Lasers and Hemangiomas

Posted on February 13, 2012 by Medical City

By John L. Burns, MD—Dallas Plastic Surgery Institute

Hemangiomas are benign (not cancerous) proliferative vascular tumors during infancy. Generally, they are not present at birth but shortly after birth, the tumor enters a six to 12 month growth phase. From 12 to 24 months they stay about the same size and from 24 months to six to eight years of age they gradually involute. Hemangiomas vary widely in their clinical presentation from small, flat, self-limiting lesions to large/massive, ulcerated, pedunculated tumors.

Treatment of hemangiomas also varies widely depending on the size and location of the hemangioma as well as the phase the hemangioma is in: proliferative or involutional. Hemangiomas can be treated with medication in the proliferative phase using either steroids (hydrocortisone) or Beta blockers (propranolol). These drugs do have side effects and their use should be carefully monitored by the treating physician.

Hemangiomas can then be evaluated for treatment which could include a watch and wait approach, early or delayed laser therapy to minimize scar consequences, or surgery. Laser treatment of hemangiomas has several advantages over traditional excisional surgery: eliminate blood loss, safely treat a hemangioma which is involving critical structures (example facial nerve), and minimize scarring. The goal of laser therapy is to remove disfiguring color from the hemangioma and reduce the size, making it blend with the surrounding skin as perfectly as possible.

The pulsed dye laser is generally used to treat the red color of hemangiomas. This laser is very superficial and penetrates only 0.7 mm into the skin making it ineffective in treating the underlying mass. The Nd:YAG laser can be used in combination with the pulsed dye laser to treat the deeper component and mass effect of the hemangioma. Using a 5 to 7 mm spot size, the Nd:YAG laser can penetrate about a 10 mm. A combination of these two lasers is the most effective.

As with most lasers, repeat treatments are almost always necessary. These treatments are spaced about six to eight weeks apart to allow all swelling to resolve before repeating the treatment. Photographic documentation is extremely helpful in evaluating the progress and in planning future procedures.

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Vascular Birthmarks

Posted on January 3, 2012 by Medical City

By: John L. Burns, MD

Vascular birthmarks are a common disfiguring condition for many people. Vascular birthmarks are distinguished from other pigmented birthmarks by their red color, which is derived from underlying blood flow. These red vascular birthmarks are also referred to as port wine stains by many people.

In contrast, pigmented birthmarks such as the common "cafe-au-lait" spots are brown in color due to an increased number of pigment-producing cells called melanocytes. These cells reside deep with the skin (reticular dermis) and generally do not respond very well to laser therapy.

Laser therapy is very effective for most forms of vascular birthmarks. Without treatment, these birthmarks can become dark purple and thick with skin nodules.

The pulsed dye laser is the gold standard and can be done as a simple office procedure. Generally, several laser treatments are necessary to achieve a good result. A rule of thumb is five treatments for about 50 percent fading, with continued improvement after each subsequent treatment.

The pulsed dye laser treatments are done with a skin cooling device to protect the skin. Patients need to avoid sun exposure by wearing sun blocking creams before and after each laser treatment. After treatment, the skin will appear purple or "bruised" for about ten days before the vascular birthmark begins to fade. Treatments are repeated every four to eight weeks until a satisfactory end point is reached.

If your child has a birthmark, you should schedule an appointment to have it examined by a dermatologist, as some birthmarks can be associated with an increased risk for skin cancer. To find out more about vascular or other types of birthmarks, contact us at Medical City Children's Hospital today. Visit us online or give us a call at 972-566-8888.

Related Post
Craniofacial Surgery

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The Very Important Job of a Child Life Specialist

Posted on December 30, 2011 by Medical City

Being in the hospital, being ill and undergoing medical procedures can be scary for children. That is why here at Medical City Children’s Hospital, we provide age-appropriate support to alleviate some of the fear and stress involved with a simple hospital visit or even intensive treatment. Child Life Services are provided at no additional cost to our patients, and help reduce the stress and anxiety that traumatic events can cause children and their families. Our Child Life Services program combines several support elements and is designed to help even our youngest patients feel at ease.

Playrooms and Teen Rooms
We know how important play is for a child’s growth and development, as well as for healing. That’s why we provide playrooms and teen rooms in our hospital to encourage kids to take a break from the hospital routine. Our playrooms are specifically for patients, and provide planned activities, games and free play. They are a safe place for our young patients to escape the stress of being in the hospital. Our teen rooms have games, music and computers to create a relaxing and fun environment for our patients who are 12 or older.

Educational Support Services
Our team of Child Life Specialists are experts in child development and are experienced in addressing the issues children may face in the hospital environment and medical setting. The Child Life Specialist Team Leader is supported by Child Life Assistants and volunteers. Our Child Life team collaborates with healthcare professionals to help children understand the hospital experience and their medical procedures. They use hands-on play and medical equipment to teach children about their procedures and what to expect, and they eliminate misconceptions.

Additional Support Services
Our Child Life team also provides additional support services to address the needs of the child and their family members, including:

  • Sibling education, to help siblings understand what their brother or sister is going through
  • Holiday celebrations and special events
  • Preparing siblings to visit in the pediatric intensive care unit
  • Pet therapy with visits by dogs
  • Music therapy

At Medical City Children’s Hospital, we are dedicated to making children as comfortable as possible in the hospital environment. For more information on preparing your child for surgery or a hospital stay, visit us online. For more information on our Child Life Services, contact our Child Life Coordinator at 972-566-4606 or the Child Life office at 972-566-2879.

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Cleft Lip and Palate Surgery

Posted on December 13, 2011 by Medical City

You may have seen advertisements for charities that provide cleft lip and palate surgery to poor children in developing countries, but the birth defect is fairly common and can occur anywhere in the world.

What It Is
A cleft lip is a deformity in which there is a split or gap in the upper lip. Likewise, a cleft palate is a deformity in which there is a split or gap in the roof of the mouth, leaving a hole between the nose and the mouth. Cleft lip and palate can cause multiple health problems related to swallowing, eating, breathing, and speaking.

The non-profit Cleft Palate Foundation has found that cleft lip and cleft palate comprise the most common birth defect in the United States, affecting one out of every 600 newborns. The American Academy of Pediatrics reports that cleft lip or palate may occur in isolation, together, or along with other abnormalities that represent a particular syndrome.

About the Surgery
Surgery is typically recommended to repair a cleft lip and cleft palate. The American Society of Plastic Surgeons stresses that cleft lip and palate surgery not only helps provide a more normal physical appearance, but also insures that a child is able to grow and function normally.

The National Institutes of Health reports that left lip and palate surgery is often done in several stages consisting of multiple procedures. Children are asleep and pain-free during the surgery due to general anesthesia

Risks
As with any surgery, there are risks involved when repairing cleft lip and palate. Risks from anesthesia include breathing problems and reactions to the drugs used for sedation. Risks associated with the surgery itself include bleeding and infection.

In most situations, the benefits outweigh the risks. Your child’s healthcare professionals will explain the surgery and risks involved in greater detail.

More Information
The Medical City Children’s Hospital Craniofacial Center is one of the world’s leading medical centers for treatment of children with craniofacial birth defects such as cleft lip and palate. For more information about the services we offer, visit the Craniofacial Center on the Web or call us at (972) 566-3423.

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5 Tips for Teaching Toddlers About Germs

Posted on December 6, 2011 by Medical City

As babies get older, and grow out of the habit of putting everything in their mouth—parents can begin to teach them about germs and introduce healthy habits that will protect them. If introduced to children when they are young, good hygiene habits are more likely to stick. It’s also easier to teach children habits from the get-go than trying to break bad habits later on. So, here are five tips for teaching your toddler about fighting big bad germs!

1. Make it fun! When you teach children about germs, they will listen and retain more if you make it into an “activity.” Teach them that they should wash their hands for the amount of time it takes to sing Happy Birthday, or try using glitter to show them how germs can spread.

2. Set an example. Kids are mini versions of us, and one of the best ways they learn to pick up habits is by mimicking adults. If you always wash your hands, cover your mouth when you sneeze or cough and use tissues—your children will be more likely to pick up these healthy habits! Set an example of healthy hygiene and your children will follow your lead.

3. Make a routine. Consistency makes a difference. Make sure your toddler understands that they should wash their hands at certain times, like before and after eating, after using the potty, after coming in from outside. Consistently reminding them will help them to form these healthy hygiene habits.

4. Use books and pictures. Books and flash cards with photos can help to teach your youngster about the importance of healthy habits like hand washing and bathing. Children’s books with catchy poems and photos will keep your child interested while teaching them about germs.

5. Encourage them. When your child starts to pick up on the healthy habits you have been teaching them, reward them and encourage them to reinforce their habits. Give them a sticker if they remember to wash their hands on their own or tell them thank you when they cover their mouth to sneeze or cough!

Teaching your young one about germs and how to avoid spreading them can help in preventing illnesses that toddlers might pick up at day care or otherwise. They also will learn healthy habits for the long run and may not get sick as often when they are older. For more information on keeping your children happy and healthy, visit us online or give us a call at 972-566-7000.        

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The Sweet Truth: Kids Get Too Much Sugar

Posted on December 5, 2011 by Medical City

Foods with added sugars that are not naturally occurring, like in fresh fruit or milk, tend to be much higher in calories and lacking in nutrients. Because of the U.S. obesity epidemic, sugar intake is becoming a growing concern for parents, schools and health organizations. So, are kids getting too much sugar—and can it contribute to obesity and other health concerns?

Bad Sugar vs. Good Sugar
Good sugars are the sugars that occur naturally in foods like milk, fresh fruits and veggies. Because these foods also contain a high level of nutrients that are essential for your body, they are acceptable.

Bad sugars are those that are added to food products, like soda, candies, sugary cereals, desserts and many snacks—and don’t provide any nutritional benefit to your body, making them empty calories.

How Much is Too Much?
Preschool aged children should not consume more than four teaspoons of added sugar per day. For children aged four to eight, they should not consume more than three teaspoons. Preteens and teens should not have more than five to eight teaspoons a day. Studies show the average teen consumes around 34 teaspoons of sugar!

How to Reduce Kid’s Sugar Intake
There are many ways you can reduce your child’s added sugar intake, but one of the easiest ways is to reduce the number of sugary drinks—like soda and juice—that they drink. According to the CDC, sugary drinks are the number one source of added sugar in the diets of children in the U.S. Another big source of added sugar is the snacks children eat on a daily basis. These include sweetened applesauce, snack cookies, canned fruits in syrup, sugary cereals, etc. Give your child healthier snacks like unsweetened applesauce, whole fresh fruits, cheese, whole grain crackers and peanut butter to reduce added sugar intake.

Sugar isn’t the only culprit in the fight against childhood obesity. Fewer healthy foods on school campuses, lack of quality physical activity, increasing portion sizes and media all play a part in the health of today’s children. The best thing you can do for your children is to give them healthy choices and set good examples for them. If you have any questions about your child’s health, or need to speak to a doctor, contact us at Medical City Children’s Hospital. Visit us online or give us a call at 972-566-7111.

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What You Should Know about Radiation Right®

Posted on November 8, 2011 by Medical City

When undergoing diagnostic imaging procedures, you may be concerned about your exposure to radiation. Here at Medical City Hospital, we follow the Radiation Right® initiative: “right exam, right site and right dose.”  We are committed to making sure your imaging procedure is only completed if alternatives do not exist, and to protect you, we use the smallest effective dose of radiation for your procedure.

The Right Exam
The Radiation Right initiative ensures that exams which involve radiation only be used when a suitable alternative is not present. In many cases, effective alternatives to radiation do exist. Ask your doctor to explain all your options to you before consenting to an exam.

The Right Site
To prevent hospital mistakes, such as giving the wrong procedure to the wrong patient, Medical City Hospital uses the Joint Commission Universal Protocol to check and double check that patients receive the right test or procedure.

The Right Dose
Sometimes radiation exposure is necessary for a patient’s diagnosis or treatment. In these cases, the Radiation Right® initiative promises that you will be exposed to the least amount of radiation possible during the exam. If you are discussing a procedure with your doctor that includes radiation, make sure he has a full medical history that includes any imaging procedures, surgeries, or radiation therapy treatments you have had in the past. This information will help determine the safest timing and dosage for you.

If you are looking for a diagnostic imaging center that you can trust with the health of your family, consider Medical City Hospital. Our experienced and helpful staff members are committed to giving you the safest and most effective procedures available. For more information, visit our website. 

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My Daughter’s Struggle & Success with Food Allergies

Posted on November 1, 2011 by Medical City

By Jennifer Kaplan, MSN, APRN, FNP-BC

I wanted to share with you both my daughters struggle and success with food allergies.

Shortly after Olivia was born, I learned she was allergic to milk. I had been nursing her during infancy and she would have a terrible rash after each feeding so I withdrew one item at a time from my diet to see what made the rash improve. After shellfish had no effect, I tried dairy product avoidance and her rash went away. When I reintroduced the dairy her rash returned. This was around three months of age.

Around the age of two, I had Olivia formally tested at her pediatrician’s office with a blood test which showed her to still be allergic to milk. This meant continued avoidance of all things dairy- even powered milk in a cracker would cause her to develop a rash, vomiting, and lip swelling, requiring her to receive a shot of epinephrine and a subsequent trip to the emergency room. Sending my daughter to preschool meant I provided all of her food and snacks because I could not trust anyone to read a package label. 

When Olivia began kindergarten her milk allergy began to trouble her as she saw herself as different from the other children—her world began to revolve around what she couldn’t eat and couldn’t do. She couldn’t eat hot lunches. She couldn’t eat the cupcake for her friend’s birthday. She couldn’t participate in the science experiment where the children blew bubbles into the glass of milk. She couldn’t do so many things—all because of her milk allergy.

     

Last year Olivia finally had enough of her allergy and wanted me to look into her becoming desensitized to the milk. She had a friend who went through the process and she was finally ready to take the challenge. So I took her to Dr. Sugarman who repeated her tests, determined she was still indeed allergic to the milk, and recommended desensitization for Olivia.

March 17th was the day we began the journey towards an allergy free life. Olivia did her induction on this day which required 8 hours in the physician’s office and every 15 minutes Olivia received escalating amounts of a weakened form of milk. She came through with flying colors and was then able to continue the process at home. Twice daily Olivia received her milk dose, and each week we returned to the allergist for a dose increase. Six months later Olivia has graduated from the program and is now eating cheese pizza, chocolate bars, and yogurt- not to mention tons of other goodies that prior would have made her deathly ill.

As a parent it brings tears to my eyes to know my daughter can participate in meals with friends at restaurants, enjoy breakfast with her gymnastics teammates, and eat safely knowing that she is no longer at life- threatening risk of anaphylactic shock due to the cow’s milk protein found in so many foods.

Jennifer Kaplan, MSN, APRN, FNP-BC is the manager of the Craniofacial Center and Pediatric Neurosurgery Program here at Medical City Children’s Hospital.

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Starting Early: Teaching Children Healthy Eating Habits

Posted on October 18, 2011 by Medical City

Monkey see, monkey do can be applied to children as well as monkeys. If your children see you setting a good example for healthy eating, they will follow your lead. There are many ways to incorporate healthy eating into your family’s lifestyle.

Follow My Plate Suggestions: At least half of the grains your child eats should be whole grain. Breads, cereals, pastas, crackers, and other snacks usually have a whole grain option. Produce can be fresh, canned, frozen, or juiced – just try to make it equivalent to half the plate at each meal. Fruits and vegetables can be prepared in many different ways to get in the 5 recommended servings a day. Children need 2 to 3 cups of dairy a day. Try low fat or skim milk and low fat yogurt and cheese snacks. Get protein from low fat meats and fish. Also try beans, nuts, and seeds.

Make it fun: Have a healthy food party with friends or family. Everyone can bring a fun, healthy snack and share recipes. Serving healthy food in a fun atmosphere will make it more appealing. Try the old favorites like ants on a log (celery with peanut butter and raisin “ants”) or create your own snack traditions. Allow the kids to look up recipes in cookbooks, magazines, or online and then try them out in the kitchen together. While making a fresh healthy snack might take longer than grabbing a few cookies from a jar, it will be worth it in the long run.

Mix it up: Kids get bored easily. Mix up colors, textures, and preparation styles of healthy foods. Try dedicating each day or week to a certain color. For instance, look for as many purple foods as you can find. There are many ways to reach your healthy eating goals. Try a cooking contest between family members to challenge each other to find new and interesting healthy recipes.

Offer options: Giving children choices about their diet can give them a sense of ownership and responsibility. Offer a few healthy choices and let your kids decide which to eat that day. Set up some lunch box options each morning and let kids select their snack on their way out to the school bus.

Make a family pact: The whole family needs to be on board with healthy eating. Discuss the benefits of eating healthy and the risks of a poor diet such as being overweight, having weak bones, or a weak immune system. Sign a family pledge to help encourage each other to eat healthy each meal.

A healthy diet along with exercise and good lifestyle choices will lead to a long and happy life. The general pediatrics department at Medical City Children’s’ Hospital can help your family plan the right diet for you! Visit us online or give us a call at 972-566-8888.

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Coping With Your Child’s Cancer Diagnosis

Posted on October 11, 2011 by Medical City

Few words are scarier for a parent to hear than, “Your child has cancer.” Sadly, this is something parents across the country hear every day. While the news may be staggering, the future of cancer research, treatment, and recovery gets brighter every day as well. Coping with the cancer diagnosis of your child will never be easy, but there are ways to make it easier to manage.

The Initial Shock
Most parents find it hard to believe a cancer diagnosis. They may want a second opinion or refuse to accept the fact. If you find yourself feeling this way, reach out to someone you trust to help you navigate the diagnosis. That person can take notes at meetings with medical staff and help you to review the information later in a more calm setting. You will experience feelings of disbelief, anger, anxiety, fear, guilt, and depression. These feelings are normal and perfectly okay. Share them with someone who understands.

Find a Support Group
Feeling alone is one of the hardest parts of dealing with a child’s cancer diagnosis. Friends and family will sympathize, but are not likely to truly understand your position. Talking to other parents who have been managing their child’s cancer can make you feel connected. You may get a sense of hope from the stories you hear of strength and survival. There are face-to-face groups in your town, telephone hotlines, and online chat groups. Build a network of people who know exactly what it feels like to seem helpless while a child is ill.

Get Educated
Part of the stress of dealing with a cancer diagnosis is the unknown. Cancer can seem to come out of nowhere and seem impossible to comprehend. The more you learn about it, the more manageable it will become. You can do research in books and medical journals or online (be cautious of your sources). Discuss anything you find with your doctor and don’t hesitate to get a second opinion, even if it is just regarding your research findings.

Strive for Normalcy
Your first instinct may be to shelter your child from the world while dealing with cancer treatment. A better choice is to carefully monitor your child’s energy levels and health risks in the environment and let him or her live as normal a life as possible. This includes school, fun outings, and even possibly dates for older children. Feeling left out will only increase your child’s stress. Positive experiences will give your child the mental and emotional strength to keep fighting. Find something fun and creative to make each day special. Embrace your faith, friends, family, and life.

Talk About It
Ignoring cancer will not make it go away. Discuss treatment and prognosis with your family from the beginning. Explain to younger children or siblings in a way that conveys the seriousness of the situation but also the opportunity to beat the cancer with positive thinking and a great medical staff.

Medical City Children’s Center’s Oncology department can help educate you, find support groups, and treat your child’s cancer. Check out the Success Stories to boost your confidence. Cancer is not an end point. It is a challenge to overcome, and Medical City Children’s can help.

Sources:
Children Diagnosed With Cancer: Dealing With Diagnosis
Support Groups at Cancer Care

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