery, are far less likely to have a cesarean section or other medical interventions, like epidurals. Continue reading

Medical Marijuana For Kids? Really?

Here’s the provocative lede of an NBC News report earlier this week:

Zaki Jackson was 6 months old when doctors diagnosed him with a form of epilepsy so severe that it sparked as many as 250 seizures a day.

For years his mom, Heather Jackson, feared for his life. “He would stop breathing,” she told NBC chief medical editor Dr. Nancy Snyderman. “All the air leaves his lungs and he does not take another breath until that seizure is over.”

After 10 years and 17 medications, Zaki wasn’t getting any better. Then, finally, his doctor wrote a prescription for a medication that calmed the electrical storms in Zaki’s brain. The surprise was that it wasn’t for a standard anti-seizure medication — it was a prescription for marijuana.

(“Caveman Chuck” Coker/flickr)

(“Caveman Chuck” Coker/flickr)

Wow, I thought, I’ve never heard of any doctors prescribing medical marijuana for kids. I called around, and none of the pediatricians I contacted knew of any specific cases.

It’s clearly not the norm, though it’s permitted under state regulations approved by the Mass. Department of Health. According to an earlier post here:

…youth under 18 will have access to the use of medical marijuana, but will need two physicians to certify that the risks and benefits have been assessed and the benefits will outweigh the risks, one being a board-certified pediatrician.

But when the state was finalizing the rules earlier this year, the Massachusetts Medical Society raised concerns about use by children in a May 8 statement:

We are concerned that the Department has changed the regulations related to children, by allowing the override of the “life-limiting” provision and by changing the definition of “life-limiting illness” from six months to two years. In the absence of well-designed scientific research data, we are concerned about extending the time from six months to two years. The scientific evidence is clear that marijuana use by children is dangerous, as studies have found toxic effects on the still-developing brains of young people.

Here, Dr. Sharon Levy, of Boston Children’s Hospital and Harvard Medical School, offers her perspective Continue reading

Marathon Medical Update: Shrapnel Abounds, Leg Amputations For Some

WBUR’s Martha Bebinger reports that the number of patients being treated for Marathon bomb-related injuries is now up to 187. At least 24 people are in critical condition at 14 area hospitals. Many have been treated and released. Three people have died.

Doctors at several hospitals are reporting that based on injuries, it appears that the bombs were packed with shrapnel.

Bebinger quotes Dr. Stephen Epstein, at Beth Israel Deaconess Medical Center saying: “What we were seeing looked like BBs,” consistent “with the explosive devices.”

WBUR’s Asma Khalid was at Massachusetts General Hospital for a news conference this morning. She said doctors have treated 31 patients; 12 were admitted, 8 are in serious condition and 4 required amputations of lower extremities, according to Dr. George Velmahos, Chief of Trauma Services at MGH. They are more optimistic than yesterday, Khalid said; “everyone who was in the ICU is alive and stable.”

Khalid was also at Tufts Medical Center and reports that doctors saw 14 disaster-related patients; 10 are still in the hospital. She reports that there have been no amputations so far. She said Bill Mackey, chief of surgery at Tufts, described injuries in the lower extremities and included open fractures, nerve damage and muscle damage. Most injuries were between the knee and ankle. She said the medical team detected small shards of metal, and small metallic fragments, ranging from 1 centimeter to a few millimeters.

A man in the crowd following the explosion. (AP Photo/The Daily Free Press, Kenshin Okubo)

A man in the crowd following the explosion. (AP Photo/The Daily Free Press, Kenshin Okubo)

As of this morning, seven of the 10 kids treated at Children’s Hospital Boston have been released, according to the hospital. Three pediatric patients remain, with two of them in critical condition in the Medical/Surgical ICU and one on a surgical unit. Here’s the official update:

Our latest patients included:

— 2-year-old boy with a head injury in good condition.

— 10-year-old boy with multiple leg injuries in critical condition.

— 9-year-old female with leg injury in critical condition. Continue reading

When Small Children Face Big Medical Decisions

Lindsey Kempton, at age 10, undergoing cancer treatment in 1998. (Courtesy)

By Lindsey Kempton
Guest Contributor

When I was ten, my parents sat me down on the edge of their bed and told me I had to go back to the hospital. I had already been to two in the Boston area; one of which I had defiantly walked out of after the radiology nurse, unable to find my vein, had made a black and blue mess of my arm. But I wasn’t going there; I was going to the other one, Boston Children’s Hospital.

My parents never used the words “sick” or “cancer” or the even scarier terms like “neuroblastoma” and “stage four” in that first conversation. My only question was: Would I have to stay overnight? Our discussion was short and simple. But was it enough? Would explaining the situation to me — really explaining it — have done any good? Or would it, maybe, have done more harm? Did I, at ten years old, have the maturity to understand what was truly happening to me, or what was really at stake?

I don’t know. But fourteen years later, I’ve done a lot of thinking about it.

I know that my parents did the best they could to explain things and to include me in the medical decisions that they felt I could handle. I also know that it was always hard. Recently, I spoke to Dr. Steven Joffe, a pediatric oncologist at Dana Farber/Children’s Hospital Boston and chair of the Children’s Oncology Group Bioethics Committee, about how involved children should be in there own medical care. Dr. Joffee was also my primary oncologist as a kid and I still see him for check ups every year or so. Continue reading

New Endometriosis Center Launches With $3M From Marriott Foundation

After 14-year-old Emily Hatch of Wellesley was treated for endometriosis at Boston Children’s Hospital, her mother, Mary Alice, asked the surgeon what she could do to help researchers find better treatments and ultimately discover a cure for the painful, chronic disorder.

That conversation led to a gift of $3 million from the foundation started by Mary Alice’s grandfather, J. Willard Marriott, to launch the first-of-its-kind Boston Center for Endometriosis, “a joint undertaking to discover causes, promote prevention, and develop new treatments and cures for the disease of endometriosis,” according to an announcement to be released today by Boston Children’s Hospital.

The Center will be the first in the world to both conduct research and treat endometriosis in women of all ages, from adolescence — when the disease often begins — through adulthood, according to Children’s Hospital. The Center will include a unique repository to collect urine, saliva, tissue and blood from patients in order to research potential biomarkers and non-surgical diagnostics, to find new treatments, and eventually a cure.

Emily Hatch saw seven specialists and underwent numerous invasive tests over 18 months to try to figure out what was causing her terrible abdominal pain before she was finally diagnosed and treated at Children’s. Read her full story on CommonHealth here.

More than 6 million women in the U.S. suffer from endometriosis, which occurs when cells that normally grow in the lining of the uterus (endometrial cells) start growing in other parts of the body. The resulting implants or lesions can be extremely painful and if left untreated, the condition can cause infertility. Continue reading

On Being Gay In Medicine: A Leading Harvard Pediatrician’s Story

Dr. Mark Schuster, Harvard Medical School professor and Chief of General Pediatrics at Children’s Hospital Boston

Dr. Mark Schuster is the William Berenberg Professor of Pediatrics at Harvard Medical School and Chief of General Pediatrics at Children’s Hospital Boston. This essay is based on remarks he made as the featured speaker at the Children’s Hospital Boston GLBT & Friends Celebration in June, 2010, and has just been published in the journal “Academic Pediatrics.” We post it here with his permission.

The first time I stood before a large audience to speak was when I was 13 years old. It was at my Bar Mitzvah. I walked up to the podium, looked out over the sea of faces, and thought to myself, I am a homosexual standing in front of all of these people. And I wondered what would happen if I told them.

That was in 1972, and even mentioning the word homosexual, unless paired with an expletive or derogatory adjective, would have been unacceptable at my synagogue. It would have been unacceptable in my home, my school, or any place I knew. I could not have conceived of telling my doctor. I assumed that I would never say out loud that I am a homosexual. The idea that I would someday be able to stand in an auditorium, stand anywhere, just a few miles from where I live with my husband, our two sons, and our dog, with everything but the white picket fence, was not something I could imagine.

He made it clear that he wasn’t going to operate on a lesbian. Then I heard a voice shout, “So, she’s a lesbian, what does it matter!” And then I realized that the voice was mine.

 

Today I stand on a different stage. The Children’s Hospital Boston GLBT and Friends group asked me to share my story as part of its celebration day. How I got here, what I learned along the way, especially at Children’s, and how the world changed — these are what I will talk about.

A decade after I considered turning my Bar Mitzvah into a public confessional, I entered medical school at Harvard. Some students had started a gay group the year before. They had scoped out the territory, searched for role models, and come up nearly empty. In a creaky old closet, tucked way in the back, they found a world-renowned senior physician at Children’s. He advised against starting the group, offering that it was much better to be secretive about being gay so that no one would bother you. I’ve heard that same advice many times from men and women from earlier generations who had fewer options in their day.

Around the same time, a Harvard physician I later met was just coming out. He was spotted at a social event with someone his hospital’s Chairman of the Board suspected was gay. The Chairman reported to the hospital that he thought the physician was gay too and said that people like that should not be allowed to work there. Continue reading

Secret Suffering: Teens With Endometriosis And Years Of Baffling Pain

Emily Hatch and her mother, Mary Alice Hatch

Emily Hatch and her mother, Mary Alice Hatch

For Emily Hatch, the pain started during a Taylor Swift concert in the spring of 2010.

During the very first song — “You Belong To Me” — and without any warning, Emily, then 13 years old, felt a stabbing pain below her belly-button unlike anything she had ever experienced. She clutched her stomach and doubled over, but that didn’t help. Before the song ended, she was rushed by wheelchair to an infirmary at the Boston stadium and her father was summoned to drive her home. “The pain was so bad I couldn’t stand up,” Emily recalled. “It was so sad because I’d been looking forward to the concert all year.”

That was the start of a medical odyssey in which the teenager from Wellesley saw seven specialists, underwent numerous invasive tests including a colonoscopy and endoscopy, and endured countless needles and scans of her body. Despite all that, her mother says, her underlying diagnosis eluded top experts at three major hospitals. At least one doctor told Emily she’d just have to live with the terrible pain. And while she was shuttling between doctors and missing school, Emily tried to keep her condition a secret, not telling friends because, well, she’s a typical teenager. “I just didn’t want to feel different,” she said.

Finally, after 18 months without a firm diagnosis, Emily and her mother, Mary Alice Hatch, found a doctor in Boston who was able to treat her.

In October, at age 14, Emily underwent surgery at Children’s Hospital Boston and only then learned she had Stage II endometriosis. Emily’s surgeon found significant red and white lesions in her pelvic cavity; her left ovary had effectively become fused to her pelvis. Today, she is still not entirely pain-free, but at least she knows what the problem is.

A Painful Secret

Endometriosis is often perceived to be a disease of adulthood. Years ago it was cast pejoratively as “a career woman’s” condition that mostly hit older women who had delayed child-bearing. But in fact, endometriosis frequently begins in adolescence. It can be passed genetically from mothers to their daughters; there is no cure.

Endometriosis occurs when cells that normally grow in the lining of the uterus (endometrial cells) start growing in other parts of the body: the abdominal cavity, ovaries, fallopian tubes, bowel, bladder or the area between the vagina and rectum, for instance. Continue reading

Flavors Of Spring Misery: How Allergies Differ From Colds

Cold or allergy? The symptoms can be similar, but colds include fever and last only for days. Allergies don't include fever and last for weeks.

Your nose feels like an ever-streaming faucet. Your sinuses are overflowing cranial pools. Your brain is stuffed with mental batting. Ah, spring!

But which is it? Allergies or a cold? Children’s Hospital Boston sent over the lovely Venn Diagram above, and also connected me with Dr. Andrew MacGinnitie, associate clinical director of its Division of Immunology.

“If it’s starting now,” he said, “It could be a cold but it’s probably allergies, because I’m hearing from people who have spring allergies that the trees are starting to bud and the tree pollens are starting to get out there.” The allergies normally don’t kick in until April, he noted, but the mild weather appears to be having an effect. And if you feel this way every spring, that’s still further indication that it’s allergies.

Other points of distinction: A cold will typically last a few days and be gone; seasonal allergies tend to last weeks. And colds often cause fever while allergies don’t (Hay fever is a misnomer, he notes, though it does convey how systemically ill people feel.) Tree pollen allergies tend to peak in May; it remains to be seen how this year’s weather will affect that.

At what point, I asked, do you say, ‘I don’t think what I have is just a cold?’ Continue reading

Preferential Treatment for Children’s Hospital and Dana-Farber? You Decide.

Just two paragraphs in a $130 million mid-year state spending bill are the latest lightning rod in the health care costs debate.

The bill creates an exemption for any patient who is “undergoing an active course of treatment (at Children’s Hospital Boston or Dana-Farber Cancer Institute) and is newly enrolled in a select or limited network plan.” Right now, patients with tiered health insurance must pay higher co-pays and deductibles to use these two “high cost” hospitals. The bill would waive additional charges for patients who are already receiving treatment at Children’s or Dana Farber.

Sparks are flying. Insurers worry that this exemption (although it sunsets in 2013) would set a precedent. High end hospitals, especially those with specialized care, don’t want to lose patients.

Governor Deval Patrick must now decide if he’ll sign the bill or send it back to the legislature for revisions. Continue reading

What To Do For Oxygen-Deprived Newborns? Cool Them Down

Nate Lawrence underwent induced pediatric hypothermia at birth. Here he is, at 1, with his parents, Elizabeth and TJ.

By Fran Cronin
Guest Blogger

Nate Lawrence was born in Winchester Hospital in Massachusetts, December 16, 2010, in severe distress. He was limp, purple and not breathing. Both his lungs had collapsed.

As his parents and grandparents began to descend into panic, the neonatology staff at Winchester went into action.

They took x-rays of Nate’s chest, put a breathing tube down his throat, wrapped a turban around his head and placed him in a clear acrylic transportation box. Children’s Hospital Boston, 13 miles to the east, had been alerted that Nate was on his way. The ambulance team was instructed not to turn on warmers or swaddle Nate. He was to arrive at Children’s a cool 92.3 degrees, more than six degrees below normal.

Nate was born hypoxic, which means that because of his collapsed lungs, insufficient oxygen was flowing through his blood and into his brain. Lack of oxygen, like Nate’s, can lead to cell injury or cell death and ultimately to irreversible brain damage. To halt this potential deterioration, Nate’s body needed to slow down. Cell metabolism had to be lessened and his demand for oxygen reduced. He needed to operate on less energy and to rest.

Since lab trials began almost a decade ago, so-called “cooling” has demonstrated that for every degree a baby’s body temperature is lowered, its body functions and demand for energy slow down by 10 to 15 percent. Continue reading